Prostate Cancer Surgery: Procedure, Recovery, Cost, Risk & Complication

The prostate is a gland of the male reproductive system, located directly under your bladder. This gland consist of tiny other glands that produce a fluid which is a part of the semen. Prostate cancer begins when the cells present in the prostate gland start to grow uncontrollably. The cancer starts with tiny changes in the shape and size of the prostate gland cells- known as Prostatic intraepithelial neoplasia (PIN).

Prostate cancer is a very slow progressing disease. In most cases, patients do not realise that they are suffering from this condition. When the cancerous tissues start spreading or there is a serious life risk, one may need to undergo a prostate cancer surgery. There are various types of surgery that can be performed for treatment such as radical retropubic prostatectomy, radical perineal prostatectomy or modern laparoscopic techniques.

A patient may require a prostate cancer surgery in the following conditions:

• The age, general health and stage of cancer determine whether a patient would need surgery or not
• For removing the cancerous tissues
• Treating localized prostate cancer, which involves removing the entire prostate and the surrounding tissues, including lymph nodes if necessary
• If the cancer has reached the outer layer of the prostate and is spreading in the seminal vesicles
• When the cancer is spreading to the other parts of the body. It could be to the nearby lymph nodes, and other organs like rectum, bladder or the pelvis.

Pre Procedure

Before surgery, you may have to undergo a cystoscopy so that the doctor can examine your prostate size and urinary system. Other tests for measuring your prostate and urine flow will also need to be conducted. Apart from this, there are certain instructions that need to be followed:

• Inform your doctor of all the medications that you are take and see if you need to stop taking any of them before the surgery. For example, you may be advised to stop medicines that can increase the risk of bleeding during the surgery.
• You may have to stop drinking and eating anything from the midnight on the day of your surgery. In case you need to take any medication, make sure you have it with very little sips of water.
• An enema may be required to be done prior to the surgery. Enema is a procedure for cleansing the bowel before a medical examination or surgery.

During Procedure

A prostate cancer surgery can be done in two ways. The main type is known as radical prostatectomy. There are further two ways to perform this operation. One is radical retropubic prostatectomy, where the surgeon makes a cut in the lower abdomen. You will be administered general or epidural anaesthesia. The prostate gland and the nearby tissues will then be removed. In case there is a possibility that the cancer has spread to the lymph nodes nearby, the surgeon may remove them too during the surgery.

The second type is the radical perineal prostatectomy, where the incision is made in the skin between your anus and scrotum. The lymph nodes cannot be removed in this case. This surgery requires less time, causes less pain and has a faster recovery period. However, there are possibilities of erection problems in patients undergoing this surgery.

There are laparoscopic approaches too for conducting a prostate cancer surgery where much smaller incisions and long surgical tools are used for removing the prostate.

Post Procedure

After the surgery has been performed, a catheter is placed in the penis so that the bladder can be drained. You need to keep the catheter for 1-2 weeks. Depending on your condition, the doctors will decide if you can be discharged in a day or if you need to spend a few more days in the hospital. You will be instructed on handling the catheter and caring for the surgical site before you go home.

The incision site can be sore for a few days. There may be other problems like blood in the urine, urinary irritation, difficulty in holding urine, urinary tract infection (UTI) and inflammation of the prostate. These symptoms are normal and will be there for a few weeks post-surgery. It is advised to decrease your activity levels for the time being, including sex.

A complication in the course of a surgery may depend on your age, overall health condition and the efficiency of your doctors. Like every other surgery, a prostate cancer surgery can have some risks and complications such as:

• A reaction to the anaesthesia that had been administered during the surgery
• Bleeding due to the surgery performed
• Blood clots in the lungs or the legs
• Damage to the nearby organs
• An infection at the site of the surgery
• In very rare cases, a part of your intestine may be affected or injured during the surgical process, leading to infections in the abdomen. Another surgery may be required to correct it.
• In case the lymph nodes are removed during the surgery, there can be a formation of lymph fluids that would need to be drained

As a surgery for prostate cancer is a major surgery, it is important that you give your body some time to recover. Take adequate rest while recuperating at home, and refrain from lifting any heavy objects for a few weeks. It is also recommended to avoid driving in the first few days. It can take about 6-7 weeks to feel normal again. Make sure that you take your medicines in time and follow the instructions of your doctor, including any lifestyle changes that you need to make.

The cost of a prostate cancer surgery could be approximately Rs. 3,14,972 - Rs. 4,50,000.