Radical Prostatectomy, surgery for prostate cancer, is done when there is a possibility of completely curing the disease. It is used for younger healthy patients in whom the cancer is in the first stage. Surgery has better results in patients in whom the ‘Gleason grade’ (a score to measure the malignancy of prostate cancer) is high. Surgery should not conducted on patients above the age 70 as it does not counterbalance the increased risk. The operation is done through a lower abdominal incision or between the scrotum and rectum or through laparoscopy or a surgical robot.
The operation involves removing the entire prostate and seminal vesicles and reconnecting the Urinary bladder to the urethra so that the patient may void normally. The open operation takes 3 to 4 hours and requires at least 3 to 5 days of hospitalization. When the procedure in done through laparoscope, the procedure takes a longer time but the hospital stay is reduced to a day.
The advantage of surgery is that the cancer is removed from the body. Post operation problems may include inability to control urine after surgery and infertility. However the best long term treatment for prostate is surgical treatment.
Operative Method to retain sexual potency after removal of cancer cells:
This type of operation is known as ‘Nerve sparing operation’ in which the surgeon makes the incision very close to the prostate or at times replaces the native nerve with a graft nerve from the foot to preserve potency. The younger the patient quicker is the recovery. He is able to lead a life like all other males with normal potency. However as his age advances he starts losing his potency. Fortunately post operative erection can be restored by the use of drugs like Viagra or PGE-1. Some patients may need a penile implant.
Post operative care
Most patients are out of bed on the first day or a day after operation. They can lead a normal life, except that they should restrict themselves from lifting or carrying heavy weight at least for four weeks and no heavy exercises for six weeks after operation. The inconsistency in urination can be brought under control through light exercises and rehabilitative services. Diet is progressed as the patient can tolerate it. Pain can be controlled through proper medication which is usually not severe.