Advanced Prostate Cancer

Surgery

Surgery for prostate cancer is generally an option for stage I or II cancer, for men whose cancer is confined to the prostate, and for men whose life expectancy is 10 years or more. But surgery may sometimes be used for stage III or IV disease. The lymph nodes just outside the prostate in the pelvic area may be removed during surgery to determine if the cancer has spread. If cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body and the surgeon may not remove the prostate. In this case, other treatment options may be suggested.

Types of Surgery for Prostate Cancer

There are five types of surgery used for prostate cancer, but not all are suitable for treating advanced prostate cancer. Some types of prostate surgery are usually appropriate only for early-stage prostate cancer (stage I or II), when the cancer has not spread beyond the prostate. Radical prostatectomy, laparoscopic and robotic prostate surgery, and cryosurgery are procedures that are usually limited to early-stage prostate cancer.

Once prostate cancer has spread beyond the prostate gland, a surgical procedure called transurethral resection of the prostate (TURP) may be used to relieve urinary symptoms for men with advanced prostate cancer, but it does not cure the disease. Urinary symptoms are caused when prostate tissue blocks the flow of urine, and a TURP may help relieve this problem. A long, thin scope is inserted through the end of the penis into the urethra (the tube that carries urine out from the bladder). When it is in place at the level of the prostate, electricity is turned on, which heats up the tip of the instrument and prostate tissue is cut or vaporized. This procedure may be done with use of spinal anesthesia, which numbs the lower half of your body, or general anesthesia, where you are asleep. The operation usually takes about an hour.

After surgery and while you heal, a urinary catheter will be in place to help drain urine. The catheter is inserted through the penis into the bladder and remains in place generally from 5 days to 3 weeks. You can usually leave the hospital after 1-3 days. You will likely have some blood in your urine after surgery and may experience some urinary leaking, but most men regain some bladder control after a few weeks.

TURP is considered a safe procedure with few serious side effects or complications. Possible complications of TURP may include:

• Problems getting an erection
• Painful urination
• Blood in your urine
• Semen entering your bladder
• Recurring urinary tract infections
• Narrowing of the bladder neck
• Inability to control urination (incontinence)

Monitoring Response

When TURP is done to relieve urinary blockage due to prostate cancer, relief usually follows quickly. A yearly rectal exam, routine blood tests, and a PSA test are the recommended follow-up practices after a TURP. Your doctor will want to know about any return of symptoms, new symptoms, or pain.

Questions about Surgery You May Want to Ask Your Doctor

• What type of surgery is best for me and how is it done?
• What are the risks of the procedure? What are the benefits?
• What kind of anesthesia will I have?
• What are my options if I don’t have surgery?
• What is the recovery process?
• Will I need pain medication after surgery?
• Will my sexual life be affected?
• How often should I have checkups?

Additional Sources of Information

• American Society of Clinical Oncology patient Web site: www.cancer.net
    Understanding Cancer Surgery
• MayoClinic.com: www.mayoclinic.com
    Transurethral resection of the prostate (TURP)