What Happens At A Follow
Discussion with your doctor or nurse
At each appointment, your doctor or nurse will ask how youve been since your last appointment.
Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.
Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.
You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.
PSA test
You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.
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.
Prostate Surgery: What To Expect On The Day Of Surgery
There are a few prostate surgery types and techniques, and what you can expect from your procedure depends on which one your surgeon uses. An incision may or may not be required all, some, or none of prostate gland may be removed and some surrounding tissue may or may not be excised as welljust to name a few differences.
The choice in prostate surgery largely comes down to whether you are having it to treat prostate cancer or the urinary symptoms or complications of an enlarged prostate, a.k.a. benign prostatic hyperplasia .
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During Surgery For Bph
The vast majority of BPH surgeries are performed using a transurethral technique, of which there are several types. With each, a tube-like instrument called a cystoscope or resectoscope reaches the prostate gland via the urethra.
Some transurethral techniques include:
- Transurethral resection of the prostate : An electrified wire loop is used to remove prostate tissue. This is the most common surgery used to treat BPH.
- Transurethral electrovaporization of the prostate : Electrical energy applied through an electrode is used to heat and vaporize an area of enlarged prostate tissue.
- Transurethral incision of the prostate : No prostate tissue is removed, but two deep cuts are made starting in the bladder neck . The purpose of these cuts is to widen the urethra in order to improve urine flow.
- Laser energy is used to vaporize prostate tissue.
- Laser enucleation of the prostate: A holium or thulium laser is used to remove large chunks of excess prostate tissue that is blocking urine flow.
- Prostate urethral lift: Implants are placed in the prostate to lift the prostate and keep the urethra open.
- Prostate water vapor therapy: Targeted, controlled doses of stored thermal energy in water vapor are used to decrease prostate tissue.
Advantages And Disadvantages Of Surgery
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
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What Are The Side Effects Of Prostate Cancer Surgery
People often ask what happens if the prostate is removed? What to expect after prostate surgery? And can you have your prostate removed at all? The answer is yes it is possible to have the prostate removed.
Life without a prostate can be close to normal for some, though not free from the after effects of prostate removal.
There are few prostate surgery complications. Some are acute, and others chronic. Among acute side effects could be a reaction to anesthesia, bleeding issues, blood clots in legs, damage to nearby organs, and infection at the surgery site.
However, in most cases, people are interested in life after prostate removal, the pain after prostate surgery, and the long-term after effects of a prostatectomy.
There are two main side effects of prostate surgery. These are urinary incontinence and erectile dysfunction.
Success Of Radical Prostatectomy
The goal of radical prostatectomy is to cure prostate cancer. However, prostate cancer cure is only possible from prostatectomy if prostate cancer is limited to the prostate.
During radical prostatectomy, the removed prostate is examined under a microscope to see if prostate cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, further treatments may be needed.
Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.Ã
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How The Surgery Is Done
Different surgical methods may be used to remove the prostate:
- open radical prostatectomy usually done through one long cut in the lower abdomen
- laparoscopic radical prostatectomy small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen for guidance
- robotic-assisted radical prostatectomy laparoscopic surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and move robotic arms that hold the instruments.
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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When Do You Come Out Of The Hospital After Prostate Surgery
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.
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Is Incontinence Normal After Prostate Surgery
Bladder leakage after prostate removal is not all that uncommon and typically will go away after your body begins to heal and your muscles regain strength. Approximately 6-8 percent of men who have had surgery to remove their prostate will develop urinary incontinence. The good news is that most men will eventually regain bladder control with time.
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Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
Why Do Doctors Perform Prostatectomies
Since the prostate gland is not an organ essential for survivability, doctors recommend its removal in some cases. Perhaps the number one cause of removal of the prostate gland would be early-stage prostate cancer.
In such cases, doctors may go for complete prostate removal, or they may even go for radical proctectomy, in which they also remove the surrounding tissues.
However, prostate cancer is not the only cause. Doctors may also recommend prostatectomy to individuals with high risk or high probability of prostate cancer. Such individuals would often have some other severe symptoms like issues urinating.
Doctors may also remove the prostate gland if there are issues like acute urinary retention, recurrent urinary infections, recurrent hematuria, bladder stone, bladder outlet problems not responsive to conservative treatment, renal insufficiency due to chronic bladder obstruction, etc.
So, prostate cancer may be the leading cause of prostatectomy, but there are many other reasons why doctors may recommend it. Moreover, when people live with different non-cancerous prostate issues, they are also at an increased risk of developing prostate cancer.
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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.
Urinary Incontinence After Prostate Surgery
Urinary incontinence and/or inability to urinate are the common side effects after prostate surgery. This side effect usually ends in a short time.
Transient urinary incontinence develops in consequence of disruption or discomfort in the sphincter muscles which control the release of urine. This type of incontinence is generally similar to the stress incontinence that women often experience after vaginal delivery.
After prostate cancer surgery, the goal is basically to recover quickly, have full control over the bladder and become sexually active again.
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Factors That Increase Risk Of Recurrence
There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.
One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely youll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.
Cancer can be extremely aggressive and will change your life forever. Make sure that youre doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.
Im Worried About All The Side Effects From Prostate Cancer Medications What Can I Do
Carefully review the side effect profile of the different hormone therapy regimens, and discuss with your health care team potential ways to minimize the effects. In the end, its important that you not only understand the value of the therapy in the management of your prostate cancer, but also that you learn how to live your life as best as possible while fighting the disease.
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Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
Can A Man Have A Normal Sex Life After Prostate Surgery
The question is loaded what is a normal sex life anyway? Most men will experience a slowing down or drop off in their sexual activity as they get older.
That said, it is still a source of pleasure and intimacy amongst older couples, and for those for whom it is an important part of their relationship, they are keen to understand what sex after surgery will look and feel like.
The majority of men with a diagnose of localized prostate cancer will undergo a conservative approach known as active surveillance, but some of them will require surgery at some point.
The surgeons will excise the growth, or in some cases remove the entire prostate. There are also less invasive surgeries, such as the TURPs and other non-surgical therapies such as radiation therapy.
With careful intervention, most men will be able to resume a healthy sex life after the initial recovery period.
If you have had a radical prostatectomy without a nerve-sparing technique, theres a high chance you will experience a significant reduction in your sexual sensation and libido
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