Radical Prostatectomy;
what is involved and what are the risks ?
(An extract
from "The Treatment of Prostate Cancer - Questions and Answers"
published by The Covent Garden Cancer Research Trust)
A
radical prostatectomy is a major operation to
remove the whole prostate and any cancer that
is inside it. This operation is different to a TURP
(trans-urethral resection of the prostate) which
only removes some of the prostate.
At the beginning of the operation some Lymph
glands next to the prostate are taken out and
checked immediately to ensure that there is no
spread. If they are clear, your prostate will be
removed completely. Unfortunately in 3-4 out of
10 men having a radical prostatectomy the
cancer will already have spread to surrounding tissue,
making the operation ineffective. Your PSA should fall
to a very low level following the operation. As long as it
does not rise, it is generally considered that you are
free of the cancer.
Radical prostatectomy is generally recommended for men
with a life expectancy of 10 years or more and who are
fit enough to cope with a major operation. For this reason
the years around 70 are a grey area. On average,
a man of this age can expect to live another 10 years -
about the same length of time it would take the cancer to
grow and cause problems. So your decision may depend
on what the adverse side-effects of each treatment mean
for your quality of life.
What adverse side-effects of this operation must I consider
•
3 out of 10 men will suffer mild urinary incontinence.
This means you will experience leakage when you cough
• between 2 and 5 in 100 men will suffer from permanent
severe incontinence (continuous leakage)
• almost all men will have some difficulty achieving
an erection (impotence)
• all men will be infertile
• 1 in 10 men will have bladder problems caused by scarring
and will need another operation
There
are treatments to help you deal with these adverse
side-effects. Some men may be offered
Viagra (also known as Sildenafil) to treat their impotence
However, not all men will be able to take this drug.
Even for those men who can take it, Viagra may not be
effective in treating their impotence. There are other treatments
available for both impotence and incontinence but most men
will
not regain their full sexual or urinary functions.
If
you feel your life expectancy is less than
10 years, the severe adverse side-effects
of surgery on your quality of life may not
be worth any possible gain in extra years.
Even if your life expectancy is more than
10 years you may be more concerned about
your quality of life. This is a decision only
you can make.
What
does the operation involve and
are there any risks?
There are risks and complications attached to
the surgery. The operation carries a risk of high
blood loss because some of the large veins next
to the prostate have to be cut in order to remove
it. There is a 1 in 100 risk of death from the
operation as a result of anesthesia, blood clot
(thrombosis) or infection.
On average you will have to wait one month for
admission to hospital. You should bring any
medication you are taking and make sure you
show this to the nursing staff and doctor. You
may be asked to attend hospital before the
operation
for routine checks that would
otherwise be done on the day of your
admission.
These
checks include the following:
• blood pressure and pulse
• urine test
• ECG (an electrical tracing of your heart)
• blood tests
•chest X-Ray (this might be taken to check
your lung function)
On
the day of your hospital admission you may
have your blood pressure and pulse rechecked.
Your temperature will also be taken. You will be
in hospital for approximately 6 days.
NEWS
FLASH
The Western General Hospital in Edinburgh is at present considering
Keyhole Surgery for this Operation.
