Our Summary
This research paper discusses the evolution of prostate cancer treatment, specifically focusing on the radical prostatectomy procedure. This surgery, first introduced around 1900, was initially quite dangerous, often resulting in significant blood loss and unsatisfactory results. Over time, the procedure has significantly improved, with the development of the minimally invasive robot-assisted method in 2000 being a major milestone.
The application of this surgery has also changed over time. Up until 1980, surgery was often the first course of action for advanced and early metastatic prostate cancer. Now, thanks to advances in molecular understanding of the disease, many men with a less aggressive form of prostate cancer can avoid surgery and instead opt for active monitoring of the disease.
In 2020, surgery is no longer recommended for men with low-grade, low-volume Gleason 6 prostate cancer. This is a significant shift, as these men make up about 40% of newly diagnosed prostate cancer cases and were previously often offered surgery, which provided little benefit and had considerable side effects.
However, surgery remains an effective treatment for those with intermediate-risk and high-risk disease. It can prevent the spread of potentially deadly prostate cancer cells. In some cases, it might also be recommended for men with a small amount of metastasis (spread of the cancer to other parts of the body), as part of a multi-treatment approach.
Even in older men in good health, surgery has been shown to be a viable option, a change from 20 years ago when these men were rarely offered surgery. While the development of new medical treatments for prostate cancer might reduce the need for surgery, the demographics of prostate cancer are changing, meaning that radical prostatectomy still has an important role to play in treating many men with the disease.
FAQs
- How has the application of prostatectomy changed over time in treating prostate cancer?
- Why is surgery no longer recommended for men with low-grade, low-volume Gleason 6 prostate cancer?
- Who are the current primary candidates for radical prostatectomy in the treatment of prostate cancer?
Doctor’s Tip
A helpful tip a doctor might tell a patient about prostatectomy is to discuss all potential risks and benefits with their healthcare team before making a decision. It’s important for patients to understand that while surgery can be an effective treatment for prostate cancer, it also carries risks such as incontinence and erectile dysfunction. Patients should also be aware that there are alternative treatment options available, such as active surveillance or radiation therapy, that may be more appropriate depending on their individual situation. Ultimately, the decision to undergo prostatectomy should be made in consultation with a healthcare provider who can provide personalized guidance based on the patient’s specific needs and preferences.
Suitable For
In conclusion, patients who are typically recommended prostatectomy are those with intermediate-risk and high-risk prostate cancer, as well as those with a small amount of metastasis. Older men in good health may also be candidates for surgery, as well as those with aggressive forms of the disease. However, for men with low-grade, low-volume Gleason 6 prostate cancer, surgery is no longer recommended as the first course of action. It is important for patients to discuss their individual case with their healthcare provider to determine the best treatment plan for their specific situation.
Timeline
Before a prostatectomy, a patient will typically undergo a series of tests and consultations to determine the best course of action. This may include a biopsy to confirm the presence of prostate cancer, imaging tests to determine the stage of the cancer, and discussions with their healthcare team to weigh the benefits and risks of surgery. Patients may also undergo pre-operative preparation, such as bowel preparation and stopping certain medications.
After a prostatectomy, patients will typically spend a few days in the hospital for recovery. They will be closely monitored for any complications, such as infection or excessive bleeding. Once discharged, patients will need to follow a strict regimen of post-operative care, including pain management, wound care, and possibly physical therapy to regain strength and mobility. Patients will also need to follow up with their healthcare team for monitoring of their recovery and any potential side effects or complications.
In the long term, patients may experience changes in urinary and sexual function following a prostatectomy. Incontinence and erectile dysfunction are common side effects of the surgery, but can often improve over time with proper management and rehabilitation. Patients may also need to undergo regular follow-up appointments and tests to monitor for any recurrence of the cancer or other complications. Overall, the experience of a patient before and after a prostatectomy can be challenging, but with the advancements in surgical techniques and post-operative care, many men are able to successfully recover and resume a normal quality of life.
What to Ask Your Doctor
Some questions a patient should ask their doctor about prostatectomy include:
- What are the potential risks and complications associated with a prostatectomy?
- How will my quality of life be affected after the surgery?
- What is the recovery process like, and how long will it take?
- Are there any alternative treatment options available, and how do they compare to surgery?
- How will my sexual function and urinary control be affected after the procedure?
- What is the success rate of the surgery in terms of removing the cancer?
- Will I need additional treatments, such as radiation or hormone therapy, after the surgery?
- How experienced is the surgical team performing the procedure?
- How often do you perform this type of surgery, and what are your outcomes?
- Are there any specific lifestyle changes or precautions I should take before and after the surgery?
Reference
Authors: Costello AJ. Journal: Nat Rev Urol. 2020 Mar;17(3):177-188. doi: 10.1038/s41585-020-0287-y. Epub 2020 Feb 21. PMID: 32086498