Prostate cancer

In most cases, surgery for prostate cancer is not recommended on an urgent basis. Usually it is recommended that a patient investigate all of his treatment options first, and when a decision is made, then proceed to schedule the treatment option that is chosen. Surgery is typically not performed within 6 weeks of biopsy to allow adequate healing following prostate biopsy. In general, surgery is done within 3 months of diagnosis, however, in cases of more aggressive prostate cancer, one may recommend earlier treatment. For patients with a small amount of cancer or a slow growing cancer, treatment more than 3 months after diagnosis may be appropriate. This is something that should be discussed with Dr. Yu.

In the short term, patients who undergo any type of surgery will have discomfort as a result of the surgical incision. They will require a period of recovery following the anesthesia. Nausea may be experienced during the first 24 hours after surgery which can be related to the anesthesia. In addition, because we fill the abdomen with air to perform this robotic procedure, you may experience a short delay in return of bowel function which could delay discharge from the hospital. In the short term, patients will have a catheter, or tube placed through the urethra into the bladder to drain the urine. This usually remains in place for approximately 6 days following surgery. Blood tinged urine may be seen while the catheter is in place. Bladder spasms are commonly experienced while the catheter is in place as a moderate cramping sensation in the lower abdomen or bladder. These spasms are usually transient and decrease over time. If severe, medications can be prescribed by your doctor to decrease the episodes of these spasms. The tip of the penis may become sore from catheter irritation. You may use a small amount of KY jelly or Aquaphor to prevent dryness and discomfort at the tip of the penis. A small amount of blood-tinged urethral secretion or even urine may leak around the catheter at the tip of the penis. Urine leakage may become especially prominent at the time of bowel movements. This occurs due to mild straining and is entirely normal. It is common for your urine to turn pink or red-tinged as you increase your activity level simply from the catheter rubbing against the lining of your bladder. If this occurs, reduce your activity and increase your fluid intake.

In the long term, men can have important quality of life effects on urinary and sexual function. The risk of permanent stress incontinence (leakage of urine with coughing, sneezing, and strenuous activity) is small, however, full urinary control can take anywhere from weeks to several months to return and is different for every patient. Return of continence can depend on baseline urination function, patient’s age, as well as body habitus.

Sexual function after surgery can also be affected. Sexual function for men is composed of erection, ejaculation and orgasm. Erections will be compromised initially following surgery. It can take anywhere from a few weeks to 2 years to fully regain erectile function. Return of function depends on the individual patient, including factors such as the patient’s age and quality of erections before the surgery. You will be encouraged to use medications, either oral medications or medications injected directly into the penis, to help improve erectile function following surgery. The ability to have an orgasm will not be affected by the surgery. There will no longer be ejaculation after undergoing surgery. The majority of ejaculate comes from the seminal vesicles which are removed at the time of surgery with the prostate.

The risks of surgery in general include the risks of anesthesia. People who have general anesthesia can experience complications such as myocardial infarction (heart attack), stroke or even very rarely death. These are very rare complications of anesthesia. Other uncommon risks of this surgery include bleeding with a low (<1%) risk of blood transfusion, infection, urine leakage from the connection between the urethra and bladder, damage to adjacent tissues/organs, and hernia formation from one of the small incisions. Patients who have cancer surgery, especially pelvic cancer surgery, can occasionally develop blood clots in their veins which may rarely travel to the lungs. Specific complications of radical prostatectomy include the risk of urinary incontinence and erectile dysfunction. Overall, the risk of these complications is low.

Following the surgery, the prostate, seminal vesicles and any lymph nodes that were removed will be examined under the microscope by a physician specialist known as a pathologist. This will allow us to determine the final Gleason score, or aggressiveness of the cancer. It will also allow us to measure the cancer volume and the extent of cancer, specifically whether or not the cancer was confined to the prostate itself or has traveled outside of the prostate. This will help a great deal in determining whether or not additional treatments are necessary as well as the ultimate prognosis. Additional genomic testing can be performed on the collected specimen which can also help tailor treatment after surgery, if needed.

You will need to have blood tests before surgery that include a complete blood count, a metabolic panel, tests of bleeding function, and a type-and-screen for the possibility of a blood transfusion. You will also need a urinalysis to confirm that there is no urinary tract infection. If you are over 55 years old you will also require an electrocardiogram and a chest x-ray.