Urologic Cancer - Prostate Cancer FAQs
Use the "+" and "-" buttons to open and close the FAQs below. Or use the "Open All" or "Close All" buttons.
Open AllClose All- Who is a candidate for surgery?
- Any patient who wants the most traditional, most reliable form of treatment. Young patients and those with aggressive disease frequently choose surgery because of the risks of developing secondary cancers with radiation treatment and the larger possibility of back-up or "salvage" treatments if cancer recurs after surgery.
- Where is the procedure being performed?
- This procedure is being performed at both the main hospital and the new satellite Fitzimons campus. In 2007 all University of Colorado Hospital operations will be performed at the Fitzimons campus.
- What is "robotic prostatectomy?"
- A few years ago the technique of removing the prostate using small instruments through small incisions was described for the prostate. However, due to the position of the prostate and its proximity to many vital structures, laparoscopic prostatectomy is very technically challenging. The surgical robot (Aesop or DaVinci) helps make laparoscopic prostatectomy easier by having joints and digits that rotate in more diverse directions that human fingers and wrists. In robotic prostatectomy, the surgeon sits away from the patient and the robot performs the surgery with the doctors input from afar, almost like "remote control surgery." This procedure has not been out long enough to have trials to compare results on similar patients done traditionally or "open". Early data suggest that the results are similar. Time to discharge from the hospital and potency rates appear similar to traditional "open" prostatectomy.
- How long will I be in the hospital?
- Most patients who have their prostates removed are in the hospital one to two nights after surgery. Many of the surgeons at the University of Colorado Hospital use special "pain buster" devices. These devices slowly release numbing medication around the wound so the pain is kept to a minimum during recovery. Insurance companies generally pay for 2-3 nights in the hospital after surgery, so if you are coming from a long ways away or if you are still having pain, then the option is open to stay longer.
- How long will it take to recover?
- After discharge from the hospital, patients generally have a foley catheter (hollow tube) in their urethra (tube carrying urine in the center of the penis). That catheter is left in place for 10-14 days. Once the catheter is removed, men do experience difficulty with continence, or urinary control. This is because the prostate usually holds in all of the urine without a man having to think about urinary control. However, there is a muscle located beyond the prostate that eventually learns to take over control of the urinary stream. It takes, on average, 6 weeks for this weaker, smaller muscle to be trained to provide good urinary control. Most men start with "Depends" undergarments since the amount of leakage can be generous during the first week. By the second week after removal of the catheter, most men do well with thick sanitary pads. By 6 weeks after catheter removal men are wearing 1-2 thin sanitary pads as a back up, or none at all. Because of the issues with the catheter and urinary control, most men take 3-6 weeks off for surgery.
- What are my limitations after surgery?
- We recommend that men who have undergone surgery refrain from driving for 2 weeks after surgery, while the foley catheter is in. Once the catheter has been removed, and once a man is no longer requiring narcotic pain medication, he can drive again. We also recommend that men refrain from lifting anything heavier than ten pounds or performing activities that would put a lot of pressure on the area of their previous prostate (horseback riding or biking) for six weeks. Click here for additional information regarding post-operative care after a radical prostatectomy.
- Where is my incision located?
- The traditional incision is approximately 4 inches long and is located from the pubic bone up towards the belly button.
- Is there anything I can do to prepare for my surgery?
- Studies have shown that men who perform kegel exercises (squeezing of the muscle that will be used to hold the urine in after the prostate is removed) have better control of their urine sooner. Additionally, studies have shown that men who smoke have fewer complications if they give up cigarettes at least 2 weeks prior to their surgery. Some studies have shown that diets low in saturated fats may help prevent prostate cancer. The effect of a low-fat diet on prostate cancer after it has been diagnosed is unknown.
- Is there anything I can do to prevent getting prostate cancer in the future?
- Again, studies are unclear on the benefit of intervention with diet after prostate cancer is diagnosed. Some studies indicate that selenium, vitamin E, and lycopene may be helpful in preventing prostate cancer in the first place, so it these elements may be useful in preventing recurrence. One should not take more than the recommended daily allowance to prevent toxicities (such as a stroke) with high doses of these supplements. A diet low in saturated fats and a lifestyle incorporating 30 minutes of exercise 3 times per week is recommended to keep all cancers to a minimum.
- What are the chances my cancer would re-occur after surgery?
- There are many sophisticated tables predicting one’s chance of cure with surgery. In general, the higher one’s PSA and the higher one’s Gleason score at the time of surgery, the more likely prostate cancer will return. Your doctor can help inform you if your cancer is considered low, intermediate, or high risk based on the factors outlined above. In general, men with low-risk prostate cancer have a 5-10% risk of cancer recurrence over time. Men with intermediate risk prostate cancer have a 15-20% risk of cancer recurrence, and men with high-risk prostate cancer have a 50% risk of cancer recurrence. Additionally, when cancer is found at the edge of the prostate when it is removed, there is a 40-50% chance cancer will still be present and will need further treatment. All men with prostate cancer who are treated by surgery should have a PSA test (blood work) drawn every six months for the rest of their lives.
- What is Gleason grade?
- Dr. Gleason is a pathologist and he noted that the more scattered prostate cancer cells look under the microscope, the more aggressive the prostate cancer. The Gleason sum or grade is made up of two individual numbers that reflect the most common patterns of a prostate cancer when it is viewed under a microscope. In general, a Gleason sum of 6 or less is considered low grade or slow growing, a Gleason sum of 7 is considered intermediate risk or moderately aggressive growth, and a Gleason sum of 8-10 is considered high grade or aggressive.
- How will I know if my prostate cancer has come back?
- Following surgery, a man’s PSA should be zero. The most sensitive most laboratories can report is <0.1. As long as one’s PSA is <0.1 there is no prostate cancer or tissue remaining. However, if the PSA is greater than 0.1 after surgery, there is a chance the prostate cancer has recurred and the patient should be seen by his urologist as soon as possible.
- Where does prostate cancer re-occur?
- Prostate cancer is a very unusual cancer because it grows slowly in most cases. This means it can re-occur even 15-20 years after treatment. This fact highlights the importance of semi-annual blood tests for PSA following prostatectomy. In general, cancer that re-occurs within 2 years is found distantly, in the bones or liver; whereas cancer that re-occurs later is found in the area of the previous prostate.
- What options are available when prostate cancer re-occurs?
- When prostate cancer re-occurs in the bones or liver (cancer outside the prostate is considered metastatic), the cancer is no longer curable. Radiation can be given to the bones to decrease pain and surgery can be performed to stabilize joints can decrease the risk of bone fractures, but this does not add to survival length. Medication to decrease testosterone is generally given in patients with metastatic disease, which drives PSA down temporarily, but is not curative. On the other hand, if there is no evidence of cancer outside the previous site of the prostate but the PSA has risen after surgery, radiation can be given to this site and can be curative in 50% of patients.
- Who performs prostatectomies at the University of Colorado?
- Dr. Wilson and Dr. Crawford perform radical prostatectomy at the University of Colorado Hospital. Both are trained specifically in cancer in addition to their general urologic training. Dr. Wilson trained with a surgeon in Los Angeles who helped describe and perfect the "nerve sparing" technique. Dr. Kim performs the laparoscopic prostatectomy.
- What are the side effects of prostatectomy?
- 99% of patients obtain urinary control after the procedure. Many patients experience short-term incontinence following prostatectomy. The muscles that normally control retention of urine in the bladder are removed during the surgery and it takes several weeks for other muscle groups to gain strength and take over this function. There is a temporary time period where a man has to strengthen a muscle he is not used to using to regain urinary control. Since the newly trained muscle is never as strong as the original muscles in the prostate about 10% of men leak a drop or two of urine if they lift something heavy or cough or sneeze. Most men feel like continence is not a problem after surgery at the University of Colorado Hospital, beginning about 8 weeks after the procedure. Another common side effect is erectile dysfunction, or "ED". Varying degrees of ED may occur in 40-50% of patients who undergo radical prostatectomy. The younger a patient is before surgery and the better his erectile function, the more likely he will maintain his erectile function after surgery.
- What are the treatments for E.D. (erectile dysfunction) after surgery?
- Patients are offered a variety of options to get them back to potency levels close to what they were prior to surgery. The list includes oral agents such as Viagra, Lavitra, and Cialis; injectable agents such as caverject; a vacuum erection device (used externally), and if all of these are ineffective, a surgical implant. Treatments for E.D. are generally started 6 weeks following the procedure and function usually improves slowly for up to one year following the procedure. It is important to realize that the nerves that produce orgasm or climax are not damaged during the procedure. Men can still climax, even without erection. Additionally, it is important to know that during climax or orgasm, no fluid will come from the penis after prostatectomy since the prostate is what provides the majority of the fluid during ejaculation.
- Will I have a lot of bleeding with the procedure?
- About 10% of patients require blood transfusion with the procedure, as the prostate is a very vascular organ. A minimum of cauterization should be performed with prostatectomy to maximize the chance of return of potency. Most men choose to donate 2 units of blood in case they should need transfusion during the surgery. Their donated blood is given back to them during surgery to help them feel stronger in recovering.
- What should I watch out for after surgery?
- The most important thing to watch for following surgery is a painful, swollen, or red calf. This, particularly if located on only one side, can be the sign of a blood clot. Blood clots are more common following surgery and are more common in patients who have had cancer. This blood clot can move to the lung which is very dangerous, so any patient with the symptoms of a painful, swollen, or red calf should seek treatment in the closest emergency room as soon as possible.