Surgery for advanced prostate cancer
Some men are offered surgery to help with the symptoms of advanced prostate cancer.
Your doctor will discuss any operation with you. It’s important that you understand what it involves, the possible side effects, and whether or not there are other treatments that may be more appropriate for you.
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This is an operation to remove part of the testicles. Sometimes both testicles are removed (bilateral orchidectomy). These procedures are done to reduce the level of the male hormone testosterone in the body. You can read more about this in our section about hormonal therapies.
Transurethral resection of the prostate (TURP)
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If you have advanced prostate cancer, it’s not beneficial to completely remove the prostate gland. But your doctors may suggest an operation called a transurethral resection of the prostate (TURP) to relieve problems you may have with passing urine. It’s carried out if part of the tumour is blocking the tube that drains urine from the bladder (the urethra). A TURP can’t remove all of the cancer cells and is only used to relieve problems with passing urine.
A tube with a small camera is passed through the urethra into the prostate. A cutting instrument attached to the tube is then used to shave the inner area of the prostate to remove the blockage.
A TURP can be done under a general anaesthetic or with an epidural. An epidural temporarily numbs the lower part of your body. It involves having an anaesthetic injected into the spine so you can’t feel anything even though you’re awake.
After your TURP
After your operation, you’ll probably be able to get out of bed and move around the next day. You’ll usually have a drip giving fluid into your vein. This will be taken out as soon as you’re drinking normally.
You’ll also have a tube (catheter) to drain fluid from your bladder into a collecting bag. It’s normal at this stage for your urine to contain blood. To stop blood clots from blocking the catheter, bladder irrigation may be used. This is when fluid is passed into the bladder and drained out through the catheter. The blood will gradually clear from your urine and the catheter can then be taken out. At first, you may find it difficult to pass urine without the catheter, but this should improve. Some men find that they have some urinary incontinence following this procedure. It can also cause some long-term difficulty in passing urine.
Most men are able to go home after three or four days. Occasionally, you may need to keep the catheter in for a while after you go home. In this case, the nurse will show you how to look after it before you leave hospital. Arrangements can be made for a district nurse to visit you at home to help with any problems.
You may have pain and discomfort for a few days after your operation. You’ll be given painkillers, which are usually very effective. If you continue to feel pain, it’s important to let the doctor or nurse looking after you know as soon as possible, so that a more effective painkiller can be found.
Following a TURP, about 1 in 5 men may have retrograde ejaculation. This means that during ejaculation semen goes backwards into the bladder instead of forwards through the urethra in the normal way. Your urine may look cloudy after sex because there is semen in the bladder, but this is harmless.
Advantages and disadvantages
Having a TURP can help relieve problems with passing urine.
There is a risk of urinary incontinence and bleeding after surgery. Some men have retrograde ejaculation after having a TURP.
Percutaneous nephrostomy and JJ stent
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In some men, one or both ureters (the tubes that connect the kidneys to the bladder) may get blocked by the prostate cancer. In this case, your doctor may insert a tube from the kidney(s) to a bag outside on the skin to drain your urine. This is called a percutaneous nephrostomy. Another way to drain the urine from the kidney(s) to the bladder is to insert a fine tube called a JJ stent into the ureter.
Your doctor or specialist nurse can give you more information about these procedures.
Care after an operation
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If you think that you might have any difficulties coping at home after your operation, let your nurse or social worker know when you’re admitted to hospital so that help can be arranged before you leave. As well as being able to offer practical advice, many social workers are also trained counsellors who can offer valuable support to you and your family, both in hospital and at home. If you would like to talk to a social worker, ask your nurse or doctor to arrange it for you.
Before you leave hospital you’ll be given an appointment to attend an outpatient clinic for your post-operative check-up. This is a good time to discuss any problems you may have.