Page 1 - Radical Prostatectomy

Urological Health
Radical prostatectomy
Localized prostate cancer may be cured by radical prostatectomy. Within a few months of
surgery most men will be able to resume their usual lifestyle.
he prostate is a gland wrapped around the urethra,
Tthe urine channel, between the bladder and its
control muscle, the urethral sphincter. Its main function
is to produce part of the semen ejaculated at male
orgasm. Each vas deferens carrying sperm from the
testicles connects to the prostate. The nerves carrying
signals to produce erections run on either side of the
prostate.
Side view of male lower urinary anatomy
Roula Drossis If you are taking blood thinners, you should discuss this
bladder
seminal
vesicle
sphincter prostate
rectum
urethra erectile
nerve
Cancer may develop in the prostate from which it can
grow into surrounding tissues or spread to other parts of
the body. Microscopic examination of prostate biopsies
confirms the suspicion of cancer and allows some
prediction of the tumour’s expected behaviour. This is
known as the tumour grade or Gleason score.
Additional investigations may be performed, when
necessary, to determine the extent or stage of the
cancer. Your prostate cancer appears to be confined
to the prostate, although there is always a chance of
undetectable, microscopic spread.
You have discussed several treatment options with your
urologist, including:
• observation with possible delayed treatment
(sometimes called watchful waiting or active
surveillance),
• surgical removal of the prostate, or,
• radiation therapy (by external beam and/or
implantation of radioactive pellets, brachytherapy).
Each option has its own advantages and risks.
Radical prostatectomy involves the complete removal
of the prostate. This option is appropriate for men with
localized prostate cancer, good general health and a life
expectancy of at least ten years.
Preoperative preparation
Preoperative laboratory tests will be obtained as
necessary. A “bowel prep” may be recommended
before your surgery. The prostate lies immediately next
to the bowel. In the rare event of a bowel injury during
surgery, a clean bowel may reduce the risk of serious
complications. Your urologist will instruct you on the
form of bowel prep required. This may involve drinking
a cleansing solution, taking antibiotic tablets and/or
enemas.
with your urologist. You may be asked to stop taking
aspirin, ibuprofen, blood thinners and any vitamin or
herbal supplements before surgery to reduce the risk
of bleeding and unexpected drug interactions. Other
medications should be continued as usual. Please
ask your urologist if you have any question regarding
medications. You will be asked not to eat or drink for
several hours before your operation.
At the hospital
Most men are admitted to hospital on the morning of
surgery. A nurse will prepare you for the Operating Room
and answer your questions. You may be fitted with tight
stockings or given medications to prevent the formation
of blood clot in the legs.
You will be taken to the Operating Room where the
anesthesiologist, the doctor responsible for keeping you
comfortable during surgery, will attach instruments to
monitor your vital functions. Your anesthetic will then
be given. Radical prostatectomy normally is performed
under general anesthesia (you are “put to sleep”).
There are several surgical approaches to remove the
prostate. Either an incision is made in the lower abdomen
below the navel or it is performed using small “keyhole”
incisions (laparoscopically). When the PSA blood test
or biopsies suggest a higher risk of cancer spread,
pelvic lymph nodes may be removed for immediate
examination. In the presence of cancer in these lymph
nodes, cure of prostate cancer by radical prostatectomy
is not likely. In the absence of obvious tumour spread, the
prostate is exposed and freed from surrounding structures.
The urethra is divided below the tip of the prostate
preserving as much of the sphincter control muscle as
possible. The prostate and seminal vesicles are separated
from the bladder and removed. An attempt to spare
the erection nerves may be made, unless this could risk
leaving cancer behind.
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