Radical prostatectomy is the procedure recommended as therapy for localized prostate cancer.
In this procedure, the prostate gland and the seminal vesicles are removed, together with some of the surrounding lymph nodes.
Radical prostatectomy is performed when, following a transrectal prostate biopsy, cancer is diagnosed which appears to be localized to the organ and has not metastasized to other parts of the body.
On admission to the hospital, a pre-operative assessment is carried out which includes:
- Blood tests
- Urine tests
- Chest X-ray
- Cardiac assessment
In the event that a patient is on anticoagulant (blood thinning) medication, it is necessary to stop taking this or to substitute it with an alternative, a few days prior to the surgical procedure.
How radical prostatectomy is performed
The radical prostatectomy takes place under general anesthesia and may be an open, laparoscopic or robotic procedure.
In the open procedure, access to the prostate is through an incision made into the abdomen, starting below the navel.
In the laparoscopic method, several small cuts are made into the abdomen, through which are inserted the camera and instruments used by the surgeon and his assistants.
In robot-assisted laparoscopic radical prostatectomy, instrument control is effected through a machine with robotic arms connected to a console which allows the doctor to remotely operate on the patient.
In a radical prostatectomy, the entire prostate gland is removed, together with the seminal vesicles and pelvic lymph nodes.
At the end of the procedure, the bladder is connected to the urethra and a catheter is fitted, which is removed one to two weeks after surgery.
Time spent in hospital following a radical prostatectomy depends on the procedure technique (open, laparoscopic, robot-assisted) and the general state of health of the patient, with an average length of stay in hospital of one week.
After the procedure
At discharge instructions are provided on:
- Time of resuming any anticoagulant (blood-thinning) medication the patient may have been taking prior to the procedure
- How long to refrain from physical exercise and strenuous activities
- Antiobiotic medication to take at home
- How histological test results are received
- Re-evaluation for PSA measurement
- Disease surveillance plan
Following a radical prostatectomy erectile function may be adversely affected or lost in up to 80% of individuals.
Moreover patients are unable to father a child naturally as the ability to ejaculate is lost.
Finally, following a radical prostatectomy, some urinary incontinence may appear, which usually improves or resolves entirely in the first six months after the procedure.
Depending on the results of the histological test, there may be a need for further therapy after the surgery which might be radiotherapy or hormone treatment.
Surveillance for prostate cancer should continue throughout the patient’s entire lifetime and includes measuring Prostate-specific antigen (PSA), as an increase in levels may indicate disease recurrence.