What should you pay attention to in surgical treatment of prostate cancer

There are many treatments for prostate cancer at present, and surgical treatment is the best way to cure prostate cancer and the best choice for controlling the disease in the later stages of prostate cancer. Below we introduce the methods of surgical treatment of prostate cancer and postoperative precautions?

Five surgical treatments for prostate cancer

1. Bilateral orchiectomy: Removal of the testicles removes the source of testosterone production, slowing the growth or regressing androgen-dependent prostate cancer. This operation is simple, safe, and has few side effects. The castration level (serum testosterone concentration is less than 1.75mmol/L) can be achieved within 12 hours after surgical resection. However, orchiectomy can cause secondary adrenal cortical zona reticularis proliferation, resulting in hypersecretion of adrenal androgens. Therefore, this operation is often combined with other therapies to achieve better results. Orchiectomy is still an effective treatment for prostate cancer.

2. Radical prostatectomy: The scope of radical prostatectomy for prostate cancer includes the prostate body and prostate capsule, in order to achieve the purpose of eliminating all tumor tissues in the body. The surgical approach uses perineal or retropubic incision, and retropubic incision is now more commonly used. During the operation, the degree of tumor infiltration behind the bottom of the bladder and near the seminal vesicle and the presence of lymph node metastasis in the pelvic area can be simultaneously explored. Generally, patients who are suitable for radical prostatectomy only account for 5% to 10% of all cases.

3. Pelvic lymph node dissection: The incidence of pelvic lymph node metastasis in prostate cancer is relatively high, so the pelvic lymph node metastasis should be fully examined during the operation. If metastasis is found, pelvic lymph node dissection should be performed at the same time.

4. Extended radical prostatectomy: Use high-frequency electrosurgery to extensively remove local tumors in situ, with special attention to the removal of the bladder base, the residual part of the seminal vesicle and vasectomy, the fascia behind the bladder, and the urogenital diaphragm around the membranous urethra. It is mainly suitable for stage C prostate cancer and should be used in combination with interstitial radiotherapy, but such extensive surgery has not achieved satisfactory results.

5. Transurethral resection of the prostate (TURp): It is suitable for the elderly and frail who have already developed complications such as urinary obstruction. For patients with local lesions that have reached stage C, TURp can only relieve symptoms and there is no possibility of cure. TURp can prevent the occurrence of uremia and improve the quality of life of patients. Many patients can undergo repeated transurethral resections to relieve bladder orifice obstruction. If it can be supplemented with non-surgical treatment methods, the value of surgical treatment can be improved. Unlike general TURp surgery, due to the invasion of cancerous masses, the landmarks (such as the seminal colliculus) are no longer very clear, and more attention should be paid to not damage the external sphincter during surgery.

Prostate cancer surgery considerations

1. After the operation, the patient's penis function will be damaged to a certain extent, which will bring mental torture to the patient. Erectile dysfunction after surgery is very common. The operation can damage the bilateral vascular nerve bundles of the penis and cause erectile dysfunction. Patients who are troubled and inferior due to loss of sexual ability should be given effective psychological counseling.

2. After surgical treatment, the patient may not be able to control his or her urination, which also requires active care. Postoperative urinary incontinence is caused by damage or traction of the urethral sphincter, which can manifest as permanent urinary incontinence or temporary urinary incontinence. The patient's inability to control urination seriously affects the quality of daily life. Long-term urinary incontinence is prone to secondary urinary tract and vulvar skin infections. Patients who experience temporary urinary incontinence after the removal of the catheter should be mentally prepared. In order to cooperate with the continued treatment after surgery, guide patients to overcome postoperative tension and anxiety and build confidence in treatment. Patients should be guided to carry out pelvic floor muscle exercises, that is, lying flat on the bed to reduce abdominal pressure, increase urethral closure pressure, and at the same time contract the anus.