Radical Prostatectomy for Prostate Cancer

The radical prostatectomy procedure

A radical prostatectomy is used to surgically remove the prostate. Surgeons typically access and remove the prostate gland via an incision made in the lower abdomen. Laparoscopic prostatectomies which incorporate robotic, keyhole surgery are also available, although opinions are divided as to which method provides the greatest accuracy and optimal results.

Radical Prostatectomy
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Advantages of the radical prostatectomy procedure

Whereas laparoscopic prostatectomies can provide patients with shorter recovery times, radical prostatectomies don’t automatically induce ongoing or irreversible erectile dysfunction or incontinence. ¹Accuracy is key during either procedure, but a surgeon’s personal experience is also recognised as critical when minimising or avoiding unnecessary damage during the operation.

Prostatectomy procedures and candidacy

A number of specific prostatectomy procedures are available, including radical, radical perineal, laparoscopic, laparoscopic radical, nerve sparing and robot-guided laparoscopic radical prostatectomies. A host of advice and information is available to prostate cancer patients and they’ll be consulted on the comprehensive range of cancer treatment methods available and talked through with their consultant.

Risks and side-effects such as erectile dysfunction or incontinence

As well as the risks posed by surgery, side-effects should also be expected following major surgical procedures such as radical prostatectomies; bleeding or blood clotting, organ damage, infection and adverse reactions to anaesthetic are common, but most patients undergoing prostate cancer treatment typically experience erectile dysfunction and/or incontinence.
Commonplace complications such as erectile dysfunction are caused when nerves which control erections are unintentionally damaged or removed; this is due to their close proximity with the prostate, as well as the actual cancer treatment. It can take up to two years for a patient’s spontaneous erections to return, but treatments are available in the meantime.
Inhibitor drugs such as Viagra, Cialis and Alprostadil are known to aid erectile dysfunction by mimicking the body’s natural functions and artificially producing erections. Non-pharmaceutical aids such as insertable and inflatable silicon penile implants and vacuum devices that pump air to draw blood into the penis are also available.

Although this natural ability diminishes following surgery, it’s believed that potency is best restored when treatment is used and post-operation erections resumed as quickly as possible. Although results vary, evidence shows that a patient’s urinary continence can also be impacted by the radical prostatectomy procedure, leading to leaking and lower levels of control in the bladder.

Incontinence is treatable, but patient response can vary and the emotional and social aspects of a radical prostatectomy can be just as trying as the varied physical changes; patients should also be prepared to recover from this impact. Younger patients and those operated on by experienced, well-practised surgeons are found to have fewer post-operation incontinence issues.

Other post-operation changes can include reduced fertility, diminished or painful sensation during orgasm, reduced penis length, hernias within the groin and Lymphedema. This rare complication causes painful swelling in the legs and/or genitals, where lymph nodes have been removed from around the prostate; physical therapy is a proven, effective treatment for Lymphedema.

The expected side-effects and risks involved with a prostatectomy or any surgical procedure can vary, depending on personal circumstance. As well as the nature and progression of a patient’s cancer, an individual’s medical circumstances and personal requirements will typically dictate the most appropriate course of treatment for individual patients.

¹ The Lancet, The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study, Volume 10, Issue 5, P475-480, May 01, 2009

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