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?
After A Radical Prostatectomy: What To Expect
Answers to your questions about sex, incontinence, fertility and more
If your medical team determines that your prostate cancer has become aggressive and needs to be treated, an operation called radical prostatectomy removal of the prostate is typically the first-line treatment. This surgery removes the prostate gland and surrounding tissues such as the seminal vesicles and sometimes nearby lymph nodes.
Minimally invasive techniques and most commonly, robot-assisted surgery help speed recovery after radical prostatectomy, since they cause less blood loss, less pain and shorter hospital stays. At Roswell Park, 100% of radical prostatectomies are performed with robot assistance. Regardless of how the operation is performed, the potential for lingering side effects urinary incontinence and erectile dysfunction must be considered as you decide on your treatment.
The good news is that not all men experience these, says Roswell Park urologist James Mohler, MD, Associate Director and Senior Vice President, Translational Research. And for most of the men who do, these effects are temporary. Here are answers to some of the most common questions men have about recovering from radical prostatectomy.
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 assist with this procedure.
Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
Changes In Your Sex Life
Most men experience some decline in erectile function after their prostate is removed, but this can be managed. It can take six months or even up to a year for the affected nerves to recover from surgery. But with proper therapy and treatment, most patients can have good erectile function again, says Dr. Fam.
Treatment options include:
Work with your doctor to find a treatment that is right for you.
Why The Procedure Is Performed
Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer.
Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.
Factors to consider when choosing a type of surgery include your age and other medical problems. This surgery is often done on healthy men who are expected to live for 10 or more years after the procedure.
While In The Hospital
It’s important to your recovery to start moving as soon as possible. Most men are out of bed and walking around the unit on the same day as their surgery. Your nurse will assist you until you can manage on your own. When you first get up, raise the head of your bed, take a couple of deep breaths, and allow your body to adjust to the change in position. Dangle your feet over the side of the bed for a few minutes, then slowly stand up. Be careful because getting up too quickly can make you light-headed.
Get out of bed at least three times each day preferably more. This helps prevent lung infections and blood clots. You may be prescribed an injectable blood thinner to further reduce the risk of blood clots. The more time you spend out of bed, the faster you will recover and the faster your bowel function will return to normal. Your nurse will also give you an oral stool softener and mild laxative to prevent constipation.
In addition to walking, you will be encouraged to do two other things that help prevent complications: Use an incentive spirometer , and wear compression stockings while in bed. Both will be provided and the nurses will instruct you on how to use them.
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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 net effect of someone having his prostate removed is:
Factors that are responsible for the ability to get erections are:
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Caring For The Incision
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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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
Immediately After A Prostatectomy
- You will stay in hospital for two to five days.
- Nurses will monitor your vital signs.
- Your pain will be managed with medication.
- You may be given antibiotics to reduce the risk of infection.
- You may have a drip inserted into your arm or hand for a few days.
- You will most likely have a drain tube out of your abdomen that will be removed in the first day or two after the surgery.
- In most cases, you will have to go home still wearing the catheter. You will be taught how to care for it.
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Additional Treatment After Surgery
Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.
Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:
- Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
- Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
- Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.
What To Do Next
Learning that your PSA level is higher than it should be can be very stressful. Talk to your doctor about what your results mean and your next steps. You may need more treatment, or you might be able to wait and have regular PSA tests to watch your cancer.
Its important to remember that your PSA test doesnt tell the whole story. Levels can go up and down, and theyre different for each person. Even if you do still have cancer or your cancer has come back, it may not spread for a long time.
If your cancer does come back, treatment options include radiation in the area where your prostate used to be, and hormone therapy. Having these treatments can reduce the risk that your cancer will grow and spread.
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What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeons sophisticated maneuvers.
Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when its half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
What Happens To A Man When He Has His Prostate Removed
The location of prostate is such that, if the patient experiences BPH then it might lead to urethral compression causing difficulty in urination and leading to LUTS . Unfortunately, BPH is a common problem in adult men and the chances of BPH drastically increases after the age of 60 years. A growth in size of prostate is also a sign of prostatic cancer.
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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.
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What Happens Right After Prostate Surgery
After surgery, youll stay in the hospital for a day or two. You may feel sore, but nurses will encourage you to get up as soon as possible. Walking helps your body start to recover from the surgery and function normally again.
Your doctor may prescribe pain medicine for a few days immediately following surgery. After that, youll switch to over-the-counter pain meds.
Life After Prostate Cancer Treatment
Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.
Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.
Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.
“It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.
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