Surgical Treatment of Prostate Cancer – Part 1

Surgical Treatment of Prostate Cancer

Surgery is a preferred modality of care in the management of localized cancer (Stage T1 or T2). Unfortunately, for advanced or widespread disease, adjuvant modalities of care are usually needed.

The team of doctors make critical decisions regarding the choice of surgery by evaluating factors like:

• Staging of cancer (size of the mass and if there is any local or distant spread)
• Gleason scoring (grading of cancer that is based on the histological appearance of cancer cells under the microscope)
• Overall prognosis (age, co-morbid health issues, general health)
• Patient preferences

The choice of treatment plan requires active participation by the patient in decision making process).

Types of Surgical interventions for the management of Prostate Cancer:

Most popular surgical interventions in practice are:

Prostatectomy:

Prostatectomy (or surgical removal of prostate gland) is a conventionally popular procedure that is performed by surgeons to remove the cancerous mass along with thin margins of normal prostate tissue. In many cases, surgeons also r
emove the draining lymph nodes for tissue analysis and detection of nodal metastasis as well as seminal vesicles (procedure is referred to as complete prostatectomy).

Depending upon the patient factors and preferences; there are several approaches to perform the radical prostatectomy procedure; such as:

• Prostatectomy via Incision in the abdomen: Retropubic prostate surgery involves the removal of prostate gland via abdominal incision under spinal or epidural anesthesia. The biggest concern with open/ retropubic prostatectomy is nerve damage (that may lead to impotency, sexual dysfunction and urinary complaints) after the procedure. With technological advancements, more sophisticated and precise options are available to perform prostate removal surgeries.
• Incision in between scrotum and perineum: Also referred to as the perineal prostectomy1; the procedure involves the removal of prostate gland with the help of incision drawn between scrotum and anal region.

The key concerns or complications after surgery depends on the expertise of surgeon and nature of procedure employed. Like most surgical procedures, surgical prostatectomy is associated with these side effects:

• Hemorrhage (excessive blood loss)
• Stroke or heart attack
• Clot formation
• Formation of lymphocele (accumulation of lymph that must be drained)
• Infection
• Urinary incontinence (approximately 40-60% cases of surgical prostatectomies are associated with urinary incontinence_
• Impotency.

Laparoscopic prostatectomy:

In this approach, a laparoscope is used as an assistance device to perform the surgical intervention. The key benefits of laparoscopic surgery are; minimal tissue damage, low blood loss and early return to a functional lifestyle.

Read more about surgical treatment of Prostate cancer in the upcoming blog post.