Prostate Cancer Surgery (Radical Prostatectomy)

What is the prostate?

The prostate is a small, walnut-sized gland that is part of the male reproductive system and is located just below the bladder. The urethra passes through this gland, allowing urine and semen to exit the body. The main function of the prostate is to produce the fluid portion of semen and to help transport sperm in a healthy environment.

What is prostate cancer?

Prostate cancer is a malignant disease that develops due to the uncontrolled growth of prostate cells. It is usually a slow-growing tumor, but some subtypes can be aggressive. It is one of the most commonly diagnosed cancers in men worldwide, and its incidence increases with age.

Who is at risk for prostate cancer?

The risk of prostate cancer significantly increases with age. It is especially more common in men over 50 years old. Men with a family history of prostate cancer, particularly those carrying BRCA1/BRCA2 gene mutations, have a higher risk. Additionally, prostate cancer tends to be more aggressive in African-American men.

What are the symptoms of prostate cancer?

Early-stage prostate cancer usually does not cause symptoms. However, as the disease progresses, symptoms such as frequent urination, nocturia (getting up at night to urinate),difficulty urinating, blood in the urine, and pain in the groin area may occur. Bone pain can be seen in cases with bone metastasis.

• Difficulty urinating
• Weak or interrupted urine flow
• Frequent urination (especially at night)
• Feeling of incomplete bladder emptying
• Blood in the urine (hematuria)
• Blood in the semen
• Erectile dysfunction
• Painful ejaculation
• Persistent pain in the groin, hip, or lower back
• Bone pain in advanced cases (especially in the spine, hip, or ribs)
• Unintended weight loss and fatigue

How is Prostate Cancer Surgery Performed?

Prostate cancer surgery in Ankara, medically known as radical prostatectomy, is a surgical procedure aimed at the complete removal of the cancerous prostate gland. This operation is generally performed in patients diagnosed with localized prostate cancer, meaning the cancer has not spread beyond the prostate gland. The surgery is done under general anesthesia and can be performed using several techniques: open surgery, laparoscopic (minimally invasive),and robot-assisted laparoscopic surgery (e.g., the da Vinci system).

In the open surgery method, an incision is made in the lower abdomen to directly access the prostate gland. In the laparoscopic method, long, thin surgical instruments are inserted into the abdomen through several small incisions; this technique may result in less bleeding, shorter hospital stays, and faster recovery times. In robot-assisted surgery, the surgeon controls robotic arms from a console to perform the operation with greater precision; this method can offer higher accuracy, especially in nerve-sparing techniques.

Along with the prostate gland, the seminal vesicles located behind the prostate are usually removed. If there is a risk of cancer spreading to the lymph nodes, pelvic lymph nodes may also be removed (pelvic lymph node dissection). Special attention is given to preserving the nerve bundles responsible for urinary control and sexual functions during surgery; damage to these nerves can lead to postoperative complications such as urinary incontinence or erectile dysfunction.

At the end of the operation, a new connection is created between the bladder neck and the urethra, and a urethral catheter is placed to allow urine to drain during the healing process. This catheter is typically removed after a few days or about a week. The entire process may vary depending on factors such as the stage of the disease, the patient's anatomical characteristics, and the surgeon's experience. When applied to the right patient group, radical prostatectomy is an effective treatment that provides long-term survival against prostate cancer.

Is Prostate Cancer Surgery (Radical Prostatectomy) Risky?

As with any surgical procedure, radical prostatectomy carries certain risks. These may include urinary incontinence, erectile dysfunction, bleeding, infection, and anesthesia-related complications. The risks can vary depending on the surgeon’s experience and the technique used.

Post-Radical Prostatectomy Care

After radical prostatectomy surgery, patients usually stay in the hospital for a few days. They are discharged with a catheter in place. During the first weeks, heavy lifting should be avoided, plenty of fluids should be consumed, and signs of infection should be closely monitored. Pelvic floor exercises (Kegel exercises) are recommended to improve urinary control.

Recovery Process After Radical Prostatectomy

The recovery period after prostate cancer surgery varies from person to person, but most patients can return to daily activities within 4 to 6 weeks. The catheter is typically removed within 1 to 2 weeks. Recovery of sexual function may take longer, and medications or devices can be used if necessary.

What should PSA levels be after prostate cancer surgery?

Since all prostate tissue is removed during radical prostatectomy, PSA levels are expected to be undetectably low (usually <0.1 ng/mL). A rise in PSA is considered biochemical recurrence and may require additional treatment.

Can prostate cancer recur after surgery?

Yes, especially in aggressive tumors or when surgical margins are positive, cancer can recur. Regular PSA monitoring allows for early detection of recurrence. In such cases, additional treatments like radiotherapy or hormonal therapy may be necessary.

Is prostate cancer completely curable?

Prostate cancer diagnosed at an early stage can be completely cured with appropriate treatment. However, in advanced or metastatic disease, achieving a cure can be challenging. In these cases, the goal is to prolong survival and improve quality of life.

Which organs does prostate cancer spread to first?

Prostate cancer most commonly metastasizes to lymph nodes and bones. The spine, pelvis, and ribs are among the most frequently affected bones. Less commonly, it can spread to the liver, lungs, and other organs.

What is the life expectancy after prostate cancer surgery?

Life expectancy after prostate cancer surgery depends on the stage of the disease, Gleason score, and overall health status. For localized prostate cancer, the 10-year survival rate exceeds 90%. However, this rate can be lower in advanced stages.

What happens if prostate cancer is not operated on?

In cases monitored without surgery, the disease may progress, leading to bone metastases and organ dysfunction. However, in some elderly patients or those with other illnesses, active surveillance or hormone-suppressing treatments may be preferred.

Does sexual function improve after radical prostatectomy?

The recovery of sexual function depends on age, preoperative function status, and whether nerve-sparing surgery was performed. In cases where nerves are preserved, erectile function may gradually return; medication or device support may be needed.

What happens when the prostate is completely removed?

When the prostate is removed, the fluid part of the semen is no longer produced, so ejaculation does not occur. However, since testosterone production continues in the testes, sexual desire is usually maintained. Fertility is generally lost after surgery.

Is prostate surgery risky?

Radical prostatectomy is a safe procedure in experienced hands. However, like any major surgery, it carries risks. The risk of complications may increase, especially in elderly patients. Risks and benefits should be thoroughly evaluated.

Prostate cancer: surgery or radiation?

Surgery and radiotherapy can be equivalent options for treating localized prostate cancer. Surgery may be preferred in young and healthy individuals, while radiotherapy might be favored in older patients or those with high surgical risks. Treatment plans should be personalized for each patient.