Prostate Cancer Surgery

Introduction

Prostate cancer is among the most frequently diagnosed male cancers worldwide. Although most instances are slow-growing and do not need to be treated immediately, others require more intense treatment. Among the therapeutic options, surgery for prostate cancer is a key treatment for locally confined and certain locally advanced situations. It has an important function in potentially eradicating the disease or highly extending survival. This article touches on the indications, categories, procedures, rehabilitation, patient life, fees worldwide, and newest clinical trials within China.

About the Disease

Prostate cancer arises in the prostate gland—a small organ below the bladder that helps produce semen. It is often slow-growing but can become aggressive in certain individuals. Prostate cancer stages range from:

• Localized (confined within the prostate)

• Locally advanced (spread to nearby tissues)

• Metastatic (spread to lymph nodes, bones, or organs)

Diagnosis is typically made using PSA (prostate-specific antigen) blood tests, digital rectal exams (DRE), imaging studies, and biopsy.

Surgical treatment is most effective in patients with early-stage disease or those with limited locally advanced tumors.

Indications

Surgery is considered when:

• The cancer is confined to the prostate (Stage I or II).

• The tumor is locally advanced but resectable.

• PSA levels are rising after radiation (salvage surgery).

• The patient is healthy enough to undergo surgery.

• Other treatment options like radiotherapy are unsuitable or refused.

In metastatic cases, surgery is rarely performed unless for palliation (e.g., relieving urinary obstruction).

Treatment Details

The primary surgical approach to treat prostate cancer is radical prostatectomy, which involves removing the entire prostate gland along with some surrounding tissue, including the seminal vesicles.

Types of Radical Prostatectomy:

1. Open Radical Prostatectomy

   • A traditional surgery with an incision in the lower abdomen.

   • May require longer recovery and higher blood loss.

2. Laparoscopic Radical Prostatectomy

   • Minimally invasive using small incisions and a camera.

   • Faster recovery, less pain, and fewer complications.

3. Robotic-Assisted Radical Prostatectomy (RARP)

   • Advanced version of laparoscopic surgery.

   • Performed using the da Vinci robotic system.

   • Offers precision and reduced risk of nerve damage.

Other surgical procedures related to prostate cancer include:

• Pelvic lymph node dissection (for cancer spread assessment).

• Transurethral resection of the prostate (TURP) for symptom relief in advanced cases.

Medicines Used

While surgery doesn’t involve regular drug regimens like chemotherapy or immunotherapy, certain medications may be prescribed around the time of surgery:

• Antibiotics: To prevent post-surgical infections.

• Analgesics: For pain management.

• Laxatives or stool softeners: To ease bowel movements post-surgery.

• Anticoagulants: In select patients to prevent blood clots.

Additionally, hormone therapy may be administered before or after surgery in high-risk cases.

Effectiveness

Radical prostatectomy is highly effective in appropriately selected patients:

• Cure rates for low-risk localized prostate cancer exceed 90%.

• 10-year survival rates after surgery are high in early-stage cases.

• Biochemical recurrence (PSA rise) may occur in 20–30% of cases, requiring additional treatment.

Surgery also provides accurate pathological staging and can help guide further therapy decisions.

Risks and Side Effects

Like all major surgeries, prostate cancer surgery carries certain risks and side effects:

Short-Term Risks:

• Bleeding

• Infection

• Blood clots

• Reaction to anesthesia

Long-Term Side Effects:

• Urinary incontinence: Leakage of urine, which improves over months in most patients.

• Erectile dysfunction: Due to nerve damage; nerve-sparing techniques reduce this risk.

• Infertility: Common, as the procedure removes the seminal vesicles.

• Narrowing of the urethra (stricture)

Robotic surgery significantly lowers the incidence of many complications due to its precision.

Recovery and Aftercare

Postoperative recovery depends on the surgical method and patient health.

Hospital Stay:

• 1–3 days for minimally invasive surgery

• 3–5 days for open surgery

Catheter Use:

• A urinary catheter is placed for 1–2 weeks to help urine drain during healing.

Recovery Time:

• Light activities: Within 1–2 weeks

• Full recovery: 4–6 weeks for laparoscopic/robotic, 6–8 weeks for open surgery

Aftercare Includes:

• Pelvic floor exercises (Kegels) for urinary control

• Erectile function rehabilitation (pills, pumps, or injections)

• Regular PSA testing every 3–6 months

• Psychological counseling and support groups

Cost and Availability

Costs depend on the type of surgery, hospital type (private or government), surgeon’s experience, and country.

In India:

• Open surgery: ₹1.5–2.5 lakhs ($1,800–$3,000)

• Robotic surgery: ₹3.5–6 lakhs ($4,200–$7,200)

• Leading centers: Tata Memorial, AIIMS, Apollo, Fortis

In China:

• Open/laparoscopic: ¥50,000–¥80,000 ($7,000–$11,000)

• Robotic: ¥90,000–¥150,000 ($12,000–$20,000)

• Major hospitals: Fudan University Cancer Center, Peking Union Medical College Hospital

Government insurance or aid may partially or fully cover the costs.

Patient Experiences

Many patients choose surgery for its potential to eliminate cancer completely. Patient feedback includes:

• “Robotic surgery helped me recover fast with minimal scarring.”

• “Incontinence lasted a few weeks, but exercises helped a lot.”

• “My PSA became undetectable after surgery, and I’m cancer-free for 5 years now.”

Support from physiotherapists, sexual health counselors, and psychologists improves outcomes significantly.

Cost in Countries Like China, India, Israel, Malaysia, Korea, Thailand, Turkey and USA

Note: Includes hospital stay, anesthesia, surgeon fees, and basic aftercare.

List of Ongoing Clinical Trials in China

China is at the forefront of integrating technology and innovation in prostate cancer surgery. Some active clinical trials include:

1. Enhanced Recovery After Surgery (ERAS) in Robotic Prostatectomy

   • Focus: Speeding up recovery and reducing hospital stay.

   • Status: Phase III

2. AI-Guided Nerve-Sparing Techniques

   • Focus: Improving erectile function preservation.

   • Status: Pilot Study

3. 3D Imaging for Surgical Planning

   • Focus: Better visualization of prostate anatomy.

   • Status: Phase II

4. Comparative Study: Open vs Robotic Surgery

   • Focus: Long-term functional outcomes and costs.

   • Status: Phase III

5. Prehabilitation Before Prostate Surgery

   • Focus: Using exercise and diet to optimize surgical outcomes.

   • Status: Phase II

Patients can explore opportunities through platforms like clinicaltrials.gov or consult major cancer centers in Shanghai, Beijing, and Guangzhou.

FAQ

Is prostate surgery the best option?

It depends on the stage and aggressiveness of cancer. For early-stage disease, surgery offers excellent outcomes.

What is the success rate of prostate cancer surgery?

Cure rates exceed 90% in localized disease. Long-term survival depends on cancer grade and stage.

How soon can I return to work after surgery?

Most patients resume desk jobs in 3–4 weeks. Strenuous work may require 6–8 weeks.

Will I have sexual side effects?

Yes, erectile dysfunction is common but often improves over time, especially with nerve-sparing techniques.

Can cancer recur after surgery?

Yes, especially if margins are positive. Regular PSA follow-up is essential.

Is robotic surgery better than open surgery?

Robotic surgery offers faster recovery, less pain, and fewer complications. However, it depends on surgeon experience.