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How Prostate Surgery Is Done

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Advantages And Disadvantages Of Surgery

Robot-assisted Radical Prostatectomy (RARP)

What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.

Advantages

  • If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
  • The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
  • Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
  • If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
  • Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.

Disadvantages

  • There are risks in having surgery, as with any major operation.
  • You might get side effects such as erection problems and urinary problems.
  • Youll need to stay in hospital for a few days usually between one and five days depending on the type of surgery you have.
  • If the cancer has started to spread outside the prostate, the surgeon may not be able to remove all of the cancer and you might need further treatment.

Do Laser Treatments Have Any Advantages Over Turp

As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.

The laser treatments include:

  • Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995 332: 75-79.
  • IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.

    Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.

Making Decisions About Surgery

Talk to your surgeon about the surgical methods available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery. See more about Making treatment decisions.

The surgeons experience and skill are more important than the type of surgery offered. Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects and no difference in long-term outcomes.

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Eight Types Of Standard Treatment Are Used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.

Surgery

Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:

Cancer May Spread From Where It Began To Other Parts Of The Body

Dr Tim Nathan Urology

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to preventbone metastases.

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Men Suffering With Symptoms From An Enlarged Prostate Could Be Offered A New Type Of Nonsurgical Treatment Thanks To Changes In Nice Guidance

25 April 2018

NICE the National Institute for Health and Care Excellence has for using Prostate Artery Embolisation as a treatment of benign prostatic hyperplasia.

Benign prostatic hyperplasia is the medical term used to describe a noncancerous enlargement of the prostate. Symptoms like needing to pass urine more frequently, trouble starting to urinate and loss of bladder control affect more than a third of men over the age of 50.

There are a number of current treatments for an enlarged prostate including medication or surgery. However, these treatments can have side effects and do not suit all patients.

PAE offers an alternative option. It blocks the blood supply to the prostate with small particles, which causes the prostate tissue to shrink and die. It can be performed under local anaesthetic, which will help patients who cannot tolerate general anaesthetic. And it can be done as a day case, which will mean the patient does not need to be admitted to hospital.

NICE first looked at PAE in 2013, but felt that more research was required to determine whether the procedure was effective and safe.

What Happens During Radical Prostatectomy

You will have general anesthesia during your prostate surgery. Your surgical team inserts a catheter to drain urine.

After your surgeon removes your prostate, they check it under a microscope to see if cancer has extended beyond the edge of the prostate or into the seminal vesicles or lymph nodes. If it has, the cancer may have spread. In that case, you may need other treatment.

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How Bad Is The Pain After Prostate Surgery

The level of pain is lower than that of open prostatectomy, due to smaller incisions. However, you will be administered pain medication both orally and intravenously, through an IV. Make sure you have someone to pick you up from the hospital, as you wont be able to drive right away. Ask your doctor to recommend some pain medication and dosages that you can take from home most common ones are Tylenol or Ibuprofen. Even though the recovery is fast, you should get plenty of rest and not force yourself with lifting weights or exercises in the first few weeks.

Where Can I Find Prostate Cancer Support Groups

Radical Prostatectomy (Prostate Cancer Surgery)

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:

  • https://www.cancerforums.net/forums/14-Prostate-Cancer-Forum
  • http://community.prostatecanceruk.org/
  • http://www.topix.com/forum/health/prostate-cancer

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.

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Uk Guidelines For Keyhole Surgery

The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:

  • tell people having the surgery about the risks and benefits
  • monitor people closely
  • collect information about any problems people have and report on them

Researchers are looking into whether keyhole surgery is as good as open surgery.

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What Happens After Surgery

You can expect to follow a liquid diet at first and then gradually be able to eat solid foods. When you go home, you will follow a soft diet, which generally means no raw fruits or vegetables. A dietitian can give you more specific guidelines.

Nausea and vomiting are common because the intestines are temporarily disabled during anesthesia and surgery. Your doctor can prescribe medications to relieve these symptoms, which will improve a few days after surgery.

You will be encouraged to get out of bed and walk as much as possible, starting the first day after surgery. You should steadily increase your activity after you go home. For 6 weeks after surgery, you should not lift or push anything over 30 pounds and should not do abdominal exercises such as sit-ups.

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Prostatectomy Offered At Mercy To Treat Prostate Cancer

The Urology Specialists of Maryland at Mercy Medical Center in Baltimore, Maryland, diagnose and treat a variety of conditions and diseases of the male reproductive organs. Our doctors offer prostatectomy, the removal of the prostate, as a treatment for conditions such as enlarged prostate or prostate cancer.

Prostate Surgery: How To Prepare

Newly Diagnosed

Before having prostate surgery, there area few things you will have to do to prepare. Depending on the type of prostate surgery you are having, you might be instructed to adjust some of your medications and/or food and drink beginning the night before your procedure. You may also need special preparation, including a process to empty your bowels the day before your surgery.

If you are staying overnight in the hospital after surgery, you should be prepared with any assistive devices you use and if you are going home on the same day of surgery, someone should be able to drive you home and assist you at home.

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Types Of Prostate Surgery

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

  • Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
  • Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

After Prostatectomy: What To Expect

At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.

First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.

One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.

This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.

One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.

  • Urinary incontinence
  • Erectile dysfunction

Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.

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Things You Should Expect After Prostate Surgery

Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.

In the immediate hours after surgery:

Caring For The Incision

TURP Transurethral Resection Prostate Surgery, patient education series

You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.

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Why Is Radical Prostatectomy Done

Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.

For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:

What Are Other Benign Prostatic Hyperplasia Surgery Options

If your symptoms are severe or minimally invasive surgical treatments dont help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Other prostate procedures include:

Transurethral resection of the prostate : This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the scope this way means no cutting into the prostate. They will then use the charged resectoscope to remove the excess tissue that is blocking the urine from leaving the bladder.

You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.

Transurethral incision of the prostate : This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.

Simple prostatectomy: This method is a surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.

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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.

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