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You may be offered surgery. There are three types of surgery used to treat locally-advanced prostate cancer: radical prostatectomy, trans-urethral resection of the prostate (TURP) and orchidectomy.
Before any operation, make sure you’ve discussed it fully with your doctor. It’s important that you understand what it involves, the chances of success, the likely side effects, and whether there are other treatment options that may be more appropriate to your particular circumstances.
Unlike radiotherapy|, there is no evidence that having hormonal therapy| before or after surgery will help to improve the results of the operation.
There are three types of surgery used to treat locally-advanced prostate cancer:
Benefits of a prostatectomy Removing the whole prostate gland may stop the cancer from spreading and may result in a cure. Radical prostatectomy appears to prolong life for some men with a higher grade cancer, but isn’t suitable for many men with locally-advanced prostate cancer.
Risks of a prostatectomy Over half of men who have a prostatectomy for locally-advanced prostate cancer will have a recurrence of their cancer and need further treatment, with either radiotherapy or hormonal therapy.
For every 100 men who have a radical prostatectomy, up to 20 will develop slight leaking of urine; around 5 will have incontinence of urine; and around 50 will have problems getting an erection. One in 200 men over 65, and one in 1000 men under 65, may die from problems caused by the surgery.
Benefits of a TURP Can help to relieve symptoms with passing urine.
Risks of a TURP It won’t get rid of the cancer cells. There is a risk of urinary incontinence. Some men have problems getting an erection after a TURP.
A radical prostatectomy is carried out by specialist surgeons. The whole prostate gland is removed, either through a cut made in the tummy area (abdomen), or through a cut made between the scrotum and the back passage. This aims to get rid of all of the cancer cells. This operation is only suitable for a small number of men with locally-advanced prostate cancer. You can discuss with your specialist whether a prostatectomy would be suitable for you.
The operation often causes impotence – the inability to have and maintain an erection. In a few men it can also cause problems with control of passing urine (urinary incontinence). It’s possible to do a special type of operation, called a nerve-sparing prostatectomy, which can reduce the risk of erection problems. However, this is not often an option for locally-advanced prostate cancer.
Doctors can’t predict which men will be affected by these side effects, so it’s important that you are fully aware of them beforehand. Your doctor will discuss the operation, its possible side effects and other possible treatment options with you.
Although a prostatectomy can get rid of the cancer cells completely for some men, the cancer cells may come back in the area of the prostate some time after the operation. If this happens, external radiotherapy may be given to the prostate area. The treatment is given over a larger area, which can cause more side effects.
With a laparoscopic prostatectomy your surgeon doesn’t need to make a large opening but can take out your prostate gland using only four or five small cuts (about 1cm each) in your tummy area (abdomen). The surgeon uses specially designed instruments that can be put through these small cuts. This type of surgery is also known as keyhole surgery.
After making the small cuts, the surgeon uses carbon dioxide gas to fill (inflate) the abdomen. A tiny video camera gives a magnified view of the prostate gland on a video screen. The prostate gland is cut away from surrounding tissues and removed through one of the cuts in the abdomen.
Most studies have shown that laparoscopic surgery is as successful at treating prostate cancer as open surgery.
Your surgeon can discuss with you the potential risks and benefits. This type of surgery is only carried out by surgeons with specialised training and experience in the technique.
After prostatectomy you will have a drip (intravenous infusion) into a vein in your arm and a tube (catheter) to drain urine from your bladder. If the operation was done through the abdomen you will also have an abdominal wound. You may have a small tube in the wound to drain any excess fluid that is produced. After your operation you may have some pain or discomfort which may continue for a few weeks, particularly when you walk. Painkillers should help ease this, so let the staff on the ward know if you’re still in pain.
You will probably be ready to go home a week to 10 days after your operation. You may be able to go home a bit sooner if you’ve had a laparoscopic prostatectomy.
Your catheter will probably stay in for one to three weeks to allow the urethra to heal. Arrangements can be made for a district nurse to visit you at home to make sure your catheter is working well. If you have any problems you should contact your doctor as soon as possible.
Surgery to the prostate can cause difficulty in getting an erection (sexual impotence) and controlling the bladder (incontinence).
Erection problems are caused by a reduction in the blood flow to the penis due to damage to the arteries or nerves. Often the need to remove all of the cancer cells makes it impossible to avoid nerve damage.
In men aged under 60 who have had nerve-sparing prostatectomy, the risk of erection problems after total prostatectomy may be 1 in 2 (50%) or higher. The risk increases to about 4 in 5 (80%) or more in men over the age of 70, and may be higher if nerve-sparing techniques are not used. We have information about ways of coping with erection problems after treatment for prostate cancer|.
The prostate gland produces semen, which is normally mixed with sperm from the testicles. Removing the prostate gland makes it impossible for men to ejaculate, and although there is still sperm it can’t get out of the body. This causes infertility.
If you want more children after your treatment, it may be possible to store sperm. It’s still possible for men who have had their prostate gland removed to have an orgasm, but there will be no ejaculation. This is known as a dry ejaculation.
Problems with controlling the bladder as a result of radical prostatectomy are less common. Most men have some incontinence when the catheter is first removed, but this usually improves with time. About a year after the operation, up to one in five men (20%) will leak an occasional drop of urine. Some men may need to wear an incontinence pad, but it’s very rare to be completely incontinent and to need a permanent catheter.
Another less common effect of surgery is scarring of the bladder, which can make it difficult to pass urine. This is fairly easily treated with minor surgery known as bladder neck dilation.
Some men may find that they have diarrhoea| or constipation| for a few months after prostatectomy.
A TURP is carried out if the part of the tumour that is blocking the urethra (the tube that drains urine from the bladder) needs to be removed. A tube which contains a miniature camera is passed through the urethra and into the prostate. A cutting
instrument attached to the tube is then used to shave off the inner area of the prostate to remove the blockage.
This can be done under a general anaesthetic or an epidural. With an epidural, the lower body is numbed temporarily by injecting an anaesthetic into the spine, so that you can’t feel anything even though you are awake.
A TURP can’t remove all of the cancer cells. It is used to relieve problems with passing urine.
You will probably be up and about the morning after your operation. You will usually have a drip, giving fluid into your vein. This will be taken out as soon as you are drinking normally. A tube (catheter) will drain fluid from your bladder into a collecting bag. It is usual for the urine to contain blood.
To stop blood clots from blocking the catheter, bladder irrigation may be used. Fluid is passed into the bladder and drained out through the catheter. The blood will gradually clear from your urine and the catheter can 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 your catheter before you leave the hospital, and 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 will 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 (20%) may have retrograde ejaculation. This means that during ejaculation semen goes backward into the bladder instead of through the urethra.
Your urine may look cloudy after sex, but this is harmless.
If you think that you might have any difficulties coping at home after your surgery, let your nurse or social worker know when you are admitted to hospital so that help can be arranged.
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 will 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.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.