What should I pay attention to when doing radical prostatectomy?

Author: Hu Jianxin, Chief Physician, Guizhou Provincial People's Hospital

Reviewer: Zhao Shanchao, Chief Physician, Nanfang Hospital, Southern Medical University

Radical prostatectomy is one of the standard methods for treating clinically localized prostate cancer. It mainly removes the patient's complete prostate, bilateral seminal vesicles, bilateral ampulla of the vas deferens, bladder neck and tumor to achieve the purpose of completely eliminating the tumor.

In order to improve surgical results and avoid unnecessary injuries, patients need to understand some surgery-related matters in advance.

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1. Which patients are suitable for radical prostatectomy?

Clinically, doctors will conduct a comprehensive analysis of the clinical stage of the tumor, the patient's expected survival and overall health status, and then decide whether to perform surgery.

1. Clinical staging of tumor

Radical prostatectomy is suitable for localized prostate cancer, that is, patients in clinical stage T1 to 2. For patients in stage T3, doctors will recommend neoadjuvant therapy before radical prostatectomy, which may transform the patient from an inoperable state to an operable state and reduce the positive rate of surgical margins.

2. Patient's expected survival

For patients with localized prostate cancer who are under 70 years old and expected to survive ≥10 years, radical prostatectomy is necessary as soon as possible to prevent future complications. For patients over 70 years old, especially those with an expected survival of less than 10 years, doctors generally recommend "active monitoring" because surgical complications and mortality rates will increase.

3. The patient’s overall health

Most prostate cancer patients are elderly men, and the incidence of surgical complications is closely related to their physical condition.

Therefore, as long as there are no diseases that significantly increase the risk of surgery (such as severe cardiovascular disease, poor lung function, etc.), no diseases that cause severe bleeding tendency or blood coagulation diseases (such as hemophilia), no bone metastasis or other distant metastasis, and the patient is in good physical condition, radical prostatectomy can be performed.

In addition, for patients with serum prostate-specific antigen concentration greater than 20 μg/L or grading score greater than 8 points

Patients with localized prostate cancer who meet the above conditions can also undergo radical prostatectomy, but they will need other auxiliary treatments after surgery.

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2. Choice of surgical method

With the development of medical technology, the surgical methods of radical prostatectomy have also been updated and improved. There are three main surgical methods, namely open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. Each of these three surgical methods has its own advantages and disadvantages.

In terms of treatment costs : Open radical prostatectomy does not require high equipment requirements, and general hospitals can perform this operation, and the treatment costs of patients are relatively low. Laparoscopic radical prostatectomy or robot-assisted radical prostatectomy cannot be performed without laparoscopes or robots. Usually, only hospitals with relatively developed medical conditions can perform them, so the treatment costs will increase accordingly.

In terms of traumatic injury caused by the operation : the incision of open radical prostatectomy is the largest, up to 10 to 15 cm; while the location, size and number of incisions of robot-assisted radical prostatectomy and laparoscopic radical prostatectomy are almost the same, both requiring only 4 to 5 small holes with a diameter of about 1 cm at the surgical site. The difference between the two is that one uses a robotic arm and the other uses ordinary surgical instruments.

In terms of operation time and blood loss : Traditional open radical prostatectomy not only takes a long time, but most patients also need timely blood transfusion due to excessive blood loss.

Laparoscopic radical prostatectomy or robot-assisted radical prostatectomy can magnify the surgical area many times with the assistance of laparoscope or robot, so the operation becomes more convenient and the operation time is significantly shortened. Compared with the two, robot-assisted radical prostatectomy is more stable, accurate and flexible, and can effectively ligate large blood vessels and control the amount of bleeding to about 100 ml.

In addition, for patients with more difficult-to-treat prostate cancer, robot-assisted radical prostatectomy has a greater chance of completely removing the tumor.

As to which surgical procedure is best, there is no definite answer clinically. Doctors often give advice after comprehensively considering the patient's specific situation and the hospital's medical conditions.

3. Postoperative precautions

After undergoing radical prostatectomy, patients need to pay attention to the following matters.

1. Urinary incontinence

If the patient has urinary incontinence, they can do pelvic floor exercises appropriately. The earlier they are done, the better the effect. The patient can do it while standing, sitting, or walking. Lift and release for 5 seconds each counts as one set. Repeat 5 to 10 sets counts as one time. Do it 3 to 5 times a day. After 3 months, the pelvic floor muscles can be fully exercised, and the urinary control function may also be improved.

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Patients can also use biofeedback to stimulate the contraction of the pelvic floor muscles. In addition, patients with urgency and mixed urinary incontinence can regain control of urination through bladder training.

If the patient's symptoms have not improved significantly after symptomatic treatment for more than 6 months, surgical treatment should be considered. Male sling surgery and artificial urinary sphincter implantation are optional surgical methods.

2. Abnormalities found during reexamination

If the patient is found to have abnormalities during postoperative follow-up, such as increased serum prostate-specific antigen concentration, or nodules touched during rectal examination, or tumor recurrence found during imaging examination, endocrine therapy will be required in a timely manner to further eliminate residual tumor cells in the body and achieve the goal of improving the surgical effect.

Generally speaking, the initial endocrine treatment plan can be used for several years, but the efficacy varies from patient to patient. Even if the effect of the first-line treatment plan becomes worse, there are other treatment plans that can be replaced. Therefore, patients do not need to worry too much, just go to the hospital for regular check-ups.

In addition to surgical treatment, prostate cancer patients should also pay more attention to rest, improve diet and nutrition, quit smoking and drinking, and maintain an optimistic attitude, because healthy living habits and mental state can help patients recover their health as soon as possible.