prostatectomy
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Introduction
Surgical resection of the prostate.
Indications
- symptomatic benign prostatic hypertrophy
- localized prostate cancer
Contraindications
- radical prostatectomy does no better than observation in reducing overall or cancer-related mortality in patients with localized prostate cancer[5][9]
Laboratory
- prostate biopsy, Gleason scoring for prostate cancer
- serum PSA
- if serum PSA undetectable by ultrasensitive assay 3 years after radical prostatectomy, probablility of prostate cancer recurrence is 0.3%, 0.0% at 5 years[8]
- PI16 may serve as a marker following prostatectomy for prostate cancer
Procedure
- transurethral resection of the prostate (TURP)
- transurethral incision of the prostate (TUIP)
- transurethral US-guided laser-induced prostatectomy (TULIP)
- radical prostatectomy
- robotic assisted laparoscopic prostatectomy may be the procedure of choice[6], eventually[7]
Complications
- urinary tract infection
- urinary incontinence at 5 years[9]
- sexual dysfunction at 5 years[9]
- postprostatecomy urinary incontinence
- robotic surgery associated with a higher rate of urinary incontinence than radical prostatectomy[4]
- at 12 years, risk of urinary or sexual complications is 7-fold greater after prostatectomy vs men without prostate cancer[10]
Management
- prophylactic antibiotics started the day prior to catheter removal appears to reduce risk of urinary tract infection
- pelvic muscle exercises & bladder retraining techniques reduce postprostatecomy urinary incontinence by 50%[3]
More general terms
More specific terms
- photoselective vaporization of the prostate (PVP)
- transurethral incision of the prostate (TUIP)
- transurethral resection of the prostate (TURP)
- transurethral US-guided laser-induced prostatectomy (TULIP)
References
- ↑ Stephenson AJ et al Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 2009 Sep 10; 27:4300 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19636023
- ↑ 2.0 2.1 Pinochet R et al. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy. Urol Int 2010 Dec; 85:415. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21099192
- ↑ 3.0 3.1 Goode PS, Burgio KL, Johnson TM 2nd, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 2011; 305(2):151-159 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21224456
- ↑ 4.0 4.1 Barry MJ et al. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of Medicare-age men. J Clin Oncol 2012 Feb 10; 30:513. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22215756
Cooperberg MR et al. Outcomes for radical prostatectomy: Is it the singer, the song, or both? J Clin Oncol 2012 Feb 10; 30:476. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22215744 - ↑ 5.0 5.1 Wilt TJ et al Radical Prostatectomy versus Observation for Localized Prostate Cancer N Engl J Med 2012; 367:203-213, July 19, 2012 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22808955
Thompson IM and Tangen CM Prostate Cancer - Uncertainty and a Way Forward N Engl J Med 2012; 367:270-271July 19, 2012 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22808963 - ↑ 6.0 6.1 Mulcahy N. 'End of Controversy': Robotic Prostatectomy Is Winner. Medscape. Jun 23, 2016. http://www.medscape.com/viewarticle/865241
- ↑ 7.0 7.1 Yaxley JW, Coughlin GD, Chambers SK et al Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. July 26, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27474375 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30592-X/abstract
- ↑ 8.0 8.1 Matsumoto K, Komatsuda A, Yanai Y, et al. Determining when to stop prostate specific antigen monitoring after radical prostatectomy: The role of ultrasensitive prostate specific antigen. J Urol 2017 Mar; 197:655. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27590477 <Internet> http://www.jurology.com/article/S0022-5347(16)31195-8/abstract
- ↑ 9.0 9.1 9.2 9.3 Hoffman KE, Penson DF, Zhao Z et al Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA. 2020;323(2):149-163> Jan 14 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31935027 https://jamanetwork.com/journals/jama/article-abstract/2758599
- ↑ 10.0 10.1 Bassett M Prostate Cancer Treatment Associated With Long-Term Complications. Researchers say inadequate understanding of risks may lead patients to regret treatment decisions. MedPage Today November 7, 2024 https://www.medpagetoday.com/urology/prostatecancer/112785
Unger JM, Till C, Tangen CM et al Long-Term Adverse Effects and Complications After Prostate Cancer Treatment. JAMA Oncol. 2024 Nov 7:e244397 PMID: https://www.ncbi.nlm.nih.gov/pubmed/39509091 https://jamanetwork.com/journals/jamaoncology/fullarticle/2826069