When it comes to choosing a treatment for prostate cancer, each patient’s situation is unique. Deciding on the best treatment for prostate cancer is specific to each patient. That’s why it is important to make an informed decision about the best treatment with a healthcare team. Speaking with other men facing the same situation and issues may be helpful as well.
Prostate Cancer Treatment and Surgery Questions and Appointments
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Types of Prostate Cancer Surgeries and Choosing a Treatment
- Radical Perineal Prostatectomy
- Laparoscopic Radical Prostatectomy (LRP)
- Mini-Lap Radical Retropubic Prostatectomy (RFP)
- Advantages and Disadvantages of the Radical Prostatectomy
- Prostate Cancer Treatment Considerations
Radical Perineal Prostatectomy
A radical perineal prostatectomy involves an incision made to the perineum, the area between the anus and scrotum. Because the large prostates cannot be removed through this approach, this type of prostatectomy is less frequently performed than the retropubic type. A nerve-sparing procedure can be performed with this approach, but the larger prostates may require more pulling the nerve bundles, and thus more nerve injury, to remove the prostate. However, it is an important option to consider if you have coexisting medical conditions that would make retropubic surgery more difficult. The operation itself is usually shorter than a retropubic prostatectomy, less painful, and the recovery time slightly shorter. Postoperative stays for radical perineal prostatectomies are usually one day (perineal).
Laparoscopic Radical Prostatectomy (LRP)
Initially described in 1997, laparoscopic radical prostatectomy (LRP), was not often used because of its technical difficulty and long operative time. LRP has begun to be used more often because of improved instruments and technical refinements. A robotic-assisted LPR is one of those refinements. The robotic technique allows for three-dimensional visualization of the area and improved range of motion. In experienced hands, both the robotic and laparoscopic prostatectomy are as effective as the retropubic and perineal open procedure. However, patient follow-up of both these techniques has been limited. Also, long-term studies of the effects of LRP on sexual and urinary health have not yet been reported.
Mini-Lap Radical Retropubic Prostatectomy (RFP)
For treatment of localized prostate cancer, technical improvements in the nerve-sparing radical retropubic prostatectomy have been achieved with the mini-lap retropubic prostatectomy. This procedure requires a small 7–8 cm incision rather than an incision three times that length. The mini-lap also uses a new retractor system that functions as a robot so there is no need for a second surgical assistant. Extensive experience with this operation has been developed over the past few years.
More than 1,000 Emory patients have undergone mini-lap radical retropubic prostatectomies (RRP) for clinically localized prostate cancer. Most of these patients are hospitalized for two to three days, and most report minimal pain following discharge. These patients reported continence rates of 90–95 percent and potency rates of 66–75 percent. The mini-lap RRP takes less time to perform than the laparoscopic radical prostatectomy, with the same discomfort and length of hospital stay as the RRP. However, a reduction in bowel and abdominal problems has been reported. Potency rates have not yet been well defined in most of the laparoscopic series.
The Emory University Urology Department continues to explore this new laparoscopic approach, but Emory experts believe the mini-lap RRP compares favorably to the standard radical open prostatectomy, the perineal prostatectomy, and the laparoscopic prostatectomy.
- Best 15-year, disease-free survival for organ-confined disease.
- Best option for younger patients.
- Incontinence in 5–8 percent of patients.
- Erectile dysfunction in 50 percent or more of patients. However, sexual function may be attained with drugs such sildenafil (Viagra) or vardenafil (Levitra), injection therapy, vacuum devices, or penile implants.
- About 30–40 percent of patients may have undetected cancer that is not confined to the prostate higher risk for future recurrence.
Prostate Cancer Treatment Considerations
Things to consider are the benefits of each treatment against its possible outcomes, side effects, and risks. The following are some variables that should be considered.
- Age: Generally, patients younger than 70 are more likely to fare better with more aggressive treatments, such as surgery—whereas patients older than 70 may fare better with the less invasive therapies, such as radiation. Those older than 80 are probably the best candidates for watchful waiting, which includes regular prostate-specific antigen (PSA) tests, digital rectal exams (DRE), or other tests whose results indicate whether the prostate cancer has developed enough to require treatment.
- Co-Existing Medical Conditions: Because prostate cancer is often slow to progress, many patients with other medical conditions such as heart disease, diabetes, or neurological conditions may be more likely to suffer complications from those illnesses rather than from the prostate cancer itself.
- Inflammatory Bowel Disease: Patients with irritable bowel or inflammatory bowel disease do not tolerate radiation treatments well. However, seed implants may be a possible alternative.
- Stage and Grade of Tumor: Doctors will rate the patient’s tumor in a system that measures the tumor’s spread and aggressiveness. This is called “staging” or “grading” the tumor.
- Prior Pelvic Radiation: Previous radiation treatments to the pelvic area would limit the use of radiation for the treatment of prostate cancer, because normal neighboring tissue (mainly from the rectum) can receive only a limited amount of cumulative