PROSTATE GLAND

It is a small walnut-sized gland found in between penis and the bladder and just in front of the rectum. It is only found in males. Fluid secreted by this gland nourishes the sperms.

CONDITIONS

Prostatitis: is the inflammation caused by infection and is usually treated with antibiotics.

Enlarged prostate: When the size of the prostate grows but is non-cancerous, it is called benign prostatic hyperplasia (BPH). Person faces difficulty in urination and is normally seen in males over the age of 50 years. This is treated with medicines and in case of failure with medical management, surgery is performed.

Prostate cancer: Prostate cancer can be treated either conservatively or surgically. Many patients leave the condition and keep an eye on its progression (as cancer has been found to grow slowly).

RADICAL PROSTATECTOMY

An operation to excise this gland and surrounding tissues is called radical prostatectomy. The surrounding tissues include lymph nodes nearby and seminal vesicles. In male patients, whose cancer is limited to the prostate, benefit the most from this surgery.

Eligibility for surgery:

Men of age less than 75 years and diagnosed with prostate carcinoma and limited to this gland only and with a life expectancy of 10 years or more.

Investigations to confirm the diagnosis:

Initially the surgeon carries out the digital rectal examination (DRE), which is done by inserting the gloved lubricated finger into the rectum and examining the prostate. The contour and tenderness is assessed. Raised PSA levels gives a higher probability of having cancer. A transrectal ultrasound is done to take a biopsy specimen. A diagnosis of carcinoma on histopathological examination of the biopsy specimen is the confirmation of cancer.

In case there is confirmation of the diagnosis, CT scan, MRI, etc. are carried out to rule out the possibilities of any metastasis (i.e. spread of malignancy to other parts of the body).

TREATMENT OPTIONS

Prostate cancer can be treated either conservatively or surgically. Conservative management includes hormone therapy, radiotherapy, etc. In case of high risk, the patient may need to undergo pelvic lymph node excision. 

Types of surgeries:

a. Open prostatectomy: A long incision of approximately 8-10 inches is made below the umbilicus and radical prostatectomy is performed. 

b. Laparoscopic prostatectomy: Many small incisions are made around the umbilicus and laparoscopic instruments (surgical tools, camera, etc.) are inserted through them and radical procedure is performed.

PREOPERATIVE PLANNING

A voluntary written informed consent is obtained from the patient and /or his/her legally acceptable representative for undergoing surgery. All the surgical procedures are explained in detail including the risks / benefits, etc.

Patient is kept nil by mouth for at least 6 to 8 hours before surgery. Preoperative medication is given. Blood cross matching is done and blood requisition done, in case of need for any blood transfusion. Though it has been reported by many authors that nearly only 3% of the patients undergoing laparoscopic radical procedure require blood transfusion, while nearly 21% of patients undergoing open surgery required it.

LAPAROSCOPIC PROSTATECTOMY

It takes nearly 3 hours to perform.  It is carried out under general anesthesia. This gland is removed along with surrounding tissue and seminal vesicles. As per the decision of the surgeon, lymph nodes may also be removed for biopsy purposes. Due to clear visualization of the pelvic region, the excision of the prostate is more precise with less blood loss in laparoscopic procedure with early recovery and lesser use of analgesics.

AFTER SURGERY

The patient is generally kept on intravenous fluids till the surgeon gives a go ahead for oral intake. Early mobilization is done to prevent operative complications and help in the healing process due to circulating blood. Pressure stockings are given to prevent thrombus formation in the legs and the patient will be encouraged to do deep breathing exercises using spirometry. Lifting of weights is restricted for at least 3-4 weeks post surgery. 

ADVANTAGES OF LAPAROSCOPIC PROSTATECTOMY:

The advantages of laparoscopic prostatectomy include:

  • Smaller hospital stay
  • Faster recovery
  • Less postoperative pain so reduced use of analgesia
  • Early return to activity (2 to 3 weeks)
  • Less scarring due to smaller incisions

ASSESSMENT OF SUCCESS OF SURGERY

After the surgery, the excised prostate is again sent for histopathological examination. If the cancer is found near the edge of the prostate, then the possibility of spread of cancer is high and then additional examinations, investigations are done and further treatment planning is done.

RISKS OF LAPAROSCOPIC PROSTATECTOMY

The risks include:

  • Urinary incontinence: Only a small patient proportion of approximately 5% of age less than 50 years and around 15% of age more than 70 years suffer from urinary incontinence.
  • Erectile dysfunction (ED): This is a common problem seen after this procedure, but majority are able to perform sex using medications.
  • Bleeding after surgery
  • Blood clot formation (thrombus)
  • Infection
  • Delayed wound healing
  • Blockage in urine flow

Overall less than 10 percent of the patients experience complications following this procedure and majority of these complications are treatable.

CARE AFTER SURGERY AND FOLLOW-UP

Some patients may need to carry a urinary catheter at home for some more time along with another catheter that is kept in the skin. Care must be taken of these catheters according to the advice. Painkillers are given to control the pain. Sexual activity should be initiated only after being advised for the surgeon. Patients are advised to come for regular follow-ups and to undergo investigations to make sure there is no recurrence of cancer.