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?
Dealing With Erectile Dysfunction After Surgery
On the other hand, a man with erectile dysfunction cannot achieve and maintain an erection for sexual penetration. Two tiny bundles of nerves on the sides of prostate control erections.
If a patient has erections before surgery, the surgeon will attempt not to injure those nerves. In other words, they will use a nerve-sparing technique. However, if cancer affects areas close to the nerves or is growing into them, the surgeon will have to remove those nerves as well.
Upon removal of both nerves, a man is unable to achieve a spontaneous erection. That doesnt mean they will never have an erection, though. Today, several aides can help a man achieve an erection.
Its useful to mention a patient may have erections when nerves on one side of the prostate are removed only. In case a surgeon doesnt remove any nerves, you have a good chance of restoring healthy erectile function. Keep in mind this may take a while.
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Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
How Long Does Erectile Dysfunction Last After Prostate Surgery
Is erectile dysfunction a possibility after prostate surgery?
Many patients are concerned about it and prefer other prostate cancer treatments.
However, they should know that most erectile issues are temporary and improve after a while.
These patients usually recover from this problem after a few months.
In this article, we cover sexual function after prostate cancer surgery thoroughly, tell you how long ED can last, and how to cope with erectile problems.
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Are There Differences Between Orp Lrp And Ralrp
According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.
But people who choose LRP and RALRP may experience:
- less blood loss
- shorter hospital stay
- faster recovery time
Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.
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Improving Sensitivity Of Psa Testing
Prostate-specific antigen testing with a cutoff of 4.0 ng/mL has a sensitivity of 67.5-80%, which implies that 20-30% of cancers are missed when only the PSA level is obtained. Sensitivity can be improved by lowering the cutoff or by monitoring PSA values so that a rise in PSA level of more than 20-25% per year or an increase of 0.75 ng/mL in 1 year would trigger performance of a biopsy regardless of the PSA value.
The specificity of PSA at levels higher than 4.0 ng/mL is 60-70%. Specificity can be improved by using age-adjusted values, PSA velocity , and the ratio of free PSA to total PSA . Another method is to adjust the PSA according to the size of the prostate or volume determinations of the transitional zone, which produces most of the PSA, and the peripheral zone, which produces less PSA but a majority of prostate cancers.
In the European Randomized Study of Screening for Prostate Cancer, Schroder et al studied a strategy for the early detection of prostate cancer that excluded digital rectal examination results and used a PSA cutoff of 3.0 ng/mL as the only indication for a biopsy. This protocol was compared with one in which a PSA level of 4.0 ng/mL or higher or the presence of a positive DRE or transrectal ultrasound was the indication for a biopsy. In a follow-up study, Schroder et al confirmed a substantial reduction in mortality from prostate cancer as a result of PSA testing.
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What Happens Immediately After Surgery
Once your surgery has finished, you are taken to the recovery room where you will wake up.
There will be a catheter in your bladder and sometimes a small wound drain.
You will often feel a sense of needing to empty your bladder. This is normal and is due to the irritation and spasm of the bladder caused by the catheter. This sensation slowly resolves and medication can be given to help relax the bladder. The catheter is held in place with a 3cm inflatable balloon on the catheter tip so cannot fall out with normal activity. Your catheter will remain in for approximately ten days to allow the new join between your bladder and urethra to heal.
Typically, after one hour in the recovery room, you are taken back to the ward. You will be able to sit up in bed and eat dinner on the evening of surgery and walk about the ward that day or the following morning. Blood thinners and calf compressors are used to reduce the risk of blood clots forming within the veins. Post-operative pain is well controlled through the use of regular pain medication. Once you are comfortable and confident in caring for the catheter you can head home. Hospital stay is typically 1-2 nights for robotic surgery and 2-3 nights for open surgery.
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What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.
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Prostatectomy: What To Expect
Many prostate cancer patients dont need surgery. But for young patients with prostate cancer that hasnt spread, a surgery called a prostatectomy can help them become cancer-free and put prostate cancer treatment behind them. John Davis, M.D., a urologist who performs hundreds of prostatectomies each year, explains what patients undergoing this procedure can expect, including prostatectomy side effects and risks.
What is a prostatectomy?
A prostatectomy is the surgical removal of all or part of the prostate gland. Prostate cancer surgery types include:
- Robotic prostate cancer surgery: In this procedure, called robotic radical prostatectomy, a surgeon makes several small incisions in the lower abdomen and uses a robotic device to remove the prostate.
- Open radical prostatectomy: The surgeon makes one large incision in the lower abdomen to remove the prostate.
Robotic radical prostatectomies have become increasingly common over the years, and most surgeons prefer to conduct the procedure this way because its a little easier on them. But its important to know that both methods are safe.
Who needs a prostatectomy?
For some patients, prostatectomies will be the only treatment they undergo. Others who may have a difficult time recovering from surgery or have more advanced cancer may also have chemotherapy or hormone therapy treatment as well.
How long does it take to recover from a prostatectomy?
What side effects do patients experience following prostate removal?
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Hifu Benefits Series: Shorter Recovery Time
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What if there was a way to treat your prostate cancer, and actually be back up and around the very same day? One of the great benefits of Sonablate HIFU is a much shorter recovery time than surgery or radiation even the ability to be active on the same day as treatment.
The Sonablate HIFU is a non-invasive medical device that used focused heat to destroy cancerous prostate cells. This device can ablate, or destroy, just the cancerous cells, or your entire prostate, without a single incision. This device is game-changing in the field of prostate cancer.
Radical prostatectomies, made through an incision in the lower abdomen or in the perineum can expect a hospital stay of up to a week, and a home recovery time of 3-4 weeks or more. Often times a urinary catheter is left in place for 1-2 weeks, and bladder control can continue to be weak for a few months. There are risks and complications possible including damage to the urethra and rectum, and possible erectile problems. While radical prostatectomies are generally effective in treating prostate cancer that has not spread beyond the prostate, with such an invasive surgery comes a long healing time.
If a man is looking to get back to life quickly after prostate cancer treatment, he really cant beat HIFU for prostate cancer. HIFU allows men to return to work much faster, return to daily activities more quickly, and allows men to return to living their life as it was before a prostate cancer diagnosis.
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.
- 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.
- There are risks in having surgery, as with any major operation.
- You might get side effects such as erection problems and urinary problems.
- Youll need to stay in hospital for a few days usually between one and five days depending on the type of surgery you have.
- If the cancer has started to spread outside the prostate, the surgeon may not be able to remove all of the cancer and you might need further treatment.
What Are The Types Of Radical Prostatectomy
Your surgeon will choose among several types of radical prostatectomy:
- Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
- Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.
After Prostatectomy: What To Expect
At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.
First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.
One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.
This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
- Urinary incontinence
- Erectile dysfunction
Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.
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Advantages And Disadvantages Of Prostate Surgery
- Surgery will completely remove the cancer if it is only in the prostate gland.
- The prostate can be removed and be fully analysed and staged in the laboratory.
- The success of the treatment can be easily assessed by PSA testing.
- If the PSA were to rise after surgery you would still be able to get other treatments like radiotherapy or hormone treatment.
It involves a general anaesthetic and the usual risks you would expect with surgery, like the risk of bleeding, infection and blood clots.
- You will have to stay in hospital for a few days.
- You may get side-effects afterwards like problems with erections and urinary incontinence.
- Recovery takes around 6 weeks.
Anatomical Mechanisms Of Male Urinary Continence
Although we still cannot claim to fully understand the mechanisms of urinary continence in males, alongside advances in radical prostatectomy techniques and increased numbers of operations, a large amount of related anatomical knowledge has been accumulated. In the 1980s, on the basis of the classical anatomical theory, the urogenital diaphragm, lying flat below the prostate gland, was thought to be a key structure in urinary continence by acting as the urethral sphincter however, at the end of the 1990s, human and cadaver studies showed that the structure previously identified as the urogenital diaphragm did not exist .
In terms of our present understanding of the mechanisms of male urinary continence, a review published in European Urology in 2010 provides a representative collection of results, and this review was updated in 2016 with the latest research .
Currently, male urinary continence is understood to be achieved by the combined actions of multiple anatomical structures surrounding the prostate gland below, we summarize the major constituent muscular structures in this urethral sphincter complex and their roles.
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Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.