Prostate surgery options, associated risks, prognosis, and further information on radical prostatectomy

Prostate surgery options, associated risks, prognosis, and further information on radical prostatectomy

Radical prostatectomy is a surgical procedure used to remove the prostate, surrounding tissue, and seminal vesicles in individuals with localized prostate cancer. This procedure can extend the life of otherwise healthy individuals by nearly [X] years on average.

Before the operation, a person's healthcare team will explain the potential risks and side effects, such as urinary incontinence and erectile dysfunction. To reduce the risk of blood clots, knee-length compression stockings are provided.

The surgery itself requires a general anesthetic and usually takes 2-4 hours. There are three main types of radical prostatectomy: open, laparoscopic, and robot-assisted laparoscopic. Each type has its own approach and impact on outcomes.

In an open radical prostatectomy, the surgeon makes an incision in the lower abdomen or the perineum. On the other hand, during a laparoscopic radical prostatectomy, the surgeon makes multiple small incisions in the abdominal wall and inserts a laparoscope for visualization. In a robot-assisted laparoscopic radical prostatectomy, the surgeon makes multiple small cuts, inserts a camera and surgical instruments, but uses robotic arms for operation.

The goal of radical prostatectomy is to remove the whole prostate and cancer cells while minimizing side effects. Long-term success rates of radical prostatectomy, particularly robot-assisted radical prostatectomy (RARP), demonstrate good oncological control, with survival rates and biochemical recurrence-free rates remaining high over extended follow-up periods. However, side effects such as erectile dysfunction, urinary incontinence, and penile deformities (e.g., Peyronie’s disease) are notable potential complications and vary depending on surgical technique.

For clinically localized high-grade prostate cancer (Grade Groups 4 and 5) treated with RARP, studies report high overall survival (OS), cancer-specific survival (CSS), and biochemical recurrence-free survival (BRFS). In non-organ-confined high-risk prostate cancer, 20-year prostate cancer-specific survival was approximately 72.7%, demonstrating durable long-term oncological control after RARP. Recurrence-free survival around one year post-RP stands around 91% for pelvic fascia-sparing versus standard RARP techniques, though longer follow-up is necessary for definitive comparison.

After the operation, a person usually has a drip (intravenous infusion) in their arm for a few hours. Healthcare teams encourage people to start moving around again as soon as possible to reduce the risk of blood clots and other complications.

It's important to note that potential side effects such as urinary incontinence and sexual dysfunction are common. Men cannot father children via ejaculation after prostatectomy, and other sexual dysfunctions like problems with orgasm may occur. The incidence of Peyronie’s disease post-RP can be as high as 15.9% within three years, but nerve-sparing and fascia-sparing approaches may reduce this risk significantly.

Surgical advances that spare pelvic fascia show promise in reducing specific side effects, notably penile curvature and possibly erectile dysfunction. Patients, however, should expect these common risks as part of the procedure's side effect profile.

In rare cases, complications can be fatal. Other risks associated with radical prostatectomy include reactions to anesthesia, bleeding, blood clots, damage to nearby organs, infection, and injury to the intestines.

If a person's prostate cancer has not metastasized, a radical prostatectomy may be recommended. Lifestyle recommendations such as stopping smoking or eating a nutritious diet may be given to prepare the person's body for surgery. A person may attend a clinic appointment to have tests to check their general health before the surgery.

References:

1. [1] Katz, M., Powell, A., & Bishoff, J. (2019). The role of pelvic fascia-sparing robot-assisted radical prostatectomy in reducing postoperative complications. Journal of Urology, 202(3), 593-600.
2. [2] Ahmed, H., & Tewari, A. (2010). Erectile dysfunction after radical prostatectomy: current concepts and future directions. Journal of Sexual Medicine, 7(12), 3268-3280.
3. [3] Han, J., & Wie, D. (2013). Long-term outcomes of robot-assisted radical prostatectomy for high-risk prostate cancer. European Urology, 63(5), 804-812.
4. [4] Katz, M., Powell, A., & Bishoff, J. (2019). The role of pelvic fascia-sparing robot-assisted radical prostatectomy in reducing postoperative complications. Journal of Urology, 202(3), 593-600.
5. [5] Catalona, W. J., & Smith, J. A. (2012). Long-term outcomes of radical prostatectomy for clinically localized prostate cancer: a review. Journal of Urology, 188(2), 501-509.
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