Prostate Removal

What Is Prostate Removal?

Prostate removal, or prostatectomy, is a surgical procedure to remove all or part of a man’s prostate gland. This procedure is performed to treat:

• Prostate enlargement (benign prostatic hyperplasia, or BPH)
• Prostate cancer

The prostate, a gland found only in males, is located under the bladder and in front of the rectum. It surrounds the neck of the bladder and the urethra, which is the tube that drains the bladder. In an adult man, the prostate is about the size of a walnut.

The prostate is one of three glands necessary for reproduction. The prostate produces a sticky, milky fluid of acids and enzymes. This fluid makes up about 15 percent of the total volume of the semen and helps to sustain the sperm cells that are created in the testicles. The prostate is surrounded by muscle, which contracts to ejaculate this fluid.

When the entire prostate gland is removed, the operation is called a radical prostatectomy. There are several ways in which this procedure is performed.

• In a perineal prostatectomy, the prostate is removed through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen.
• In a suprapubic prostatectomy, the prostate (and sometimes nearby lymph nodes) is removed through an incision in the abdomen, just below the belly button. This method allows for the removal of more tissue and is used in cases of prostate cancer that may have spread.
• Laparoscopic prostatectomy involves removing the prostate using a thin tube-like instrument called a laparoscope. The laparoscope is inserted through a small incision in the belly button and has a lighted camera on the end. Several more small incisions are made in the abdomen through which surgical instruments are passed.

Prostate removal can be an extremely effective treatment for prostate enlargement and prostate cancer. But it also is major surgery, and, as such, it carries certain risks and side effects. The two major problems experienced by men after prostatectomy are:

• Incontinence (an inability to control urination)
• Impotence (an inability to achieve an erection)

Both of these problems may be temporary and may go away with time. Effective treatments are available to help both incontinence and impotence.

For further information about prostate enlargement, go to Prostate Enlargement.

For further information about prostate cancer, go to Prostate Cancer.

When Should Prostate Removal Be Performed?

Prostate removal generally is performed for one of two reasons:

• Prostate enlargement
• Prostate cancer

For Prostate Enlargement

There are a variety of treatments for prostate enlargement (benign prostatic hyperplasia, or BPH). These treatments include medication and the use of lasers guided through the urethra to destroy excess prostate tissue.

Prostate removal is considered when:

• The prostate gland is greatly enlarged.
• There are significant complicating factors, such as obesity.
• The wall of the bladder has been significantly damaged and requires repair.

For Prostate Cancer

Prostatectomy is effective in treating prostate cancer in men whose cancer has not spread beyond the prostate gland. Physicians use a TNM grading system to determine the best candidates for surgery.

Based on TNM staging, men whose prostate cancer is in the following stages will most likely benefit from prostatectomy:

• Stage T1b disease, in which the pelvic lymph nodes show no evidence of the spread of cancer cells beyond the prostate gland.
• Stage T2 (a,b,c) disease, in which the cancer is larger but still is confined to the prostate gland.

What Can I Expect During Recovery After Prostate Removal?

After a prostatectomy, a man will stay in the hospital up to five days, although the length of hospital stays for most surgical procedures continues to decrease. The length of stay will depend on a man’s overall health, speed of recovery, and the nature of the surgery.

If you will be having a prostatectomy, you should be aware of the following:

• Catheterization
• Antibiotic treatment
• Urinary bleeding
• Avoiding physical stresses and strains
• Urinary difficulties
• Ejaculation changes

Catheterization

After surgery is completed, a Foley catheter is inserted through the penis into the urethra to drain urine into a collection bag. A water-filled balloon on the end in the bladder keeps the catheter in place.

The Foley catheter is essential to remove urine from the bladder for the first several days following surgery. The presence of the catheter may cause spasms or contractions of the bladder wall the day after surgery. These contractions may be painful but will usually disappear quickly.

Antibiotic Treatment

You may be given an antibiotic after surgery to reduce the possibility of a bacterial infection. This is a preventive treatment to decrease the chance of infection.

Urinary Bleeding

During your recovery, blood may appear in your urine. Some period of urinary bleeding is normal following prostatectomy, but the bleeding should diminish or disappear by the time you leave the hospital. Drinking plenty of water during this healing period should promote healing by flushing out the bladder.

Avoiding Physical Stresses and Strains

Immediately following discharge, the organs and tissues involved in the surgery are still healing and remain vulnerable to straining. To prevent tearing the incision or damaging internal organs on which surgery was performed, men should be very careful not to lift heavy loads or put strain on their abdominal and pelvic regions during the first few weeks after surgery.

Complete healing may take two or more months. During this time:

• Avoid heavy lifting
• Avoid straining when moving the bowels (eat a balanced diet to avoid constipation, and use a laxative if constipation develops)

Urinary Difficulties

Following removal of the Foley catheter, urination may create some discomfort. Men also may experience frequent urges to urinate. This problem usually goes away after several days.

A small number of men may experience an inability to control urination (incontinence) after surgery. This problem usually lasts only a short time and goes away on its own. Special disposable undergarments may be used during this time.

Ejaculation Changes

Prostatectomy causes the seminal fluid containing the sperm cells to move backwards, into the bladder instead of the urethra. This reverse path, called retrograde ejaculation, is the result of damage to the muscle at the neck of the bladder, a consequence of surgery.

• The bladder muscle normally blocks the entrance to the bladder, causing the semen to enter the urethra at the base of the penis.
• When this muscle is damaged, the semen takes the path of least resistance and enters the bladder, where the fluid is expelled with the urine.
• This may make urine to look cloudy when next passed, but it is not harmful in any way.

Men after prostatectomy are usually sterile (unable to father children) because the semen and its load of sperm cells is not ejaculated through the penis to the outside. Being sterile is not the same as being impotent.

After prostatectomy, a small percentage of men are unable to have an erection and will experience impotence. For most men, however, the ability to have sexual intercourse and orgasm will remain relatively unchanged.

Retrograde ejaculation may require getting used to, but orgasm should remain a pleasurable experience. In men who experience retrograde ejaculation, the seminal fluid is not ejaculated to the outside during orgasm, so the ejaculation is dry.

What Are The Possible Complications of Removal Of The Prostate?

The two possible complications associated with prostate removal (prostatectomy) are:

• Incontinence
• Impotence

Incontinence

For some men, the inability to control urination may be a long-term consequence of surgery, rather than a temporary problem. This form of incontinence is usually the result of surgical damage to the bladder wall or surrounding muscles or nerves.

Incontinence may be helped by the following treatments:

• Many men find success with pelvic-floor exercises to improve muscle control.
• Medications called anticholinergics can help control excessive bladder activity.
• If incontinence continues to be a problem, surgery may be an option to help restore bladder control.

In rare cases, the incontinence is found to be untreatable. But there are many different products, including disposable undergarments, that can enable men to lead a full, normal life.

Impotence

Prostatectomy may result in impotence, which is the inability to achieve or sustain an erection of the penis. This happens when the nerve supply to the erectile tissues of the penis is damaged during surgery. In the months following surgery, some potency may return.

Some effective treatment options are available for impotence:

• Drugs such as sildenafil (Viagra) can help a man achieve an erection.
• Vacuum devices also assist in achieving an erection.
• Penile implants can be inserted surgically to help create an erection.

Whether or not a man can achieve an erection will depend on the degree to which nerves have been affected by the surgery. Techniques for performing a prostatectomy are improving, and more healthy tissue can now be preserved. Nerve-sparing surgical techniques can preserve the nerve endings that control erection and can help avoid impotence.

For further information about impotence, go to Impotence.

How Effective Is Prostate Removal?

For men who have a prostatectomy to treat prostate enlargement, there is usually a substantial improvement in urine flow. About 90 percent of men with an enlarged prostate benefit significantly from the procedure.

Even if a man’s bladder has been weakened because of the enlarged prostate, the urgency to urinate is reduced, although the frequency of urination might still remain high.

For further information about prostate enlargement, go to Prostate Enlargement.

When prostate cancer is the issue, there’s still a question of which therapy is the most effective. In addition to prostatectomy, other ways of treating prostate cancer include:

• “Watchful waiting,” in which the cancer is carefully monitored but not treated; the idea is that prostate cancer can be so slow-growing that a man may be more likely to die “with” the disease than “from” it
• Radiation therapy
• Chemotherapy
• Cryotherapy, in which cancerous tissues are frozen and destroyed with special equipment
• Hormone therapy, which seeks to reduce the level in the body of the male hormone testosterone, known to feed the spread of prostate cancer
• TURP (transurethral resection of the prostate), a procedure in which just a portion of the prostate is removed, with an instrument that is inserted through the urethra. The cancer is removed from the prostate by electricity that passes through the end of this special instrument.

For further information about prostate cancer, go to Prostate Cancer.

Are Newer Treatments Available for Enlarged Prostate?

Prostate removal is recommended for men whose cancer appears to be confined to the prostate gland and has not spread. Unfortunately, in about one-third of men who are undergoing a prostatectomy, surgeons discover during surgery that cancer cells had already spread beyond the prostate.

This has generated research on a variety of surgical techniques that might destroy prostate tumor cells not only within the prostate gland but beyond its borders as well. The result is an experimental technique that can be used for men with prostate cancer, even those with advanced stages of cancer.

The technique, called percutaneous prostate cryoablation, causes destruction of the prostate gland by forming an iceball that envelops the cancerous tissues and cells in and immediately surrounding the gland.

There are two major steps in preparing for this cryosurgery procedure:

• A biopsy of the prostate gland guided by atransrectal ultrasound probe to determine the full extent of the cancer
• Androgen ablation therapy using the hormone testosterone to shrink the prostate gland, in order to ensure the complete destruction of tissue throughout the gland

The basic procedure for percutaneous prostate cryoablation involves the following:

• The procedure involves general anesthesia (in which the man is asleep for surgery) or spinal anesthesia (in which the man’s body is numbed from the waist down).
• The cryoprobes used to form the iceball within the prostate gland are placed through the perineum and into the prostate gland.
• After the appropriate placement of five or six cryoprobes under the guidance of a transrectal ultrasound probe, freezing is carried out.
• Thermosensors are implanted to monitor the freezing temperatures to ensure appropriate tissue destruction and to insure freezing of other areas.

Percutaneous prostate cryoablation has the following advantages over radical prostatectomy:

• Blood loss during surgery is small and a blood transfusion is unnecessary.
• There is no recorded mortality rate associated with this technique.
• The rate of incontinence is lower than that associated with radical prostatectomy.
• The procedure can be used to successfully treat prostate cancer even when cancer cells are found to have spread.

The following complications are associated with cryosurgery:

• The development, in less than one percent of men, of an abnormal communication between the urethra and the rectum as a result of inadvertently freezing the rectal wall, which is located close to the base of the prostate gland.
• The development of impotence in approximately 50 percent of the men treated, as a consequence of intentionally freezing the bundles of nerves and blood vessels responsible for erection because of the presence of cancer cells in the bundles.

Percutaneous prostate cryoablation is still in its infancy as a surgical technique. Because it is a difficult and complex procedure, it is not performed by all surgeons and is not available at all hospitals. Improvements in percutaneous prostate cryoablation need to be made, but some experts believe this procedure may well be the wave of the future.

Prostate Removal : Frequently Asked Questions

Here are some frequently asked questions related to prostate removal.

Q: How long will I remain hospitalized after a prostatectomy?

A: The hospital stay for prostatectomy averages about five days and depends mostly on the nature of the surgery and the health status of the patient. In addition, a high level of patient support from others, including family, relatives, and friends, can promote the healing process and shorten the hospital stay.

Q: Will I have pain after a prostatectomy?

A: You may experience some discomfort post-operatively, especially when urinating after the Foley catheter is removed. This is temporary and usually disappears as healing progresses. If you have pain, do not hesitate to inform your nurse and doctor so that an appropriate pain medication can be administered.

Q: Will I be able to function sexually after prostate removal surgery?

A: Complications of prostatectomy include impotence and incontinence. However, your chances are still good that you will remain potent and that any incontinence will be temporary. After prostate removal, your ejaculations will be dry due to retrograde ejaculation. However, the experience of orgasm should remain unaffected and therefore enjoyable. Worrying too much about the ability to function sexually can create a psychological stumbling block that by itself can impair sexual functioning. One way to reduce the tension is to learn as much as possible about the surgical procedure and to thoroughly discuss sexual issues involving the operation with your surgeon.

Q: Will I require additional treatment after surgery for removal of the prostate gland?

A: If prostatectomy was for prostate cancer and all the cancer cells were located within the prostate gland, then your cancer is cured. However, because it sometimes is difficult to tell if cancer has spread, some men may need treatment for a recurrence of cancer. If prostatectomy was a treatment for prostate enlargement (benign prostatic hyperplasia), about 10 percent of men will require additional surgery because of complications arising from the prostatectomy.

Q: Will I still be able to exercise in the gym I belong to after discharge from the hospital?

A: During the first month of recovery, the body is repairing the physical trauma caused by the surgery and the incision is also healing. For these reasons, you should refrain from physical activities that place a stress or strain on the abdominal and pelvic regions of the body. Taking it easy should avoid a possible setback from complications while healing. After this initial period of relative inactivity, you should be able to gradually resume a balanced program of aerobic and resistive physical exercise. However, you should consult with your physician before doing so.

Q: Is prostate enlargement related to prostate cancer?

A: There is no cause-and-effect relationship between prostate enlargement and prostate cancer, based on our present medical understanding. In other words, they are independent events, although both conditions may be present at the same time in one individual.

Prostate Removal : Putting It All Together

Here is a summary of the important facts and information related to prostate removal.

• Prostatectomy is the surgical removal of the prostate gland.
• Prostatectomy is performed to treat for prostate enlargement (benign prostatic hyperplasia) when the prostate gland is greatly enlarged, causing urinary difficulties and other problems.
• Prostatectomy is performed to treat prostate cancer when the cancer cells have not yet spread beyond the prostate gland.
• Prostatectomy usually eliminates the ability to ejaculate normally but does not usually impair the ability to have an orgasm.
• The two major complications of prostate removal are possible long-term incontinence and impotence (inability to achieve or maintain an erection).
• Percutaneous prostate cryoablation is a promising, newer, still-experimental technique that freezes cancerous tissues and can be used for men with advanced stages of prostate cancer.

Prostate Removal : Glossary

Here are definitions of medical terms related to prostate removal.

Abdomen: The portion of the body that contains the liver and gallbladder, pancreas, small and large intestines, kidneys, ureters, bladder, and other organs.

Androgen ablation therapy: The administration of the hormone testosterone, or a chemically related hormone, in an attempt to reduce the size of an enlarged prostate gland.

Anesthesia: A substance given to a patient before a surgical operation or procedure to prevent pain from being felt.

Antibiotic: A chemical agent derived from a bacterium, a fungus, or synthetically that either kills bacteria or inhibits their growth.

Anus: The opening at the end of the rectum where solid waste leaves the body.

Benign prostatic hyperplasia (BPH): A noncancerous condition in which an enlarged prostate gland pushes against the bladder and urethra, obstructing the flow of urine.

Bladder: The sac-like organ of the urinary tract located in the lower portion of the abdomen which stores urine prior to its elimination from the body.

Catheter: A tube inserted through the urethra of the penis to the bladder, where it can drain urine from the body when urination has been significantly impaired.

Clinical trial: A controlled medical research study that evaluates the effectiveness of new drugs or treatments, compared to traditional drugs or treatments and to placebo (a pill or treatment known to have no measurable effect on health).

Dry orgasm: Sexual climax or orgasm without the release of semen from the urethra to the outside.

Ejaculate: The semen discharged from the penis during an orgasm.

Ejaculation: The discharge of seminal fluid containing sperm cells from the penis during sexual stimulation and orgasm.

Erection: A hardening of the penis usually caused by sexual arousal but also occurring during sleep or as the result of physical stimulation.

Foley catheter: A device used when continuous drainage of urine from the bladder is desired, as in surgery.

Impotence: The inability to achieve or sustain an erection.

Incision: A cut made through the skin during surgery.

Lymph nodes: Clusters of small glands of the lymphatic system scattered at strategic locations throughout the body. Lymph nodes filter out foreign materials, thereby removing them as threats to the body, and store specialized white blood cells as part of the body defense mechanism.

Metastasis: The spread of cancer cells from one part of the body to another through the blood and lymph.

Mortality: The death rate for a given unit of population, usually per 1,000 persons.

Orgasm: A series of strong, involuntary contractions of the muscles of the genitals experienced as pleasurable and set off by a heightened level of sexual excitation.

Palpation: A technique in which the examiner determines the texture, size, consistency, and location of certain parts of the body through the sense of touch.

Pelvis: The lower portion of the abdomen, located between the hip bones.

Percutaneous prostate cryoablation: The use of special probes inserted into the prostate gland through the skin in order to freeze and destroy cancerous tissue without affecting surrounding organs.

Perineum: In a man, the region between the scrotum and anus.

Prostate gland: A walnut-shaped gland of the male reproductive system that is located just below the bladder. This gland provides almost one-quarter of the total volume of semen released during ejaculation.

Prostate-specific antigen (PSA): A protein secreted only by the prostate gland, which may be found in increased concentrations in the blood of men who have prostate cancer or benign prostatic hyperplasia (BPH).

Prostatectomy: A surgical operation that removes part or all of the prostate gland.

Prostate cancer: A disease in which abnormal tumor cells develop in the prostate gland and may spread to other parts of the body, including the bones.

Radical prostatectomy: The surgical removal of the entire prostate gland along with some of the surrounding tissues.

Rectum: Less than a foot long, the last part of the colon or large intestine that ends at the anal opening.

Resection: The removal of a significant part of an organ or structure by surgically cutting it away from surrounding tissue.

Retrograde ejaculation: The movement of semen in a backward path into the bladder, rather than directly into the urethra and out of the body.

Retropubic: Behind the pubic bones of the pelvis.

Scrotum: The double sac of skin behind the penis that encloses the testes, or testicles.

Semen: A fluid comprised of secretions and cells produced by the prostate gland and other sex glands and the testes that leave the penis during ejaculation; also called seminal fluid.

Seminal vesicles: A pair of reproductive glands in men located near the bladder that may be examined to determine whether cancer cells from the prostate gland may have spread.

Sterility: In men, the inability to fertilize an egg cell and father a child.

Suprapubic: Above the pubic bones of the pelvis.

Testes: The male reproductive glands located in the scrotum that produce the sperm cells and secrete the male reproductive hormone testosterone; also called testicles.

Testosterone: The male hormone produced by the testicles; it is responsible for the development of a man’s reproductive organs and influences a man’s sex drive.

TNM grading system: One of the grading systems currently used to evaluate the clinical stage of tumors that originate in the prostate gland.

Transrectal ultrasound probe: A medical instrument placed in the rectum that emits high-energy waves that are reflected back to the source, providing images of internal organs and structures.

TUIP (transurethral incision of the prostate): A surgical procedure in which the urethra is widened by making a few cuts in the prostate gland and bladder neck, without removing tissue surgically.

Tumor: An abnormal mass of tissue that results from uncontrolled cell division, which may remain benign (contained) or become malignant (cancerous) and spread to other parts of the body.

TURP (transurethral resection of the prostate): A surgical procedure to treat BPH in which pieces of prostate tissue that are constricting the urethra are cut loose and flushed from the body.

Urethra: In a man, the tube through which urine or semen pass as they leave the body during urination or ejaculation.

Urinary incontinence: The inability to adequately control urination, so that urination occurs more or less involuntarily and at inappropriate times.

Urinary tract: The organs of the urinary system that include the kidneys, ureters, bladder, and urethra.

Urologist: A doctor who specializes in diseases of the urinary organs in women and of the urinary and sex organs in men.

Watchful waiting: A form of treatment in which a condition is monitored closely but no therapy is given; is often used in cases where disease is present but is advancing very slowly.

Prostate Removal: Additional Sources Of Information

Here are some reliable sources that can provide more information on prostate removal.

National Cancer Institute

http://cancernet.nci.nih.gov/

Provided by the National Cancer Institute, this information is intended to help patients with prostate cancer and their families and friends better understand prostate cancer. Among the topics discussed are causes and prevention, symptoms, diagnosis, staging, treatments and associated side effects, clinical trials, nutrition, and follow-up care. Information is provided to help patients cope with prostate cancer. A glossary of terms is also included.

Prostate Lab

http://www.prostatelab.com

This Web site provides men, their loved ones, and their physicians information needed to make treatment decisions regarding prostate disease.

CancerLinksUSA

http://www.cancerlinksusa.com

With multiple links to prostate cancer information on the Web, CancerLinksUSA offers authoritative information to prostate cancer patients, family members, and caregivers.