Msks Approach To Radical Prostatectomy
Our prostate surgery team includes experts in several techniques, including robot-assisted surgery, open surgery, and laparoscopic surgery. Regardless of which surgical approach you choose, our goal is to remove your cancer completely and preserve normal urinary and sexual function.
With all surgical approaches, weve developed and use innovative techniques to preserve the tiny nerves and blood vessels attached to the prostate that help control erections. These and other advances have made some of the complications of prostate cancer surgery less common and more manageable and can spare nerves from damage. Well work closely with you and your medical team to manage any short- or long-term side effects you may experience.
Ultimately, youll help determine which approach your surgeon takes.
Things That Can Happen When You Live Without A Prostate
Beyond the oft-reported effects of urinary incontinence and impotence following surgery, there are a number of less widely known possible side effects of prostate removal.
Fun fact number one: Half of all men who die in this country this year will be killed by heart disease, stroke, or cancer. Fun fact number two: Half of all doctors seem to have different ideas about how to prevent the biggest killers of men. We spoke to the best of them, and we’ve simplified, clarified, and prioritized their advice on minimizing the risks of dying before your time. For more tips, . Reporting by Sarah Z. Wexler.
As more men deemed to be at genetic risk of prostate cancer opt to have the organ removed preemptively, lesser-known side-effects of the procedure are coming to the fore. In addition to the oft-reported effects of urinary incontinence and impotence following surgery, here are some symptoms more rarely accounted for:
Shrunken penises. As many men are prescribed antiandrogen treatments to block testosterone effects on advanced prostate-cancer tissue, Dr. Celestia Higano of the University of Washington reports that up to 68 percent of men experience penile shortening after radical prostatectomy surgery.
“Dry orgasm”or, rather, orgasm without ejaculation, which occurs after surgery when retrograde ejaculation sends semen back into the bladder instead of out the penis.
This article originally appeared in Esquire‘s November issue.
What Have I Learned By Reading This
You learned about:
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
Read Also: Does Enlarged Prostate Affect Ejaculation
Sexual Life After Prostate Removal
This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.
Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.
The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination and is a leading cause of cancer.
The nerves that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.
The net effect of someone having his prostate removed is:
Factors that are responsible for the ability to get erections are:
Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
The Three Parts Of Male Orgasm
Kacker starts by pointing out a common misconception that erections are necessary for male orgasm. They arent. Men can have experience orgasm without an erection. The converse is also true, of course: men can have an erection without having an orgasm.
When discussing orgasm and radical prostatectomy, its useful to think of the male orgasm as having three separate parts, says Dr. Kacker.
First, secretions from the testicles, the prostate, and the seminal vesiclessmall, slender glands near the prostateflow into the urethra, the tube-like structure that carries semen through the penis and out the body. The emission of those fluids creates a feeling of fullness and a sensation of inevitability.
Second, theres ejaculation, which is accompanied by contractions of the pelvic floor muscles, the group of muscles used to hold in intestinal gas and urine.
And third is the mental componentall of the processing the brain does of incoming sensory signals from penis and pelvis that contribute to the mental experience of build up and release.
What Treatment Options For Sexual Dysfunction Are Safe After Prostate Surgery
All of the treatment options come with risks, even the all-natural ones. You need to be careful about sourcing supplements, being confident in the supply.
Many US-based manufacturers were caught by the FDA selling natural Tongkat Ali which actually contained prescription ED drugs! Likewise, overtraining can lead to injury or soreness. However, theres no doubt that the natural approach is safer than the alternative.
Only purchase Tongkat Ali supplements from a reputable company that provides 3rd party lab tests to prove that it is an unadulterated and safe supplement.
If you are looking for a safe and natural testosterone boosting supplement that contains Tongkat Ali, we recommend our Testo-Booster supplement.
The side effects from the most commonly used ED pharmaceuticals include minor ones, such as headache, flushing, runny nose and pains in the stomach or back.
In some cases, dizziness and a sudden drop in your blood pressure can take place. Thats why men with heart conditions have to be evaluated by a physician before they take it, and may have to rely on a lower dose.
Around 1 out of every fifty men who take those drugs will also experience painful or persistent erections.
The highest risk group, however, is those who undergo surgery to get an implant. Thats why its always the last choice. As the surgeon needs to make an incision into the scrotum, penis and often the abdominal wall, there is a risk of infection.
Don’t Miss: Why Does Tamsulosin Affect Ejaculation
Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
What Is A Radical Prostatectomy
Surgery to remove the prostate is called a radical prostatectomy. Before the operation, the surgeon will explain what will happen and tell you about the possible side effects. They may also tell you about other treatments that may help in your situation, such as radiotherapy.
The aim of the surgery is to remove all of the cancer cells. It is usually only done when the cancer is contained within the prostate and has not spread to the surrounding area.
Read Also: No Ejaculate Flomax
When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety
Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.
The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.
For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.
You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.
Treatment Of Rising Psa
If PSA levels are rising slowly or by a small amount, a person may not need treatment. A doctor usually considers an individuals overall health, medical history, and age when giving advice on treatment.
Doctors often use active surveillance if PSA levels are rising. Active surveillance is a series of regular tests and health checks, with treatment only if necessary. Prostate cancer often progresses very slowly, so it may be many years before a person needs treatment.
If a person has had a prostatectomy, a doctor may also recommend radiation therapy, which kills cancer cells using high-energy particles.
Radiation therapy is not suitable for everyone who has had a prostatectomy. If a person had radiation therapy before surgery, they cannot usually have this treatment again. Having radiation therapy a second time can cause side effects.
Doctors may also use hormone therapy to shrink a persons tumors. This can make other treatments such as radiation therapy more effective.
It is not always possible to prevent PSA levels from rising. The best way to safeguard health after having a prostatectomy is by undergoing regular medical checks.
- stopping smoking or using tobacco products
- exercising regularly
- eating a healthful diet, with plenty of fruits and vegetables
- limiting alcohol intake to a moderate amount
Recommended Reading: What Is Perineural Invasion In Prostate Cancer
Radical Prostatectomy Perineal Approach
You’ll be placed in a supine position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.
An upside-down, U-shaped incision will be made in the perineal area .
The doctor will try to minimize any trauma to the nerve bundles in the prostate area.
The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.
The seminal vesicles may be removed if there’s concern about abnormal tissue in the vesicles.
How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
You May Like: Cialis Prostatitis
The Purpose Of Prostate Surgery
Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.
It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.
Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:
Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.
The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.
Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.
Where Can I Find Prostate Cancer Support Groups
Even though once you complete the surgery you most likely will find yourself cancer-free, the anxiety and stress may never totally go away. The support of your friends and family is essential in these moments, but the most relief you will find is among people that have gone through the same experience.
We advise you to search locally for prostate cancer or cancer survivors support groups and discuss your journey in beating this. You will find there plenty of people that lived through the same emotions and painful experiences and you will gather your strength to overcome this and not let it define the rest of your life.
If physical presence is not an option for you, there are plenty of forums and online communities that gather around this subject. You can find people that share their experiences and advice below:
Prostate cancer surgery is not as severe of a surgery as other ones. The recovery, especially after robotic surgery, usually lasts up to 2 to 3 weeks and patients can return to work and to living their normal lives.
You May Like: How Effective Is Chemotherapy For Prostate Cancer
Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
Sex After Prostate Surgery And Achieving Orgasm
Sex after prostatectomy is an important concern for most men. The total removal of the cancerous tissues is the primary goal, but the quality of life after prostate surgery is also important. Worrying about ED makes men be nervous and anxious when thinking about undergoing radical prostatectomy.
However, whilst most patients focus on erectile dysfunction, orgasm is somehow under-considered. But is it possible to achieve orgasm after prostatectomy? Erections and orgasm are equally important for a healthy sex life.
The good news is that sex after prostate surgery is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.
Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.
Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.
Don’t Miss: Does Enlarged Prostate Affect Ejaculation