Prostate surgery is a procedure indicated for the treatment of localized prostate cancer, when the disease has not yet progressed and has not affected other organs, as it allows the entire malignant tumor to be removed and the cancer to be definitively cured.
Although this treatment is very effective and curative for localized prostate cancer, it may also be recommended to perform radiotherapy after surgery in specific cases, to eliminate any malignant cells that may have remained in the area.
Surgery for prostate cancer, also called radical prostatectomy, is performed by an oncological or urological surgeon, in the hospital, and is offered free of charge by the SUS or can be performed in private hospitals, and the type of surgery must always be clarified with the doctor. to be performed, as well as the risks and possible complications.
When is it indicated
Surgery to remove the prostate is indicated in the following cases:
- Localized prostate cancerthat is, the tumor is confined to the prostate, having not spread to the tissues around the prostate or other organs, such as lymph nodes, bones, liver, lungs, bladder or intestines, for example;
- Locally advanced prostate cancerin which the cancer has spread to the external area of the prostate, with surgery being performed in combination with other treatments.
Surgery to remove the prostate is normally performed on men under 75 years of age, considered to be at low to intermediate surgical risk, that is, with controlled chronic diseases, such as diabetes or hypertension.
Radical prostatectomy must be performed with the recommendation of an oncologist and performed by an oncological or urological surgeon.
Make an appointment with an oncology surgeon in your nearest region:
How to prepare for surgery
To prepare for prostate surgery, it is important to clarify with your doctor all your doubts about the surgery, the technique that will be used, risks, complications, recovery and expectations.
Furthermore, it is important to inform if you have any allergies to medicines, foods or any other substance, in addition to informing all the medicines you frequently use, including supplements, vitamins, teas or natural remedies.
In some cases, the doctor may ask you to stop taking medications a few days before surgery to prevent bleeding or hemorrhaging.
Before undergoing surgery, all tests requested by the doctor must be carried out, which must be taken to the hospital on the day of surgery. On the day before surgery, you must fast for at least 8 hours, as per medical advice.
How it is made
Surgery for prostate cancer is performed by a urological or oncological surgeon, in the hospital, with general anesthesia, however, it can also be performed with spinal anesthesia, which is applied to the spine, which varies with the surgical technique that will be performed.
During surgery, the entire prostate is removed, in addition to the tissues surrounding the prostate, the prostatic urethra, the seminal vesicles and the ampullae of the vas deferens.
This surgery may also be associated with a lymphadenectomy, which consists of removing lymph nodes from the pelvic region.
The surgery takes an average of 2 hours and, generally, it is necessary to stay in hospital for around 2 to 3 days. See more details about how prostatectomy is performed.
Types of prostatectomy
To remove the prostate, surgery can be performed robotically or laparoscopy, that is, through small holes in the belly through which instruments are passed to remove the prostate, or by laparotomy where a larger cut is made in the skin.
The main types of surgery used are:
- Radical retropubic prostatectomy: in this technique, the doctor makes a small cut in the skin near the navel to remove the prostate;
- Prostatectomia radical perineal: a cut is made between the anus and the scrotum and the prostate is removed. This technique is used less frequently than the previous one, as there is a greater risk of affecting the nerves responsible for erection, which can cause erectile dysfunction;
- Robotic radical prostatectomy: in this technique, the doctor controls a machine with robotic arms and, therefore, the technique is more precise, with a lower risk of sequelae;
- Transurethral resection of the prostate: It is generally performed in the treatment of benign prostatic hyperplasia, however, in cases of cancer in which radical prostatectomy cannot be performed but there are symptoms, this technique can be used.
In most cases, the most recommended technique is that performed robotically, because it causes less pain, causes less blood loss and recovery time is faster.
What is recovery like?
Recovery from prostate surgery is relatively quick and it is only recommended to rest, avoiding exertion, for approximately 10 to 15 days.
After this time, you can return to day-to-day activities, such as driving or working, however, heavy exertion is only allowed 90 days after the date of surgery. Intimate contact can be resumed after 40 days.
Post-operatively after prostatectomy, it is necessary to place a bladder catheter, a tube that will carry urine from the bladder to a bag, because the urinary tract becomes very inflamed, preventing the passage of urine. This probe should be used between 7 and 15 days and should only be removed after a doctor’s advice. Learn how to care for your bladder catheter during this time.
In addition to surgery, it may be necessary to undergo hormone therapy, chemotherapy and/or radiotherapy to kill malignant cells that were not removed during surgery or that have spread to other organs, preventing them from continuing to multiply. See all treatment options for prostate cancer.
Possible complications
In addition to general risks, such as infection at the scar site or hemorrhage, surgery for prostate cancer can have other important consequences, such as:
1. Urinary incontinence
After surgery, men may have some difficulty controlling urine output, resulting in urinary incontinence. This incontinence can be mild or total and usually lasts between a few weeks and months after surgery.
This problem is more common in the elderly, but it can happen at any age and depends on the degree of cancer development and type of surgery. Treatment usually begins with physiotherapy sessions, with pelvic exercises and small instruments, such as biofeedback, and kinesiotherapy. In the most extreme cases, surgery can be performed to correct this dysfunction. See more details on how urinary incontinence is treated.
2. Erectile dysfunction
Erectile dysfunction is one of the most worrying complications for men, who are unable to start or maintain an erection, however, with the emergence of robotic surgery, rates of erectile dysfunction have decreased. This happens because next to the prostate there are important nerves that control erection.
Thus, erectile dysfunction is more common in cases of very developed cancer in which it is necessary to remove many affected areas, and it may be necessary to remove the nerves.
In other cases, the erection may be affected simply due to inflammation of the tissues around the prostate, which put pressure on the nerves. Generally, these cases improve over the months or years as the tissues recover.
To help in the first few months, the urologist may recommend some medications, such as sildenafil, tadalafil or iodenafil, which help to have a satisfactory erection. Learn more about how to treat erectile dysfunction.
3. Infertility
Surgery for prostate cancer severs the connection between the testicles, where sperm are produced, and the urethra. Therefore, man will no longer be able to father a child by natural means. The testicles will still produce sperm, but it will not be ejaculated.
As the majority of men affected by prostate cancer are elderly, infertility is not a major concern, but if you are a young man or want to have children, it is recommended that you talk to your urologist and evaluate the possibility of preserving sperm in specialized clinics. .
Exams and consultations after surgery
After completing treatment for prostate cancer, a PSA test must be carried out serially for 5 years. Bone scans and other imaging tests may also be performed annually to make sure everything is okay or diagnose any changes as early as possible.
The emotional system and sexuality can be very affected, which is why it may be recommended to be followed by a psychologist during treatment and in the first few months afterwards. Support from family and close friends is also an important help to continue calmly.
Can cancer come back?
Yes, men diagnosed with prostate cancer and treated with curative intent may experience recurrence of the disease and need additional treatment. Therefore, regular follow-up with a urologist is essential, carrying out the requested tests to better control the disease.
Furthermore, it is advisable to maintain healthy habits and not smoke, in addition to carrying out diagnostic tests periodically, whenever requested by the doctor, because the earlier cancer is diagnosed or its reappearance, the greater your chances of a cure.
