The Laparoscopic Radical Prostatectomy

Radical prostatectomy is a surgery mainly used in the treatment of prostate cancer. The goal of radical prostatectomy is to altogether remove the prostate cancer along with the prostate, reduce the risk of recurrence, and improve the patient's prognosis. This surgery can be performed through several surgical techniques, including laparoscopic radical prostatectomy, robotic radical prostatectomy, and "open" radical prostatectomy. The choice of technique depends on several factors, including the tumor size, the disease stage, the patient's overall health, and the surgeon's preferences.

Pre-operative preparation:

• Pre-operative examinations: blood tests, kidney function tests, prostate ultrasound, prostate biopsy, and possibly an MRI will be requested;
• Risk assessment: Your surgeon will assess your anesthetic and surgical risk, taking into account your overall health and the severity of your prostate cancer.

On the day of surgery:

• Fasting: you will have to abstain from eating and drinking for a set time before the surgery, generally from midnight before;
• Follow your doctor's instructions: Carefully follow your doctor's instructions regarding medications to take or avoid before surgery.

During surgery:

• Anesthesia: you will be under general anesthesia so that you will be completely asleep during the surgery;
• Laparoscopic procedure: During laparoscopic radical prostatectomy, the surgeon will make small incisions in the abdomen through which he will insert one or more laparoscopic instruments. These tools include a high-definition camera and small surgical tools;
• Prostate removal: Using laparoscopic instruments, the surgeon will remove the prostate and, if necessary, surrounding tissues, such as lymph nodes.

After surgery:

• Monitoring in the recovery room: you will be transferred to the recovery room, where you will be monitored by specialized medical personnel while you recover from anesthesia;
• Post-operative monitoring: You will often be monitored for pain level, urinary function, and other vital indicators;
• Rest and recovery: You will need to rest and recover for a period of time, during which you may need to stay in the hospital for a few days.

Post-operative care:

• Follow the doctor's instructions: carefully follow the doctor's instructions regarding the care of the surgical wound, taking medication, and the activities allowed;
• Rehabilitation: A rehabilitation program that includes pelvic floor exercises and other physical therapies may be advisable to aid in the healing and restoration of urinary function.
• Continuous monitoring: You will be regularly checked by your doctor to monitor recovery, urinary function, and residual or relapsed prostate cancer.

Possible complications:

• Bleeding: excessive bleeding may occur during or after surgery;
• Infection: there is a risk of infection of surgical wounds or urinary tract;
• Erectile dysfunction: radical prostatectomy can affect erectile function, although the possibility of recovery depends on several individual factors;
• Urinary incontinence: Temporary or permanent urinary incontinence may occur after surgery.

Results and follow-up:

• Recovery of urinary and erectile function: most patients recover urinary continence within a few months of surgery, while recovery of erectile function may take longer and sometimes requires additional therapies;
• Cancer check: After prostatectomy, you will be monitored regularly via PSA (prostate-specific antigen) blood tests and, if necessary, other diagnostic investigations to monitor for any signs of prostate cancer recurrence.

When to see a doctor after discharge

After radical prostatectomy surgery, it is essential to follow your doctor's instructions for the recovery period. Usually, it is recommended to consult a doctor in the following cases:

• persistent fever;
• excessive bleeding;
• intense pain;
• abnormal swelling and purging of pus from wounds;
• difficulty urinating.

Alternatives to radical prostatectomy surgery

Suppose you decide not to have a radical prostatectomy to treat prostate cancer. In that case, your treatment options will depend on your case's severity, age, overall health status, and personal preferences. Here are some alternatives:

1. Active monitoring or supervised surveillance: If the cancer is at low risk, you may opt for an active monitoring approach, which involves regular surveillance and observation of the tumor without immediate intervention. During this period, periodic examinations will be carried out to monitor the growth of the cancer and intervene only if necessary;
2. Radiation therapy: Radiation therapy uses high-energy beams to destroy cancer cells. It can be administered through external radiation (EBRT) or by implantation of radioactive sources directly into the prostate (brachytherapy). This option can be considered as primary treatment or after a period of active monitoring;
3. Hormone therapy: Hormone therapy aims to reduce testosterone levels, which fuels the growth of cancer cells in the prostate. This treatment can be used alone or in combination with other therapeutic approaches;
4. Ablation therapy: This includes techniques such as high-intensity focused ultrasound (HIFU) ablation or cryotherapy ablation, which aim to destroy cancer cells without surgically removing the prostate.

It is essential to discuss these options with your urologist oncologist to assess the risks and benefits of each and make an informed decision based on your situation.

Risks of not treating prostate cancer

Not treating prostate cancer can lead to several long-term risks and complications, including:

• Disease progression: Without treatment, prostate cancer can progress over time, growing and spreading to surrounding tissues such as the bladder, rectum, or nearby organs. This progression can lead to more severe symptoms and a less favorable prognosis;
• Metastasis: Untreated prostate cancer has the potential to spread (metastasize) to other parts of the body, such as bones, liver, lungs, or other organs. Metastases can cause additional symptoms and make the cancer more difficult to treat;
• Worsening symptoms: Without treatment, symptoms associated with prostate cancer, such as difficulty urinating, blood in the urine or semen, pain when urinating or ejaculating, can worsen over time and negatively affect quality of life;
• Urinary complications: Advanced prostate cancer can compress the urethra and cause urinary problems such as difficulty initiating or maintaining urinary flow, urinary incontinence, or retention;
• Sexual complications: Prostate cancer and its treatments can affect erectile function and libido. Without treatment, deterioration in erectile function can progress over time, making it difficult or impossible to have sexual intercourse;
• Emotional impact: Living with untreated cancer can cause anxiety, depression, and emotional stress for both the patient and their loved ones. Fear of disease progression and its consequences can have a significant impact on mental health and overall well-being.

In summary, not treating prostate cancer can lead to several risks and complications that can negatively affect the patient's quality of life and long-term prognosis. It is important to discuss treatment options with your doctor early to make informed decisions about managing your disease.