What Is A Robotic Or Laparoscopic Radical Prostatectomy
Now routine procedures at Cleveland Clinic, laparoscopic or robotic prostatectomy are minimally invasive surgery procedures used to remove the prostate. Both forms of surgery are now routinely offered at the Cleveland Clinic to patients with prostate cancer. Our single-institution experience now exceeds 1000 cases of laparoscopic and robotic prostate surgery performed.
Operating By Remote Control
Many physicians recommend a robotic prostatectomy, shown here, over traditional open surgery because the recovery is less taxing. But complications can still occur.
Because many prostate cancers grow so slowly, an older man with the disease may choose active surveillance, which involves following the cancer to see if it advances and causes symptoms. If it does, or if the man prefers to have immediate treatment, radiation therapy can control the disease for years. Hormone therapy can also help.
The bottom line: If your doctor says that you are too old for surgery, dont despair. Other, less-risky treatments may hold the cancer in check. Talk with your doctor about the options.
SOURCES: Alibhai SM, Leach M, Tomlinson G, et al. Rethinking 30-Day Mortality Risk After Radical Prostatectomy. Urology 2006;68:105760. PMID: 17113897.
Thompson RH, Slezak JM, Webster WS, Lieber MM. Radical Prostatectomy for Octogenarians: How Old is Too Old? Urology 2006;68:104245. PMID: 17095073.
Originally published July 1, 2009; Last reviewed April 8, 2011
You Can Improve Your Surgical Outcome
Surgery is scary for everyone. There is always the risk that something serious could go wrong, resulting in serious harm or death. That being said, surgery is a necessary, often life-saving, procedure. The good news is that you can improve your surgical outcome by doing some homework before you schedule your procedure.
Unfortunately, the risk for medical errors during surgery is real, including wrong site surgery, items left in the patient, introduction of infections, and the wrong procedure being performed. How can you improve your surgical outcome? Read on for some important tips.
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Why Prostate Laser Surgery
Compared to;open prostatectomy and;transurethral resection of the prostate, prostate laser surgery offers significant advantages to the patient. They include a general lower risk of post-surgery bleeding, a much shorter hospital stay , and a much quicker recovery. Men who undergo prostate laser surgery for BPH will also, in contrast to other procedures, generally notice an improvement in their urinary output and comfort right away. They are highly unlikely to need a urinary catheter for longer than 24 hours, again unlike with other procedures.;
Long-term complications are also much less likely with prostate laser surgery than with more traditional forms of prostate surgery. Though that is good news, laser prostate surgery still carries both short-term and long-term risks, just like practically any other surgery. What are they?
What Happens After Robotic Prostate Surgery
- Robotic prostate surgery operative time is typically 2-4 hours
- Hospital stay is typically 1-2 days
- Our team will be seeing you on a daily basis during your stay in the hospital and will give you detailed after-surgery instructions prior to your discharge home.
- Foley Catheter typically comes out on day 5 after a cystogram
- Jackson Pratt drain comes out around the time of Foley catheter removal depending on your individual circumstances
- No driving for 7 days after prostate surgery
- No other restrictions in physically activities after surgery – just do what you can tolerate
- Aspirin can be restarted when you are back to eating regular meals
- You will be given Viagra upon the removal of the foley catheter. Typically 50mg a night, increasing to 100mg if no response. This is not given to necessarily induce erections, but to help improve the blood supply to your penis. If you have any heart conditions, your internal medicine doctor needs to clear you before taking Viagra.
- The first PSA check after prostate surgery is at 1 month and then 3-6 months thereafter.
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What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Prostate removal may be recommended if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines, and they did not help your symptoms or you no longer want to take them
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of surgery do you recommend for me and why?
- What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
- How many of these operations have you done and how many do you do each year?
- Can I see the results of radical prostatectomies youve carried out?
- What pain relief will I get after the operation?
- How and when will we know whether the operation has removed all of the cancer?
- How often will my PSA level be checked?
- What is the chance of needing further treatment after surgery?
- What is the risk of having urinary problems or erection problems and what support can you offer me?
Conditions Prostate Massage Might Help
Although studies are limited, prostate massage may be helpful in some medical situations and with some health conditions.
Prostatitis
Prostatitis is swelling and inflammation of the prostate gland. It can cause symptoms like pain when you pee and pain around your groin and pelvis.
A doctor might do a prostate massage to diagnose the condition. They can test the fluid that comes from your prostate ducts to see whatâs causing the problem.
Although the most common treatments for prostatitis are antibiotics and non-steroidal anti-inflammatory drugs , prostate massage is another option. It can help ease pressure and swelling by releasing fluids that build up in the prostate. Small studies have found that massaging the area several times a week — along with taking antibiotics — can give relief from pain and pressure.
Diagnosing a Medical Condition
Sometimes a doctor might do a prostate massage during a prostate exam. The purpose is to get some fluid to examine under a microscope to look for signs of an infection or other problem.
Erection Problems
The main treatments for erectile dysfunction include medications, pumps, shots, and implants. Lifestyle changes that can help treat the condition include getting more exercise, eating a healthy diet, and doing pelvic floor exercises. Some men say they’ve had increased sexual pleasure and are able to ejaculate more easily with prostate massage, though there isnât scientific proof to back up those claims.
Urine Flow
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Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy; is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
Prostatectomy: What To Expect During Surgery And Recovery
If youve been diagnosed withprostate cancer, your doctor will consider many factors before recommending the besttreatment. For many men, that may mean a prostatectomy. In this surgery,doctors remove the entire prostate.
The Johns Hopkins Hospital performs more of these procedures than almostanywhere else in the world. One of the most common questions they hear frompatients: What should I expect after surgery?
Johns Hopkins urologistMohamad Allaf, M.D., explains the surgery and recovery.
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What Are The Side Effects
The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .
Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.
Does Viagra And Cialis Work After Prostate Removal
During recovery, medications like Viagra and Cialis will help. Viagra can restore impotence and contributes to more pleasurable sex life.
A study published in the Journal of Urology;reported that 53% from a total of 80 men who underwent radical prostatectomy had their erection function restored after taking Viagra.
But is Viagra an addictive drug?
Many men experienced a high rate of improvement in their sexual performance due to medications such as Viagra, Cialis, or Levitra. If you have been wondering whether these medications are addictive, you should know that the active ingredient in Viagra, sildenafil, is not an addictive substance.;
These medications work by increasing the blood flow to the penis and facilitate the erection process. Addiction is brain-triggered, but Viagra does not target the nervous processes in the brain. That is why it is considered a safe option for those who want to faster recover their sexual potency after prostate cancer treatment.
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Why You Have The Test
The goal of a prostatectomy is to remove all the cancer, or as much of it as possible. If your cancer hasn’t spread, it might cure you.
But no surgery is perfect. It’s possible that some of the cancer cells spread outside your prostate before your procedure. Or the operation might have left a few cancer cells behind. Those cells could start to grow in the future.
A regular PSA test after a prostatectomy is a way for your doctor to keep tabs on your treatment. It can help your doctor see how well your surgery worked, and if your cancer has come back.
What Your Psa Numbers Mean
The PSA test measures the level of prostate-specific antigen in your blood. The lab will report your results in nanograms of PSA per milliliter of blood.
Only the prostate gland releases PSA, so your numbers should drop to almost zero within 4 weeks after your surgery. A test result above 0.2 ng/mL a few months after your procedure could be a sign that your prostate cancer has come back. This is called a biochemical recurrence.
If your number is higher than it should be, it doesn’t mean you definitely have cancer. Results can vary from person to person and from lab to lab. A more accurate way to find out if you have cancer is to test how quickly your PSA levels rise.
A PSA velocity test measures the change in your PSA levels over time. PSA doubling time tests calculate how long it takes for your PSA levels to double. If they rise quickly, it could be a sign of cancer. Knowing how fast yours is rising can help your doctor predict whether your cancer will spread, and if — or when — you’ll need treatment.
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Transurethral Resection Of The Prostate
This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.
The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.
You will probably have some blood in your urine after surgery.
Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.
Psa Doubling Time Is More Accurate Than Gleason Score
Detecting recurrence with PSA at the earliest possible stage creates an opportunity to determine the seriousness of the relapse. With repeated, sequential testing of PSAsay with monthly blood drawsthe rate of PSA increase can be accurately determined. How quickly the PSA doubles reveals the grade of relapse. This information is very important because low-grade relapses are treated very differently than high-grade relapses.
Most people are familiar with the Gleason grading system, the most popular methodology for cancer grading in newly diagnosed men, that is, prior to relapse. With the Gleason system, the cancer cells are graded by a special doctor called a pathologist. The pathologist views the biopsy specimen under a microscope and assigns a grade to cancer. The Gleason system is the most powerful prognostic indicator for grading newly-diagnosed prostate cancer and has a very important role in determining optimal treatment for newly diagnosed men. However, in relapsed prostate cancer, the PSA doubling time easily supersedes the accuracy of the Gleason score. Knowledge of the cancers growth rate is the most accurate way to grade the cancers aggressiveness, and, luckily, the PSA determines this with unparalleled exactitude.
Once the PSA doubling time reveals the severity of the relapse, a treatment strategy is implemented. Treatment varies drastically depending on the grade of relapse, so the optimal;type of treatment for each grade of relapse is discussed below.
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What Are The Risks Of Prostate Cancer Surgery
If your prostate cancer treatment plan includes surgery, you might be wondering about the risks associated with your procedure. The oncologists in the Urologic Oncology Program at Moffitt Cancer Center can provide some general information for you to consider. We encourage you to review this information prior to having an in-depth discussion about your individual risk profile with your treatment team, which is always your best source of advice and support.
The most commonly recommended type of surgery for prostate cancer is a radical prostatectomy. This procedure involves the removal of the entire prostate gland and some surrounding tissues, including the seminal vesicles. Like all forms of surgery, a radical prostatectomy has some inherent risks, which can vary widely from patient to patient.
What Is A Common Misconception You Find In Patients Regarding Complications That Might Occur After Prostate Cancer Surgery
I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, I have a 75 percent chance of returning to my baseline function. It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because as is usually the case the devils in the details.
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Reduce Your Risk Of Surgical Site Infections
Surgical site infection are infections related to a surgical procedures that occur at or near the surgical incision within 30 days of the procedure . These infections are among the most common preventable complication after surgery.
SSIs occur in 2% to 4% of all patients having inpatient surgeries. Although most infections are treatable with antibiotics, SSIs are significant cause of harm and death after surgery, with approximately 3% of patients with SSIs dying.;Additionally, SSIs are the leading cause of readmissions to the hospital after surgery.
Because of the potential harm, I suggest you follow these steps to reduce your risk:
- Ask your doctor if he/she recommends antibiotics before the surgery.
- Follow pre-surgical instructions very carefully, including prepping the area.
- If you have hair in the surgical site, do not shave. Instead, be sure staff shortens hair with clippers or removes it with a depilatory.
- Because staying warm can reduce the risk of infections, ask for a blanket for the pre-surgical waiting period.
- Be sure everyone, all visitors and the medical team, wash their hands before touching you, or touching any hard surface you may touch. Importantly, if you do not see your doctors and other medical staff wash their hands, speak up!
- The patient should wash his/her hands regularly.
- Follow post-surgical instructions very carefully.
You can learn more at Safe Care Campaign.