Several issues on radical prostatectomy

The so-called radical surgery of tumor refers to the complete removal of the tumor, which usually includes the tumor and some surrounding tissues, as well as local lymph nodes. After radical surgery, the tumor may be cured, which is the best way and outcome of tumor treatment. If the tumor has spread or has metastasized to distant sites, radical surgery cannot be performed in this case. For prostate cancer, the opportunity for radical surgery has been lost.

Orchiectomy performed on patients with advanced prostate cancer is an endocrine therapy, not a radical surgery, because the prostate cancer itself is not removed and remains in the patient's body.

What kind of patients are suitable for radical prostatectomy?

Prostate cancer is in the early stage and the tumor has not yet metastasized. From a professional perspective, we call it organ-confined prostate cancer, which means that the prostate cancer is confined to the prostate capsule and has not yet spread or metastasized. Only radical surgery for this kind of early prostate cancer is meaningful and can achieve a radical cure.

Radical prostatectomy is generally suitable for patients under 75 years old, and from a professional point of view, it is suitable for patients with a life expectancy of more than 10 years. Because prostate cancer is a tumor that progresses very slowly compared to other malignant tumors, it generally does not endanger the patient's life in the short term. Therefore, it does not make much sense to choose radical surgery for elderly patients, because cardiovascular and cerebrovascular diseases are often life-threatening for elderly patients, not prostate cancer.

What are the common complications of radical prostatectomy? Currently, there are three common complications of radical prostatectomy:

First, bleeding.

In the past, when the anatomical structure of the prostate was not well understood, bleeding was a very serious complication. About 10 to 20 years ago, radical prostatectomy was rarely performed in my country, and experience was very limited. People were not familiar with the anatomy, so the amount of bleeding was very large, often exceeding 1000 ml, and sometimes even reaching 5000 ml.

With the deepening of research and the advancement of surgical techniques, we can now control the amount of bleeding during radical prostatectomy to 100 ml to 200 ml, and in better cases, it can be controlled within 50 ml. However, for units or doctors with less skilled techniques, bleeding during radical prostatectomy is still a relatively large complication, and blood transfusions are often required during or after surgery.

Second, urinary incontinence.

This is a relatively common complication, which means that the patient cannot control his or her urination after the operation, and the urine will flow out involuntarily, wetting the pants. This complication is mainly due to the damage of the external urethral sphincter at the tip of the prostate during the operation. The external urethral sphincter is a muscle structure that specifically controls urination. It is often closely adjacent to the tip of the prostate and cannot be identified by the naked eye during the operation. Therefore, if the experience is not rich enough or the tumor itself invades the sphincter, urinary incontinence often occurs after the operation. Better medical institutions abroad report that the incidence of urinary incontinence can be controlled within 5%, but in general it reaches about 10%.

Third, erectile dysfunction, also known as sexual dysfunction

Because the sexual nerves on both sides of the prostate capsule are often damaged during surgery, the sexual nerves cannot be identified by the naked eye during surgery, so protecting the sexual nerves depends entirely on the doctor's personal experience and operating skills. The incidence of this complication is reported to be around 30% abroad, but it depends on the patient's own situation, such as the patient's sexual function before surgery and the invasion of the prostate capsule by the tumor. If the patient's sexual function is not very good before surgery, then the recovery of sexual function after surgery will be relatively poor.

Radical prostatectomy is a relatively high-tech operation that requires a good understanding of anatomy and high surgical skills to achieve better surgical results.