Prostate Cancer Surgery

Prostate cancer is the 3rd most common cancer among Singaporean men. Prostate specific tumor antigen (PSA) blood testing can be done in men with symptoms suggestive of prostate cancer or in men at high risk of developing prostate cancer.

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​Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate.​

The prostate is a gland in the male reproductive system located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder). The prostate gland produces fluid that is one of the components of semen.

With greater public awareness, early detection is on the rise and mortality rates are declining. Additionally, new advances in medical technology are enabling cancer patients to go on to live active and productive lives after their treatment. Treatment options may include active surveillance, surgery or radiation. However, surgery is the only treatment that actually removes the cancerous prostate from the body. All prostate cancer treatments can affect urinary continence, as well as sexual potency and function. Patients should always consult with their doctor for advice on the options that are available to treat their individual condition and what to expect before, during and after treatment.

The Treatment: Radical Prostatectomy

The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including latest high-definition 3D vision and a magnified view. Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body.

Though it is often called a “robot”, da Vinci cannot act on its own. Instead, the surgery is performed entirely by your doctor. Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you may be able to get back to your normal activities faster – without the long recovery that usually follows open surgery.

The da Vinci System has been used successfully worldwide in hundreds of thousands of procedures to date.

Robotic Surgery: The Potential Benefits Of The Da Vinci ® Prostatectomy

For qualified candidates, da Vinci Prostatectomy offers numerous potential benefits over traditional open prostatectomy, including:

  • Effective Cancer Control(1)

  • Faster Return of Continence (2) (3)

  • Minimally Invasive Surgery (Smaller wounds)

  • Shorter hospital stay (3) (4)

  • Significantly less pain (4)

  • Less blood loss and fewer transfusions (3), (4)

  • Shorter recovery time4

  • A faster return to normal daily activities(4)

  1. Barocas DA, Salem S, Kordan Y, Herrell SD, Chang SS, Clarke PE, Davis R, Baumgartner R, Philips S, Cookson MS, SmithJA Jr. Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short term biochemical recurrence-free survival. J Urol, 2010 Mar;183(3):990-6. Epub 2010 Jan 18.

  2. Ficarra V, Novara G, Fracanlanza S, et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. Mar 5 2009;104(4):534-539.

  3. Rocco B, Matei DV, Melegari S, ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy in a laparoscopically naïve centre: a matched-pair analysis. BJU International. Published online: 5 May 2009. DOI 10.1111/j.1464-410X.2009.08532.x.

  4. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the vattikuti Urology Institute experience. Urology 2002 Nov;60(5):864-8.

General Risks of Having An Operation​

POTENTIAL DISADVANTAGES OF DA VINCI ® PROSTATECTOMY

While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. da Vinci Prostatectomy remains a surgical procedure, and as such carries inherent risks. Though clinical data supports high rates of cancer control, maintaining sexual function and return to urinary continence, there is no guarantee of these benefits to every patient. Some individuals may not be candidates for a full nerve-sparing procedure due to the extent of their cancer. Results are surgeon-dependent and improve significantly with surgeon experience in this surgical modality.

Specific Risks Of Having An Operation

More common complications are outlined on the following page. Some are far less common than others, so please speak to your Urologist about them.

THE RISK

WHAT HAPPENS

WHAT CAN BE DONE ABOUT IT

Incontinence (loss of bladder control)

Poor bladder control with urine leakage can occur following RALP. It usually improves in a few weeks but can be permanent in some patients.

Will usually recover without intervention. Rarely a second operation may be necessary.

Erectile dysfunction

Some men experience difficulty with getting an erection after the operation.

Professional counselling, medication and treatment are available.

Bleeding

Blood loss during the operation.

This may require a blood transfusion.

Not being able to pass urine (urinary retention)

Blood clots or swelling of the bladder neck stops urine flow after removing the catheter.

The urinary catheter may be replaced until the problem resolved.

Infection

Infection in the operation site or urinary tract.

Treatment with antibiotics or additional surgical procedures.

Scarring of the bladder neck or urethra

A stricture (scar) can develop in the urethra or the bladder neck. This can slow or block the urinary flow.

The scar may need stretching or cutting to allow the urine to flow freely. This scar tissue can reform and need ongoing treatment.

Pain in the testicles

Swelling and pain in the testicles can occur due to inflammation or infection.

Treatment with antibiotics.​

Alternative Treatment Options

When prostate cancer is believed to be still localised within the prostate gland, there are essentially three treatment options available to a patient:​

  1. Observation (Active surveillance)

  2. Radiation therapy

  3. Surgical removal of the cancerous prostate (radical prostatectomy)

Patients should discuss the advantages and disadvantages of each treatment approach with their doctor. For localised prostate cancer, radical prostatectomy (surgical removal of the prostate and surrounding cancerous tissues) has historically been considered the definitive way to remove the cancer.

Drugs Before Surgery

It is important to tell your doctor of any prescription, herbal, or over-thecounter drugs you are taking. Some can cause thinning of the blood and this can increase the risk of bleeding.

These drugs should not be taken before surgery for a period as specified by your doctor. If these drugs have not been stopped in advance, it may be safer to postpone the operation to avoid increased risk of bleeding.

Before Your Operation

After consultation with your surgeon, you will be given a date for the operation and a prescription for the bowel preparation to be administered on the night before your surgery. You will also be given an appointment with the Nurse Clinician to do a pre-operative Pelvic Floor Exercise and an assessment with the Pre-Admission Clinical Evaluation (PACE) clinic to determine your fitness for operation.

During your PACE appointment, you will be asked questions about your health. A general body checkup will also be conducted. Blood tests, chest Xray and electro-cardiogram (ECG) may be done if needed. The purpose of these tests is to ensure that you are healthy and fit enough to proceed with the operation.

A Day Before Your Surgery

On the night before your surgery, you have to administer the bowel preparation prescribed to you to clear your bowel. And you have to start fasting from 12 midnight.

Day Of Your Surgery

On the day of your operation, head down to the Day Surgery Centre located on Medical Centre block level 3. Following registration, you will be led to the centre’s waiting area where a nurse will verify your identity and go through a preoperative checklist with you. When the theatre is ready, you will be assisted onto a bed and pushed to the operating theatre, accompanied by a nurse. At the operating theatre, you will meet your anaesthetist and he or she may ask you some questions and examine you.

During Surgery

Once in the operating theatre, a nurse will again verify your identity and the procedure that you have agreed to.

A blood pressure cuff will be applied to your arm and 3 discs will be placed on your chest to monitor your heart rate. A small clip will also be placed on your finger to measure the amount of oxygen in your blood. You will then be given your anaesthesia and the operation will proceed.

Recovering from your Operation

Following your operation you will be moved to the post anaesthesia care unit (PACU) where a PACU nurse will monitor you closely until you have recovered from the anaesthetic. If you feel nauseous or in pain, please inform the nurse so medication can be given to relieve your discomfort. You will then go to the ward where you will recover until you are well enough to go home. Your stay in hospital will likely be about 2 to 3 days.

Diet

When you return from the operating theatre, you will have a drip in your arm. This will be removed once you are able to eat and drink normally. Eat lightly for the first 2 to 3 days. Avoid carbonated beverages (sodas) for the first week – as they can cause gas pains. If you are not hungry, don’t eat too much, but if you are hungry it is fine to eat what you like.

After The Surgery

Catheter Care

  • Always wash hands before and after catheter care with soap and warm water.
  • Maintain good hygiene. Clean the skin around the catheter daily.
  • Keep urine bag below bladder level (waist level) to prevent urine back flow.
  • Wear underwear or diaper, especially if there is leak around the urine catheter.
  • Drink at least 8 glasses of fluids daily, unless otherwise advise by the doctor.
  • Do not tug or pull tubing to prevent bleeding.
  • Do not remove the catheter till advised by the doctor.
  • Blood in the urine is common and can be seen for a few days after surgery. f you do see blood in the urine, make sure you drink plenty of fluids (to wash it out), and limit your activity until it clears up.
  • Leaking around the catheter may occur. It commonly happens during bowel movement or during bladder spasms. Bladder spasms cause a sudden sensation that you need to urinate, has crampy pain, and a sudden flow of urine through and around the catheter. Bladder spasms are harmless, and typically don’t happen so often.

Activity

You should be physically active and try to do a little more each day, to build up your stamina. You may walk and climb stairs with no limitations. You may not lift more than 7kg, or do any vigorous physical activity for 4 weeks (running, swimming, going to the gym, golf, tennis, etc.). Doing this kind of activity too soon may cause internal bleeding or hernia formation. Even after 4 weeks, you may not be comfortable doing strenuous exercise in a seated position (bicycling, motorcycling, etc.).

Driving

You should not drive for at least one week. After one week, if you are not taking pain killers, not having pain and are just as mobile as before surgery, you should be fine to drive.

Surgical Wounds

Keep your wounds clean and dry to prevent infection. If needed, the doctor may refer you to a polyclinic or general practitioner for wound dressing. For robotic surgery, there are about 6 small incisions. They are closed with absorbable sutures or non-absorbable ones.

You may shower beginning the 3rd day after surgery. Please do not swim or take baths in bathubs until the catheter is removed. Swelling or bruising is normal around the incisions, penis or scrotum which will resolve in 10-20 days.

Firmness or hardness under the incisions is normal and takes several months to resolve.

Bladder and Urine

The urine may often be bloody for a few days after the operation. A flexible plastic tube called the urinary catheter will be inserted into the bladder to drain urine. This tube is kept in place for 7 to 10 days, only to be removed during the next follow-up appointment with your doctor in the clinic.

Bowels

Most men will not move their bowels for the first time until 4 to 5 days after the surgery. Keep taking the stool softeners until your bowels become regular. Pain medications and inactivity typically slow down bowel function.

Medication

It is normal to have a moderate amount of pain for the first 2-3 days. After that the discomfort should lessen rapidly.

Take pain medication when you first start feeling pain. You will not be addicted to the painkiller when it is taken over a short period of time. Controlling your pain allows you to rest well and sleep through the night.

After surgery you should immediately resume any regular medications that you take. If you regularly take Asprin or anti-inflammatory medicines, please follow the doctors’ instruction strictly.

Common Side Effects Of Prostate Cancer Surgery

Incontinence is when you leak or pass urine when you do not want to. It is normal not to be able to control your urine after removal of your catheter, which can continue for weeks or months. However, this control improves as time goes by. There are some products that are helpful to prevent soiled clothes. Continue pelvic floor exercises to improve urine control. Consult your doctor or incontinence nurse if you have problems with your urine control.

Impotence is the inability to achieve or sustain an erection for sexual intercourse. It can last up to a year or longer for some men. Erectile dysfunction occurs because the nerves that are present near the prostate may need to be removed during the prostate surgery. There are medications and medical devices available to help. Consult your doctor if you and your partner have a concern with impotence.

Emergency

Seek medical aid if you encounter any of the following:

  • Urinary Catheter slips out.

  • Severe urine leakage around the catheter. No urine flow to the drainage bag.

  • Thick red urine (like ketchup) or large blood clots in the urine.

  • Unable to pass urine after removal of urinary catheter.

  • High fever (>38.5°C).

  • Severe pain, not relieved with pain medication.

  • Heavy bleeding, yellowish discharge, worsening redness or gapping of your operation wound

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Prostate Cancer Surgery

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