Prostate surgery: recovery and consequences

Surgery is the main form of treatment to eliminate prostate cancer because, in most cases, it is possible to remove the entire malignant tumor and definitively cure the cancer, especially when the disease has not yet evolved and has not reached other organs.

This surgery, known as radical prostatectomy, is performed, preferably, on men under 75 years old, without chronic diseases, such as diabetes and hypertension, diagnosed with prostate cancer who do not yet have metastases. Although this treatment is essential, it may also be necessary to undergo chemotherapy and radiation after surgery to eliminate all malignant cells, complementing the treatment.

The prostate tumor is slow-growing and therefore it is not necessary to perform surgery immediately after discovering the carcinoma, and you can wait a few days without increasing the risk of complications.

How is the recovery from prostatectomy

Recovery is relatively quick and it is only recommended to rest, avoiding efforts, for approximately 10 to 15 days. After that time, you can return to day-to-day activities, such as driving or working, however, permission for great efforts only occurs after 90 days from the date of surgery. Intimate contact can be resumed after 40 days.

In the post-operative period of prostatectomy it is necessary to place a bladder probe, a tube that will lead the urine from the bladder to a bag, because the urinary tract becomes very inflamed, preventing the passage of urine. This probe should be used between 1 and 3 weeks, and should be removed only after the doctor's recommendation. Learn how to care for the bladder catheter during this period.

In addition to surgery, chemotherapy and radiotherapy may be necessary to kill malignant cells that were not removed in the surgery or that have spread to other organs, preventing them from continuing to multiply. See how all treatment options for prostate cancer work.

Possible consequences

In addition to the general risks, such as infection at the scar site or hemorrhage, surgery for prostate cancer can have other important sequelae such as:

1. Urinary incontinence

After surgery, the man may have some difficulty controlling urine output, resulting in urinary incontinence. This incontinence can be mild or total and usually lasts for a few weeks or months after surgery.

This problem is more common in the elderly, but it can happen at any age and depends on the degree of cancer development and type of surgery. Treatment usually starts with physiotherapy sessions, with pelvic exercises and small instruments, such as biofeedback , and kinesiotherapy. In the most extreme cases, surgery can be performed to correct this dysfunction. See more details on how to treat urinary incontinence.

2. Sexual impotence

Sexual impotence is one of the most frequent and worrisome complications for men, as they are unable to start or maintain an erection. This happens because next to the prostate there are important nerves that control the erection. Thus, impotence is more common in cases of highly developed cancer in which it is necessary to remove many affected areas, and it may be necessary to remove the nerves.

In other cases, the erection may be affected only by inflammation of the tissues around the prostate, which press on the nerves. These cases usually improve over months or years as the tissues recover.

To help in the first few months, the urologist may recommend some remedies, such as Vardenafil or Sildenafil, which help to have a satisfactory erection. Learn more about how to treat sexual impotence.

3. Infertility

Surgery for prostate cancer cuts the connection between the testicles, where sperm are produced, and the urethra. Therefore, man will no longer be able to generate a child by natural means. The testicles will still produce sperm, but will not be ejaculated.

As most men affected by prostate cancer are elderly, infertility is not a major concern, but if you are a young man or want to have children, it is recommended to talk to the urologist and evaluate the possibility of conserving sperm in specialized clinics..

How is the surgery done

Techniques for prostate removal

The surgery is done, in most cases, with general anesthesia, however it can also be done with spinal anesthesia, which is applied to the back, depending on the surgical technique that will be performed. The surgery takes an average of 40 minutes to 2 hours and it is usually necessary to stay in the hospital for about 3 to 5 days.

Prostatectomy consists of the removal of the prostate, including the prostatic urethra, seminal vesicles and ampoules of the different ducts, associated or not with bilateral lymphadenectomy.

Main techniques to perform the surgery

To remove the prostate, surgery can be done by laparoscopy, that is, through small holes in the belly where instruments to remove the prostate pass, or by laparotomy where a larger cut is made in the skin. Thus, some techniques can be:

• Radical retropubic prostatectomy: in this technique, the doctor makes a small cut on the skin next to the navel to remove the prostate tumor; Radical perineal prostatectomy: a cut is made between the anus and the scrotum and the tumor is removed. However, this technique is used less frequently than the previous one, since the nerves responsible for the erection are almost always affected, and can cause impotence; Robotic radical prostatectomy: in this technique the doctor controls a machine with robotic arms and, therefore, the technique is more accurate, with less risk of sequelae. However, it is a very rare and more expensive technique; Transurethral resection of the prostate: it is usually performed in the treatment of benign prostatic hyperplasia, however, in the case of cancer it also helps to relieve some symptoms, such as difficulty urinating.

In most cases, the most suitable technique is the one performed by laparoscopy because it causes less pain, causes less blood loss and the recovery time is faster.

Exams and consultations after surgery

After completing treatment for prostate cancer, you need to perform the PSA exam every 6 months for 5 years. Bone densitometry and other imaging tests can also be performed annually to ensure everything is fine, or to diagnose any changes as early as possible.

The emotional system and sexuality can be very shaken, so it may be indicated to be followed by a psychologist during treatment and for the first few months thereafter. The support of family and close friends is also an important help to proceed in peace.

Can cancer come back?

Yes, men diagnosed with prostate cancer have a higher risk of developing other types of cancer, such as rectum, leukemia, bowel or bladder, for example. Thus, it is advisable to maintain healthy habits and not smoke, in addition to performing diagnostic tests periodically, whenever requested by the doctor, because the earlier it is diagnosed, the greater your chances of cure.