What you need to know about:

Radical Prostatectomy

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Average Cost:

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Recovery Period:

1-3 days in hospital

Permanence:

Depends on patient condition

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Time it takes:

2-4 hours

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Anesthetize:

General Anesthesia

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Overview of

Radical Prostatectomy

in Thailand

A radical prostatectomy is an operation to remove the prostate gland and tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph nodes. Radical prostatectomy can cure prostate cancer in men whose cancer is limited to the prostate. There are several types of radical prostatectomies: Open prostatectomy - In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus. Laparoscopic prostatectomy - In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen. Robot-assisted laparoscopic prostatectomy - Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

Goals of

Radical Prostatectomy

The primary purpose of a radical prostatectomy is to remove the prostate gland completely, most commonly for treatment of cancer. Additional key goals are to preserve sexual function as well as urinary continence and control. As part of the procedure, in many cases the surgeon will also remove lymph nodes to assess for possible spread of cancer. 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 a 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 (urologist) 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.

Price of

Radical Prostatectomy

Average Cost

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Pros and cons of

Radical Prostatectomy

Pros

-For men with BPH, the main benefit of prostate removal is symptom relief. An enlarged prostate will press against the urethra and bladder causing symptoms including; urination frequency, painful urination, urinary incontinence

Cons

-Prostate removal is major surgery, even with minimally invasive techniques. Risks with any surgery include bleeding, blood clots, infection, and problems related to anesthesia. The two main prostatectomy side effects are erectile dysfunction (ED) and urinary incontinence.

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How it works:

Radical Prostatectomy

An open prostatectomy is done with an incision made in the abdomen, under the belly button. A laparoscopic prostatectomy has been developed from the open technique where five small incisions are made in the abdomen to insert a camera and surgical tools. The camera displays images onto a computer monitor, allowing the doctor to visualize the prostate. This technique is less painful than the open technique, recovery is quicker, there are fewer side effects, and the results are better than those of open surgery. A robotic-assisted laparoscopic prostatectomy (da Vinci prostatectomy) involves the use of a robotic arm to perform the surgery, controlled by a specialist doctor. Incisions are small and there is less pain for the patient. Recovery is quicker and the patient is more likely to be able to control their bladder and have erections after the procedure. In an open radical prostatectomy, your surgeon makes an incision in your lower abdomen, from below your navel to just above your pubic bone. After carefully dissecting the prostate gland from surrounding nerves and blood vessels, the surgeon removes the prostate along with nearby tissue. The incision is then closed with sutures.

Preparation before

Radical Prostatectomy

Pre - treatment

Your medical team will ask you about your medical history, including any previous surgeries and any allergies you have to medication. Please let your doctor know about all medication you are currently taking as some may need to be stopped before the procedure. Anticoagulants, including aspirin, must normally be stopped at least one week before the procedure. You will be asked to fast for eight hours before the procedure.

Recovery after

Radical Prostatectomy

Post - treatment

Your treatment plan will depend on the stage of your disease and your general health. Immediately after the procedure you will have a catheter in place to empty your bladder. You will see your doctor about one week after being discharged to have your wound checked. You will likely be recommended to avoid lifting heavy objects for a while after the procedure. Full recovery normally takes three to four weeks.

Risks & side effects

Incontinence - After prostate surgery, some men are unable to control the flow of urine from the bladder (urinary incontinence). If the rectum is injured, men may be unable to prevent the escape of stool from the body (fecal incontinence). Impotence - Some men may become impotent. Nerve-sparing surgery is an attempt to avoid the problem of impotence. When the doctor can use nerve-sparing surgery and the operation is fully successful, impotence may be only temporary. In some cases, however, even men who have this procedure become permanently impotent. Men can talk with their doctor about medicine and other ways to help manage the sexual effects of cancer treatment. Lack of Sperm Production - Men who have a prostatectomy no longer produce semen, so they have dry orgasms. Men who wish to father children may consider sperm banking or a sperm retrieval procedure.

FAQs:

Radical Prostatectomy

How is prostate cancer detected if I do not present with any symptoms?

Screening for prostate cancer can be performed in a physician's office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE). The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50. Men at high risk, such as African American men and men with a strong family history should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40.

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What if the procedure is not performed?

A prostatectomy is not the right treatment option for everyone and you should discuss all risks and benefits of the procedure (and of not having the procedure) with your doctor.

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How long will I need to stay in the hospital?

The majority of patients are discharged the day after surgery. However, the time of discharge is decided on a case-by-case basis. By the second night, over 90 percent of patients are comfortable enough to go home.

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