Life After Prostate Removal: What To Expect
The prostate gland is prone to inflammation and developing cancer.
Almost half of the men above the age of 60 have benign prostate hyperplasia or prostate enlargement.
However, BPH does not cause removing the prostate, but the presence of cancer or its early sign is the reason for prostate removal.
Prostate cancer has become a significant concern in recent years. Its incidence is increasing, and now its diagnosis is becoming more common even among middle-aged men.
Prostate cancer is now among the most common cancers in older men.
Aging indeed has lots to do with the increased prostate cancer rate, but it is not the only cause. It seems that this disproportionate increase in the annual incidence of prostate cancer also has to do with other lifestyle issues like a high-fat diet, greater prevalence of metabolic disorders, environmental toxins, hormonal changes, and more.
The prostate plays an important role in male fertility and sex life. Although men can survive without a prostate, unfortunately, for many men, prostate removal results in poor quality of life, issues like erectile dysfunction, and more.
Some men can expect to recover well from proctectomy. However, for others the journey to recovery is prolonged and distressing. Keep reading to find out more about life after prostate removal and what you can expect.
About Your Prostate Surgery
A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.
A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision , which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.
In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button . Theyll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.
Figure 2. Open prostatectomy incisions
Laparoscopic or Robotic-Assisted Prostatectomy
During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen . Theyll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to help with this procedure.
Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
The Basics: How An Erection Occurs
Image: Hank Grebe/Getty Images
Its usually difficult for a man to get another erection right away. The length of the interval between erections varies, depending on a mans age, his health, and whether he is sexually active on a regular basis. A young, sexually active man in good health may be able to get an erection after just a few minutes, whereas a man in his 50s or older may have to wait 24 hours. One reason may be that nerve function slows with age.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
What Are The Risks Or Complications Of Radical Prostatectomy
- Urinary incontinence: Some people experience urinary incontinence, although most people recover continence. Your provider can help you manage loss of bladder control and urine leakage.
- Erectile dysfunction: Many people have problems maintaining erections after this surgery. The likelihood of recovery of erectile function depends on your erections before surgery and your surgeons ability to spare the nerves that control erection at the time of surgery. You may need to use erectile dysfunction medications or other treatments. The older you are, the more likely problems may occur.
There is also a small risk that you may experience:
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What To Expect After Radical Prostatectomy
Most men stay in the hospital for 1 to 3 days after radical prostatectomy. Your care team inserts a urinary catheter during the surgery, and some men may need to wear the catheter home for a few days to a few weeks. Another catheter inserted through the skin also may need to stay in place for a few days after returning home.
Pain after radical prostatectomy can generally be controlled with prescription pain medicines. It can take weeks or months for urinary and sexual function to return to their maximum levels.
After radical prostatectomy, itâs important to see your doctor for all your regular follow-up appointments to make sure your prostate cancer doesnât return.
How To Treat Erectile Dysfunction After Prostate Surgery
Prostate surgery is challenging enough. But to make matters worse, such an operation may impact ones sex life. The prostate is a vital part of the reproductive system. Its responsible for producing fluids that carry sperm.
So when the prostate is affected, this can lead to conditions like erectile dysfunction.
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After Prostate Removal The Sperm Has To Go Somewhere But Where
Men who are facing prostate removal due to cancer will surely wonder where their sperm will go after removal of the prostate gland. Its fair to wonder about this.
First of all, sperm is produced in the testicles.
People can continue to have orgasms, though, because the nerves that have to do with climax are unaffected, and are actually not related to whether or not someone ejaculates.
The sperm gets broken down and reabsorbed by the body. This is the same process as if someone were abstinent or had a vasectomy.
In short, prostate removal will not affect sperm production or quantity. It only affects what happens to the sperm once its produced.
Unfortunately, removal of the prostate may be more of an issue to a woman than to the man, if she believes she cant enjoy intimate relations without ejaculations.
Men who have partners like this should focus on all that can be done to treat their prostate cancer and prevent a recurrence.
Prostate cancer affects one out of six men as a lifetime risk, and the number it kills every year in the U.S. averages in the high 20,000s.
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Urinary Problems After Surgery
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Pauls story for one mans experience of managing urinary problems after surgery below.
Sexual problems after surgery
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What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
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Advantages Of Ralp Over Traditional Surgery Include:
- Small incisions
- Less blood loss than in traditional surgeries
- Less pain than an open incision surgery
- Less risk of infection over other kinds of surgery
- Shorter stay in the hospital
- Faster recovery at home
The magnification system provides your surgeon with a clear view of the tiny blood vessels, nerves, and muscles surrounding your prostate to help minimize side effects after your surgery.
Not every man who needs prostate removal surgery will be a candidate for robotic surgery. Each prostate cancer patients situation is unique, with some patients requiring a different surgical method either traditional open surgery or, less frequently, radical perineal prostatectomy.
If you have recently been diagnosed with prostate cancer and are looking for a second opinion on treatment options before undergoing surgery, consult with one of the prostate cancer specialists at Compass Oncology located throughout the Portland-Vancouver area.
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
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Is There Sex After Prostate Cancer Surgery
The surgical procedures that are needed in order to cure prostate cancer are invasive and may lead to long-term side effects. One of these side effects is impotence.
Nevertheless, even in the most severe cases of prostate cancer surgery, the affliction to ones sexual life can be reversible. Through extensive efforts over a period of around 12 months, a man who previously had a normal sexual function can regain potency. This is called penile rehabilitation which usually resorts to drugs or devices in order to accelerate the recovery of erectile function.
Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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How Do Doctors Perform Prostate Removal
During prostate removal the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. A prostatectomy takes about two hours and is performed under general anesthesia.
There are two approaches used for a prostatectomy:
- Robotic surgery
- Minimally invasive procedure with faster recovery time
- Uses smaller incisions and robotic technology
The surgical process is as follows:
- The doctor will make a small incision to gain access to the prostate
- The prostate is removed
- The bladder is reconnected to the urethra
- A catheter is connected to the bladder to allow urine to drain while the area heals
Days Before Your Prostate Surgery
Follow Your Healthcare Providers Instructions for Taking Aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare providers instructions. Do not stop taking aspirin unless they tell you to.
For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.
Stop Taking Vitamin E, Multivitamins, Herbal Remedies, and Other Dietary Supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.
If your healthcare provider gives you other instructions, follow those instead.
For more information, read Herbal Remedies and Cancer Treatment.
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The Success Rate Of Prostate Surgery
Survival rates can tell you how many people with the same type and stage of cancer are still alive 5 years after being diagnosed. For example, if you have stage 3 colon cancer, there is a 66% chance that 5 years later, you will be alive. But the rates cannot tell you how long you will live. However, they may help give you an idea of how likely your treatment will be successful.
Survival rates are estimates. They are based on data from many people who have had cancer before. These numbers might be confusing because they dont tell you what will happen, but they can help doctors decide treatments. Talk with your doctor to see if these statistics apply to you because they know about your situation.
A relative survival rate tells how likely a person is to survive a particular type of cancer. I.e., if the 5-year close survival rate for prostate cancer is 90%, it means that men who have this type of cancer are about 90% as likely as other men to live a minimum of 5 years after being diagnosed with the disease.
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Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. âIf a man has only six months of treatment, their level of testosterone rises again, and theyâll go back to feeling like themselves,â Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. âIf we can manage those other side effects, then often that improves mood,â she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
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Open Rp Versus Robotic
The ability to perform robotic-assisted laparoscopic RP was first described in 2000. Over the past decade, RALRP has gained widespread acceptance and now is the dominant approach to RP in the United States. Many attribute the adoption of the RALRP to marketing as opposed to any objective outcomes data showing superiority over the open approach.
All of the intermediate- and long-term HRQOL outcomes reported in the literature are limited to open RP. The question is, are these findings relevant to RALRP?
Unfortunately, there are no randomized studies comparing HRQOL outcomes following open versus robotic RP. The majority of studies comparing HRQOL outcomes between the two techniques are flawed in design. First, the level of experience of surgeons performing the two techniques and their patient volume are often not comparable. In addition, validated instruments for capturing outcomes are usually not employed. Surgeons are sometimes involved in the data acquisition, entry, and interpretation, which can introduce bias. There are several studies that have examined large administrative databases, which often mitigate bias, but the quality of outcome measures is subject to criticism. A few studies stand out as objective and worthy of comment.
Barocas and colleagues compared men undergoing open and RALRP and failed to show any advantages of either approach for preventing biochemical recurrence.
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