Prostate cancer: no matter how you approach it, side effects happen

The surgical treatments for prostate cancer have progressed from open abdominal surgery, but the surgery itself still causes a number of unpleasant side effects that may or may not go away.

Prostate cancer is the third cause of death from cancer for men of any age, and the most common cause of death from cancer for men over 75, according to PubMed Health. However, this cancer rarely strikes anyone younger than 40 years of age. Many treatment modalities exist to deal with this cancer, including watchful waiting, but if your cancer is in the early stages and restricted to your prostate, surgery might help.

Radical retropubic prostatectomy: an open surgical scar

The radical retropubic prostatectomy involves a surgical incision in your abdomen below your belly button. Your surgeon will remove your prostate and some of the tissue surrounding it to make sure all the cancer cells are removed. Lymph nodes are also removed and tested for cancer. If cancer is found, the surgeon will likely not continue the surgery because the cancer has spread and removing the prostate will not remove the cancer, according to the American Cancer Society. Your surgeon will insert a catheter, or plastic tube, with a collection bag that will collect your urine for the next week as your surgical area heals.

Alternate surgical approaches for prostate cancer: laparoscopic radical prostatectomy

Your surgeon can perform this surgery in a few different ways other than a large incision in your abdomen. One possible approach is called a radical perineal prostatectomy, and the incision is made between your scrotum and anus. The benefit of this approach is that it is easier to recover from, but the surgeon cannot remove lymph nodes and often destroys nerves that he could avoid in other approaches. The laparoscopic radical prostatectomy is rapidly gaining favor with surgeons trained to do it. In this approach, the surgeon uses multiple small incisions and long tools to remove the prostate. It offers quicker recovery times, less blood loss and similar side effects to the retropubic approach.

Dripping and leaking post-op: incontinence and prostate cancer surgery

One of the major disadvantages of prostatectomy through any surgical approach is the risk for urinary incontinence, leaking or dribbling. In a large study of 901 men, 15 percent had frequent urine leakage, 16 percent had leakage twice per day and 29 percent wore incontinence pads to maintain dryness, according to the American Cancer Society. Your doctor cannot predict how your body will respond to the removal of your prostate and if your will have trouble holding your urine. It might take weeks to months for your body to heal enough after surgery for you to have some control over your urination. Medications, surgery and exercises known as Kegels might help reduce some of this side effect.

Not even Viagra can help: impotence and prostate cancer surgery

When your doctor performs a prostatectomy either through the retropubic or laparoscopic approach, he can attempt to make it a nerve-sparing procedure. Two bundles of nerve fibers run down either side of the prostate that control your ability to have an erection. If the cancer has not spread to these nerves, the surgeon can leave them. However, if the cancer is encroaching into this tissue, those nerves must come out and impotence is an unfortunate side effect. Even with nerve-sparing surgery, it may take up to two years to restore sexual function. Medications can help, but only if the nerves stayed intact. If you can get an erection, though, you cannot father children because the connection between your testicles and urethra is cut in the surgery.

References:

• PubMed Health; Prostate Cancer; Scott Miller, MD; September 2010
• American Cancer Society; Prostate Cancer: Surgery; June 2011
• Prostate Cancer Foundation; Prostatectomy (Surgery); 2011

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