Our Summary

This research paper discusses a type of prostate cancer surgery known as nerve-sparing radical prostatectomy. This surgery is the best option for men who want to keep their ability to have an erection after their prostate cancer is treated. However, the effectiveness of this surgery in preventing erectile dysfunction (ED) has been decreasing over time, likely due to more accurate ways of assessing erectile function before and after the surgery. There’s still a lot we don’t know about which specific nerves need to be preserved during this operation to maintain erectile function. However, some promising methods have been suggested for visualizing the nerves and blood vessels that are preserved during the surgery and estimating how well the nerves have been preserved.

FAQs

  1. What is nerve-sparing radical prostatectomy and why is it considered an optimal treatment for prostate cancer?
  2. Why has there been a decline in the effectiveness of nerve-sparing radical prostatectomy in preventing erectile dysfunction?
  3. What are the proposed methods for visualizing the elements of the preserved vascular-neural bundle in nerve-sparing radical prostatectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about prostatectomy is to discuss the importance of nerve-sparing techniques in order to preserve erectile function. It is important for the patient to understand the potential impact on sexual function and to have a thorough discussion with their surgeon about nerve-sparing options and the potential risks and benefits. Additionally, it is important for the patient to communicate openly with their healthcare team about any concerns or questions they may have before and after the procedure.

Suitable For

Patients who are recommended for prostatectomy typically include those with localized prostate cancer, especially those with a life expectancy of more than 10 years and a prostate-specific antigen (PSA) level of less than 20 ng/mL. Additionally, patients who are young and otherwise healthy, with good urinary function and sexual potency, may also be candidates for prostatectomy. Nerve-sparing radical prostatectomy is often recommended for patients who want to preserve erectile function, as it aims to spare the neurovascular bundles responsible for erectile function.

Timeline

Before Prostatectomy:

  1. Patient undergoes diagnostic tests such as PSA blood test, digital rectal exam, and possibly a biopsy to confirm prostate cancer diagnosis.
  2. Patient discusses treatment options with their healthcare provider, including nerve-sparing radical prostatectomy for those concerned about maintaining erectile function.
  3. Patient undergoes pre-operative counseling and education about the procedure, potential risks and benefits, and expectations for post-operative recovery.

After Prostatectomy:

  1. Patient undergoes surgery to remove the prostate gland, with the goal of removing cancerous tissue while preserving erectile function by sparing the nerves responsible for erections.
  2. Patient may experience temporary side effects such as urinary incontinence and erectile dysfunction immediately following surgery.
  3. Patient undergoes post-operative monitoring and follow-up appointments to assess recovery, monitor for any complications, and discuss strategies for managing side effects such as erectile dysfunction.
  4. Patient may be prescribed medications or referred for additional treatments such as physical therapy or counseling to help manage erectile dysfunction.
  5. Patient may experience gradual improvement in erectile function over time as the nerves heal and regain function, with some patients able to resume normal sexual activity within a few months to a year post-operatively.

What to Ask Your Doctor

  1. What are the potential side effects and complications of a prostatectomy?

  2. How will erectile function be affected after the surgery?

  3. Are there any alternative treatments or procedures for prostate cancer that I should consider?

  4. What is the success rate of nerve-sparing radical prostatectomy in preserving erectile function?

  5. How experienced are you in performing nerve-sparing radical prostatectomy procedures?

  6. Can you explain the techniques you will use to preserve the nerves during the surgery?

  7. How long is the recovery period after a prostatectomy, and when can I expect to resume normal activities, including sexual activity?

  8. Will I need any additional treatments, such as hormone therapy or radiation therapy, after the surgery?

  9. What are the chances of the cancer returning after a prostatectomy?

  10. Are there any lifestyle changes or medications I should consider to improve my erectile function after the surgery?

Reference

Authors: Akhvlediani ND, Shvarts PG, Kirichuk YV. Journal: Urologiia. 2017 Dec;(6):149-152. PMID: 29376613