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.
What Can I Expect Before And After Robotic Prostatectomy
If after consulting with Dr. Engel, becoming educated on the topic of prostate cancer, potentially seeking other opinions, and being presented all options, a patient opts for robotic prostatectomy, he will then be taken extensively through what to expect. Dr. Engel currently performs robotic surgery exclusively at George Washington University Hospital, and a date and time will be scheduled for surgery there. The patient will generally be urged to see his internist for a pre-operative physical, although this can also be accomplished at the hospital itself. Tests to rule out spread of cancer such as a bone scan and CT scan, looking for spread to bones and lymph nodes, may be performed in higher risk cases. The patient will be given detailed instructions regarding a bowel preparation regimen and the patient must follow this strictly. The purpose of the bowel prep is not only to create more space in the abdomen, but also for safety in the very unlikely event that there is an inadvertent injury to the intestine or rectum during the surgery. If this occurs, a bowel prep will likely keep this from being a life threatening problem.
What To Expect During And After Prostate Cancer Surgery
At the time of surgery, patients will have a urinary foley catheter placed in the urethra. Upon hospital discharge, patients will keep the urinary catheter with them for one week. Urine drains into a small bag that is strapped to the upper leg. There is a valve at the bottom of the bag to empty it from time to time. It will be necessary to drain the bag as it fills.
After the surgery and while still in the hospital, patients will begin digesting clear liquids. This will be followed by solid food based on the surgeons recommendations. The first bowel movement occurs three to four days later, which is normal. In order to make the first bowel movement as easy as possible, we recommend drinking prune juice daily, while taking a stool softener and laxative. These are highly important to consider because patients should minimize straining and pushing during a bowel movement after treatment.
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Prostate Removal Side Effects
Urinary incontinence
It is a common but temporary effect of prostate surgery. Usually, the symptoms improve within a year after the prostate removal.
Sexual dysfunctions
Erectile dysfunction is one of the most common prostate removal side effects. About 40% of men lose some erectile function after radical prostatectomy, but they see gradual improvements within 2-3 years.
Infertility
Other side effects of prostate removal
In rare cases, bowel function is affected and dry orgasms appear.
Dealing With Treatment Side Effects
Often there are unwanted and unexpected side effects that result from the various treatments for prostate cancer. These are not from the cancer itself, but from the surgery, radiation or hormone therapy or chemotherapy that are typically used to treat the disease.
All treatments will have some side effects, some short term, and some are long term. Short-term side effects tend to be common and reversible or diminishing. Long-term side effects are less common and are not always fully reversible.
Those side effects vary from person to person and as well as physical, they can also effect men psychologically and emotionally. Men about to undergo treatment should seek out information on what the potential side effects might be from their upcoming treatment.
Urinary Problems
Surgery can affect the ability to control the bladder. It can lead to incontinence or leaking urine when coughing or with a sudden movement. Radiation treatment can lead to other problems with urination.
Sometimes men who have had surgery or radiation therapy can experience a slowing of their urine stream and a feeling they are not able to completely empty their bladder. In rare cases, men who have had radiation therapy may also experience blood in the urine. Sometimes it can be due to the prostate cancer treatment, but it can also be a sign of other health issues that should be investigated.
It is important to report any changes or concerns about your urinary symptoms to your healthcare team.
Bowel Problems
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Surgery Vs Radiation For Prostate Cancer: Uses Benefits Side Effects
Prostate cancer is the most common form of cancer other than skin cancer in people who have a prostate . Depending upon the stage of the cancer, different treatment options are available. These treatment options include:
This article will review how surgery and radiation are used to treat prostate cancer. Both can be very effective forms of treatment in men with the disease. Although they may have the same goals of therapy, there are differences between these treatments.
Be sure to see your healthcare provider for the diagnosis, so you can receive the best treatment for you.
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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.
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What About Impotence And Incontinence After A Robotic Prostatectomy
Robotic surgery is really only the performance of a radical prostatectomy with better tools. These tools are specifically designed to allow for a more elegant surgery in a small space with better vision. And although most robotic surgeons do believe that this leads to a minimization of impotence and incontinence, unfortunately these two side effects are a part of every mans recovery after any prostatectomy, regardless of how it is performed or who performs it. Many men will recover quickly and completely, but this should not be expected as the norm at all. Dr. Engel is very experienced, but still has patients that leak permanently, and certainly has men that have permanent erectile dysfunction after surgery and need help. Highly skilled robotic surgeons like Dr. Engel just have fewer of them, and he is committed to providing help to those who need or want it.
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What The Study Found
According to the results, both methods were equally effective at removing cancer from the body, and post-surgical complications between them occurred relatively infrequently. However, there were some short-term differences between the two approaches. For instance, the robotically-treated men had shorter lengths of hospital stay , and they also reported lower pain scores after surgery. Men who underwent robotically-assisted surgery also reported fewer complications such as blood clots , urinary tract infections , and bladder neck contracture, which is a treatable condition that occurs when scarring in the bladder outflow makes it hard to urinate. In all, 45 men experienced a bladder neck contracture after open surgery, compared to nine men treated with the robotic method.
This is an excerpt from an article that appears on the Harvard Health Publishing website.
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Side Effects Of Robotic
The rates of major side effects from robotic-assisted laparoscopic radical prostatectomy are about the same as open surgical approaches. The most common side effects include the following:
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Urinary incontinence : Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
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Erectile dysfunction : The return of erectile function following prostatectomy is based on the patients age, degree of preoperative sexual function and whether the nerves were spared during surgery. Unless cancer is suspected in the nerve tissue, surgeons will use nerve-sparing techniques during robotic prostatectomy to minimize the surgical impact on sexual function.
Robotic Prostate Surgery | Q& A
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Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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Impotence After Prostate Surgery
In the past, up to 70 per cent of men who had their whole prostate removed because of cancer had some difficulty achieving an erection afterwards. This is because the prostate lies next to the nerves and blood vessels that are important for erections, and these nerves and vessels can be damaged during the operation. Newer surgical techniques that aim to spare the nerves associated with erectile function have reduced the risk of impotence.
While there is a still a significant risk of erectile dysfunction after prostate surgery, there is often a gradual improvement in erectile function over time. Some men only have short-lived erectile dysfunction and others continue to improve for up to 3 years.
Who Should Undergo Radical Prostatectomy
Men younger than age 75 with limited prostate cancer who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.
Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.
If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.
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Benefits Of Robotic Prostate Cancer Surgery
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
After the initial shock of finding out that you have prostate cancer, you will probably think of multiple questions for the surgeon. A question we are frequently asked is whether surgery is the only course of action.
When surgery becomes the best option for removing prostate tumors, the next question typically is whether robotic prostate cancer surgery is an option what the risks are, and how long the recovery takes.
Robotic surgery is an innovative technique that can minimize bleeding, risk of infection and damage to surrounding tissues. Educating yourself about the benefits of robotic surgery may help allay your fears of the procedure, thereby reducing stress and worry, and enabling you to have a more positive treatment outcome.
The Risks of Traditional Prostate Surgery
The prostate gland is located in the deepest part of the males pelvis. This area is full of blood vessels and nerve structures that control sexual function. The prostate gland is also adjacent to the urinary sphincter, which controls urinary function. During traditional prostate tumor removal surgery, it can be difficult to identify the adjacent muscles, veins and nerves that tightly surround the prostate gland.
Robotic Prostate Cancer Surgery: Who Is a Candidate?
Factors that indicate viability for robotic prostate cancer surgery include:
- Being sexually active
Surgery To Remove Prostate Cancer
Surgery is one of the main treatments for prostate cancer. You usually have surgery to remove your prostate gland. This is a radical prostatectomy.
A radical prostatectomy is a major operation with some possible side effects. You may not need this type of surgery if you’re an older man with a slow growing prostate cancer. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.
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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.
After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
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How Does Robotic
The computer-enhanced robotic surgical system consists of three components that provide:
How Does It Work
There are multiple types of radiation treatments that can be used for prostate cancer.
External beam radiation: This treatment is administered through a specialized machine that directs beams of radiation to targeted areas in the prostate. It is usually given in daily doses five days a week for about six weeks.
Stereotactic radiation: This type of radiation uses advanced images of the prostate with a different type of radiation machine. This may also be referred to as Gamma Knife or CyberKnife.
This type of radiation often uses much higher doses than standard external beam radiation. However, it is given in such a way that healthy tissue around the prostate is spared from high doses of radiation. Because of the high doses of radiation, this type of treatment may only need five or fewer treatments.
Brachytherapy:During this type of radiation, radioactive seeds are placed into the prostate. These radiation seeds emit radiation for a period of time and remain in the prostate even after the radiation has left.
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