What is prostate cancer?
Cancer develops when cells in the body start to multiply out uncontrollably. Cancer cells can form in almost any region of the body and spread to other parts.
Prostate cancer is a type of cancer that develops in the prostate gland, which is only found in males. It is small and walnut-shaped, and its main function is to generate fluid that is part of the semen. The prostate is situated in front of the rectum and beneath the bladder. The size of a man’s prostate might fluctuate as he ages. It is roughly the size of a walnut in younger men, however in older men it can be much larger.
Many cases of prostate cancer are localised to the prostate gland, where they often grow slowly and may not do much harm. While some varieties of prostate cancer develop slowly and require little or no therapy, others are aggressive and spread rapidly. This type of cancer is very common in men, and if detected and treated in time, the chances of remission are high.
How is prostate cancer detected?
There may be no early signs of prostate cancer, so annual screenings of the gland are recommended. Your doctor may recommend a digital rectum exam or a prostate-specific antigen test for this.
If you are experiencing symptoms like trouble while urinating, bloody pee and semen, erectile dysfunction, pain in your bones, or unexplained weight loss, then it’s best to seek medical intervention.
Based on your medical history, family history, physical exams, and symptoms, your doctor will recommend several tests to confirm or rule out the presence of prostate cancer.
Imaging tests like ultrasounds, MRIs (magnetic resonance imaging), and biopsies of the prostate gland tissue are typically employed in this case.
When a biopsy confirms the presence of cancer, your doctor will determine how aggressive the cancer is and how quickly it may spread to other parts and tissues of the body.
Your cancer cells will be examined in a laboratory to figure out how much they differ from your healthy cells. A higher grade means the cancer is more aggressive, and there is a higher chance of it spreading in the body.
Then the extent of the cancer will be determined with further testing through more imaging tests like CT (computerised tomography) scans and PET (positron emission tomography) scans. Not everyone needs to undergo these imaging tests. Your doctor will decide whether the tests are needed for an investigation or not.
The results of these tests are used by your doctor to determine the stage of your cancer. Roman numerals from I to IV are used to represent the different degrees of prostate cancer. The malignancy is restricted to the prostate in the early stages. Stage IV signifies the cancer’s expansion outside of the prostate to the rest of the body.
What is prostate cancer surgery?
Prostate cancer surgery is typically used to treat early-stage prostate cancer that has not spread to other parts of the body. The intention of surgery in this scenario is to eradicate all the cancer. The most frequent prostate cancer surgery known as “radical prostatectomy” involves the removal of the entire prostate gland, and some surrounding tissue and lymph nodes. When treating severe or metastatic prostate cancer, surgery may also be employed as one of several treatment modalities.
When do you need prostate cancer surgery?
Your prostate cancer treatment options are determined by a number of factors, including the rate at which your cancer is advancing, if it has spread, your general health, and the advantages and side effects of the prescribed treatment.
Generally, low-grade cancer does not require a prostate cancer operation or any treatment at all. Active surveillance or regular check-ups, which include blood tests, biopsies, and rectal exams, to keep an eye on the status of the cancer are usually enough. Only when the cancer has progressed will the doctor suggest prostate cancer surgery or radiation.
Types of prostate cancer surgeries
Prostate cancer operation is counted among the local treatment options that may eliminate the cancer completely, especially when it is in the early stages. If the cancer has gone beyond the prostate gland, further treatments (such as drug therapy) may be required to eradicate cancer cells in other parts of the body.
The primary prostate cancer operation types you should know about are:
Radical (open) prostatectomy: The more traditional surgical approach, known as an “open prostatectomy,” involves the surgeon removing the prostate and surrounding tissues through a single large skin incision (cut). This type of surgery is performed less frequently now. This surgery is either done through the perineal approach or the retropubic approach.
An incision is made in the lower abdomen from the belly button to the pubic bone by the surgeon for a radical retropubic prostatectomy. An incision between the anus and the scrotum is made to execute a radical perineal prostatectomy. You will most likely be hospitalised for a few days following the surgery, and your movements will be restricted for several weeks after discharge.
Laparoscopic radical prostatectomy: This is a minimally invasive approach to prostate cancer surgery, which means that the incisions are small, the recovery time is quick, there is less bleeding, and your hospital stay will be brief. With this approach, the surgeon looks inside the patient’s body with a video camera attached to a long instrument. Then there is the robot-assisted laparoscopic radical prostatectomy, where the surgeon is assisted by a robot during the procedure. You can normally go home within 24 to 48 hours after robotic surgery.
Other prostate cancer operations you should know of are:
Transurethral resection of the prostate (TURP): It is the most commonly used to treat the symptoms of a urinary obstruction in prostate cancer patients. Prostate cancer can put pressure on the urethra, which transports urine from the bladder. You can find it challenging to urinate as a result. Your doctor may advise you to have surgery to remove some of the cancer so that you can urinate more easily.
Pelvic lymphadenectomy: Lymph nodes in the pelvis are removed for evaluation to check if they have cancer.
Bilateral orchiectomy: The testicles are removed during an orchiectomy. The scrotum, which is the skin pouch where the testicles are located, and the penis are left undamaged. An orchiectomy is performed to stop most of the body’s testosterone production, which prostate cancer typically requires to flourish.
Recovery after prostate cancer surgery
Immediately after surgery: You will awaken in the recovery room following your operation, after which you will be taken to a hospital ward. Because recovery rooms and hospital wards are busy and often noisy, some people find the environment unusual and unsettling. The anaesthetic and medications will make you feel drowsy.
The average hospital stay after a radical prostatectomy is 1 to 2 days. For a week or two following prostate cancer surgery, you will require a catheter to help drain your bladder.
Movement for recuperation: No matter the surgical technique, you should anticipate walking shortly following your treatment. Walking speeds up your recuperation and lowers your chances of problems. However, you will be asked to refrain from indulging in strenuous activities like weightlifting, running, and playing contact sports. Most patients can resume normal activities 6 to 8 weeks after surgery.
Refrain from intercourse: You will be asked to refrain from engaging in any sexual activity because it might derail your recovery. Ejaculation can frequently result in pain or blood in the sperm. When your doctor gives the okay, you can resume having intercourse. Even then, you may be able to orgasm, but there may be little or no semen.
The process of restoring continence (regulation of the urine system) and potency is typically part of the recovery from prostate cancer (erectile function).
Pain management: For the first week, you will experience pain, which is completely normal after a surgery. To counter this, your doctor will prescribe you painkillers. They will determine which pain reliever is best for you and the appropriate dosage. Immediately after the surgery, you will be administered painkillers through an IV. This is called an epidural. After discharge, you will be taking painkillers at home as well. Contact your doctor if the pain does not go away or worsens.
Wound care: You will have a wound, and the size will be determined by the surgical approach chosen by your surgeon. Dressings will be applied to your wounds following a radical prostate cancer operation. If you have open surgery, you have one wound. If you had laparoscopic surgery, you may have multiple tiny wounds. Your dressings will be changed, and your wounds treated within 48 hours of the surgery.
Stitches or clips should be left in for at least a week to 10 days. You may need to go to the hospital to have them removed, depending on the doctor’s orders. Before you leave, you will be taught how to care for the wound, bathe with the dressing on, and what to do if the dressing comes undone.
Follow-up appointments: You’ll have follow-up appointments to assess your healing and resolve any issues. They are also an opportunity for you to express any concerns and worries you have about your recovery.
Your first check-up will occur approximately 4 weeks after your prostate cancer surgery. After that, you’ll usually get a checkup every three months for the next year. Then, for the next two years, every 6 months.
Risks of prostate cancer operation
The risks associated with any type of prostate cancer surgery are like those associated with any major surgery. Issues that may arise during or immediately after the operation include:
- A bad reaction to anaesthesia
- Bleeding because of the surgery
- Blood clots
- Damage to adjoining organs
- Infection at the site of surgery
Occasionally, during surgery, a portion of the intestine may be damaged. If this happens, infections in the abdomen may develop, requiring additional surgery. Intestinal injuries are more likely with laparoscopic and robotic approaches than with open procedures.
A lymphocele—an accumulation of lymph fluid—can develop after the removal of lymph nodes and may require drainage.
The patient may, in exceedingly rare circumstances, pass away because of this operation’s complications. The degree of risk is influenced by a variety of factors, such as the patient’s age and general health, and the surgical team’s expertise.
Side effects of prostate cancer surgery
Urinary incontinence (inability to control pee) and erectile dysfunction are the most serious potential adverse effects of prostate cancer surgery. Other types of prostate cancer treatment can also cause these side effects.
Incontinence: Prostate surgery may impair your capacity to control your urine, resulting in urine leakage. Many individuals regain bladder control within a few weeks or months. The prevalence of incontinence issues is generally higher in older men than in younger men. Patients may become chronically incontinent in rare circumstances. Incontinence is treatable. You can still get assistance with your incontinence even if it can’t be fully resolved.
Erectile dysfunction: This refers to the inability to get or keep erections for sexual penetration. Your capacity to have an erection following surgery is determined by your age, your ability to have an erection prior to the operation, and whether the nerves that control erections were severed. Although all men can anticipate a certain amount of decline in erection capacity, the likelihood that you will maintain this capacity depends on how young you are. If your capacity to have erections returns following surgery, it usually does so slowly. It may take anywhere between a few months and 2 years. You won’t likely be able to get an erection on your own during the first few months, so you could need to take medications or other treatments.
Prostate cancer surgery cost in India
Many factors can influence prostate cancer surgery in India, including:
- The hospital admission fee (which varies between public and private hospitals)
- Oncologist consultation fee (varies according to the doctor’s experience and area of expertise)
- patient’s age and overall health
- Type of surgery to be performed
- severity of the condition, like the stage it has reached
- Post-operation complications
- The admission room that you chose and the number of days you will have to stay
- The city where you are located
- Any additional tests, like ultrasounds or ECGs, that may be required
To have a complete picture of what the overall surgery cost will be, it is best to speak to your surgeon and hospital. You should also ask whether the surgery is covered by your health insurance plan.
Prostate cancer is a common type of cancer that occurs in men. While early stages can be countered with active surveillance and other passive methods, surgery may be a viable option when the cancer progresses. Open surgery is not as popular because it can get messy, increase the length of your hospital stay, and cause more bleeding and scarring.
Laparoscopic methods have taken over because medical techniques have become more sophisticated with technological advancement. They are also comparatively safer than traditional surgery. However, both approaches come with some risks, which can increase depending on the patient’s overall health, their age, the severity of their condition, any comorbidities, an unanticipated ill reaction to anaesthesia, and the surgical team’s expertise.