Choosing the right treatment option may feel overwhelming but your urologist will make a careful individualised assessment of how to best control your disease while minimising any side effects.
The entire prostate and seminal vesicles (sperm sacs) are removed while taking care to protect urinary and sexual structures nearby. There are different techniques used; the traditional route was through an incision on your lower abdomen. This prostate surgery is still routinely done by expert surgeons who have perfected this technique.
With advancements in technology, it has become possible to perform keyhole surgery, using either laparoscopic or robotic instruments, to remove the cancerous prostate while protecting nearby vital urinary, bowel and sexual structures.
Robotic-assisted radical prostatectomy is the technique where the surgeon controls multiple tiny robotic arms with wrist-like tips that allow for precise tissue dissection which reduces pain, enhances recovery and minimises complications.
You’ll need to stop blood thinners a week before prostate surgery and your anaesthetist will go over your medical history.
The prostate is located deep in the pelvis, sandwiched between the bladder and pelvic floor muscles and has delicate nerve fibres running along its surface on either side that help control erections. All attempts to spare these nerves are made, but in some cases, it may not be possible if the cancer has invaded that area.
In addition, once your prostate is removed, your bladder and urethra will be reconnected, and a urinary catheter left inside to help drain the bladder while that area heals. You may have a temporary drain on your lower abdomen to monitor for post-op bleeding.
You’ll spend the first night in ICU then spend one or two days in the general ward while you build up your appetite and receive nursing care and physiotherapy. This will help to control any pain and prevent blood clots and other post-operative risks. You will go home with a catheter strapped to your leg for the next seven to 10 days with medication for pain and constipation, should you require.
At the 10-day visit, the catheter and surgical clips will be removed, and the final pathology result will be reviewed to assess the stage and grade of your cancer. You will also be offered erectile dysfunction medication to help your erections recover and you’ll be advised to continue Kegel exercises to improve bladder control.
One to two-month recovery
You may find that you’ll need to wear a pad for occasional urine leakage during recovery. The first follow-up PSA test will only be done at six weeks post-surgery to assess if complete cure has been achieved. At this time, you should be getting back to normal.
Dr Shauli Minkowitz is a urologist practicing out of Sandton Mediclinic and Netcare Waterfall hospitals and is also the director of prostate cancer services at Chris Hani Baragwanath Academic Hospital and an honorary lecturer at Wits University. He is a member of the Gauteng Uro-Oncology Forum and sits on the board of the Prostate Cancer Foundation of South Africa.
Header image by Freepik