All about Prostatectomy

Although Prostate cancer is the second most leading cause of death due to cancer in men, the advancement of medical science has presented several types of treatments that have brought about a significant improvement in the survival rate. Surgery is the most common approach to treating this condition, where the prostate is removed entirely or partially. This process is better known as prostatectomy.

What is a prostatectomy? 

The term is used to describe the surgical procedure that removes the prostate gland, partially or completely. Typically, it involves a small surgical incision to accomplish it. There are two methods to do this: retropubic incision in the lower abdomen and a perineum incision done through the skin between the scrotum and the rectum. However, the approach will be determined depending upon your condition. 

Prostatectomy is a highly favored approach for the treatment of localized prostate cancer. Sometimes, it can also take place after radiation or hormone therapy. There are different options for this approach, such as radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy. 

Different types of radical prostatectomy 

Men who have been diagnosed with localized prostate cancer can opt for radical prostatectomy, which is used to surgically eradicate the entire gland and surrounding lymph nodes or a part of it. 

The several approaches to radical prostatectomy are-

Retropubic approach- This is the most commonly favored approach to conduct prostate cancer surgery. It is even effective if cancer has spread beyond the gland to the lymph nodes because the doctor can remove them easily by this procedure. However, if cancer has spread to other parts other than the lymph nodes, this form of surgery may not be sufficient to treat the condition. An incision is made in the abdomen to remove the prostate gland that is connected to the blood vessels. It is quite less invasive compared to the other types and ensures the recovery of the patient within a shorter time. 

Nerve Spring Prostatectomy- In highly complicated cases, cancer may get spread to the nerves that make it difficult for the surgeon to maintain the original structure or the proper functioning of the nerves. In fact, the nerves may be removed to get rid of cancer. However, if the nerve is cut from both sides, there is a high chance that the patient may face erectile dysfunction, which would not be getting better over time. Therefore, the most suitable approach is to cut and eliminate only one side of the nerve, if the situation permits that would let the patient have minor erectile functions left. In this way, the excellent network of blood vessels along the prostate gland will also be protected.  

Laparoscopic- Here, different small cuts are made, inside which thin tools are placed. A thin tube with a video camera is passed through a cut while several instruments are passed through others, which offer a clear vision to the doctor while performing the surgery. 

Robot-assisted procedure- This is nothing but laparoscopic surgery with the help of a robotic system. A robotic arm is controlled by the surgeon from a computer. Special sets of equipment are required to perform this surgery. 

Perineal approach- This procedure is favored not quite often due to the complications. However, if the nerve-sparing approach isn’t applicable in a certain condition, this can be helpful. It takes relatively less time, and the pain is also quite lesser compared to the other procedures. 

Reasons for getting a radical prostatectomy 

1. Treatment of localized prostate cancer
2. Recurring prostate bleeding 
3. Bladder stones 
4. Treating hydronephrosis 
5. Inability to empty bladder 

Risks factors

• Urinary incontinence
• Urine leakage
• Permanent erectile dysfunction 
• Sterility 
• Lymphedema

You are required to do the following before the surgery takes place-

• Fast for 8 hours
• Inform the doctor whether you are allergic to any anesthetic agents and latex, iodine, tape, etc.
• Inform the surgeon if you’re on any anti-coagulant medications
• Stop smoking 
• Remove any piece of jewellery from the body
• Empty your bladder completely 

Conclusion

Usually, regional anesthesia is preferred in this process. You are required to stay in the hospital for a couple of days after the surgery is over. Your diet will be monitored strictly, and you will gradually advance towards a solid food diet from liquid one. 

Read:- List of prostate cancer medications

List of Surgery for Prostate Cancer

The radical prostatectomy, basically a process for removal of the entire prostate gland, the seminal vesicles, and the vas deferens, is performed for malignant cancer. There are various ways through which radical prostatectomy surgery can be performed. Surgery for prostate cancer treatment involves removing the prostate gland, surrounding tissue, and a few lymph nodes. The entire prostate gland must be removed in order to make sure cancer cells aren’t left behind. This procedure is known as radical prostatectomy or “RP.”

Robotic-Assisted Laparoscopic Radical Prostatectomy: 

With the help of a robotic system (a mechanical device) that basically holds the surgical tools as well as camera. The prostate gland is removed through several 1- or 2-inch incisions into your belly. The success rate of this surgery generally depends upon how experienced your surgeon is. The more surgeries your doctor has done, the better he/she will be at performing this surgery.

Laparoscopic Radical Prostatectomy: 

Your surgeon will make six 1-inch cuts in your belly. Surgical tools and a small video camera fit through the incisions in order to remove your prostate.

Radical Retropubic Prostatectomy (Open): 

Your healthcare provider will make a cut in your lower belly for removing your prostate. This kind of surgery allows your healthcare provider in order to access the prostate gland and surrounding tissue at the same time, while reducing injury to other nearby organs.

Transurethral resection of the prostate: 

This is the standard surgical treatment for benign enlargement of the prostate.
This surgical procedure is used in order to relieve symptoms of urinary retention caused by the large prostate tumor, but it is not used in order to treat the cancer itself. Transurethral resection is done under spinal anesthesia, a kind of resectoscope is inserted inside the penis and the extra prostatic tissue is cut for clearing the way in order to pass the urine.

What can I expect after surgery:

As a patient you can expect to stay in the hospital for a few days after the surgery. You will return home with a catheter. Your doctor removes it at your first office visit, usually from 1 to 2 weeks after the surgery. In the case of confined prostate cancer, your doctor will go through with a screening test in order to check your PSA (prostate-specific antigen) level every 6 to 12 months. If your cancer has spread, your healthcare provider can recommend additional therapies, such as hormone therapy or radiation therapy.

When is surgery the best treatment:

Discuss with your healthcare provider as well as your family in order to find out appropriate treatment. But before making a decision you must consider the following:

• Your cancer stage and grade: Surgery is effective for prostate cancer stages T1 or T2 (cancer confined to the prostate) and sometimes stage T3 (cancer has spread outside the prostate). 
• Your overall health and age: Surgery is more suitable to those men who are healthy enough in order to handle the major operation and likely to live ten years or more. 
• Your intent: Some men with prostate cancer out there positively want their cancer completely removed. Others usually concerns about the several side effects from their treatment may affect their quality of life.

What are the side effects of surgery: 

Your side effects may be based on your health and age, and the type of the surgery you choose. But you may deal with:

• Erectile dysfunction: In some cases, erections can be recovered in about 24 months or sometimes longer. In case of not any effect, medicines, devices or surgery may help. Your healthcare provider can also prescribe drugs and devices during recovery in order to help bring back the erection function.
• Bladder problems (incontinence): Trouble controlling your urine is often temporary, but can last 6 to 12 months. You could also develop bladder irritation or infection, urine leakage, and blockage of the urine flow.                                                                                                  Physical therapy can improve bladder control.
• Changes in the shape of penis: There are chances of having a curve or a slight shortening of the length of the penis.
• Bleeding: A patient can be instructed in order to donate their own blood prior to the surgery or take a hormone in order to boost the blood count.
• Blood clots in the leg or pelvic veins: This occurs in a very small group of patients.
• Infertility: After surgery, a patient may no longer be a father through sexual intercourse. If this situation, discuss with your healthcare provider about alternate options, like artificial insemination.

Note: Apart from surgery, there are various FDA approved prostate cancer medications that are popular amongst the doctors in order to treat prostate cancer. These medications are as follows:

• Abiraterone Acetate: This medication (abiraterone 250 mg) is combined with other corticosteroids for the treatment of metastatic high-risk Castration sensitive prostate cancer and metastatic castration-resistant prostate cancer.  Abiraterone belongs to an antineoplastic class of drugs and is available in tablet form.

• Apalutamide: It is a non-steroidal anti-androgen medication used in the treatment of non-metastatic castration-resistant prostate cancer. It is consumed orally in the form of a tablet.

• Bicalutamide: This drug is an anti-androgen medication which is combined with gonadotropin-releasing hormone (GnRH) analog for the treatment of prostate cancer. It comes in a form of tablets.

• Cabazitaxel: It belongs to the microtubule inhibitor class drug used in the treatment of Castration resistant metastatic prostate cancer. This drug blocks the growth of cancerous cells by inhibiting its division.

• Casodex (Bicalutamide): It is an anti-androgen drug that is used for the treatment of prostate cancer it works by inhibiting the production of the male hormones and slowing down the growth of the cancerous cells. It is inhibited to be used in women or children.

• Darolutamide: It is a synthetic nonsteroidal androgen receptor (AR) commonly used in the treatment of non-metastatic castration-resistant prostate cancer. The highly recommended dosage of darolutamide is 300 mg available in tablet form.

• Degarelix: It is a hormonal therapy used in the treatment of advanced prostate cancer. It belongs to a group of the class called gonadotropin-releasing hormone (GnRH) receptor antagonists.

• Docetaxel: This drug is used in the treatment of prostate cancer, breast cancer, advanced stomach cancer, non-small cell lung cancer, pancreatic cancer, ovarian cancer, melanoma, soft tissue sarcoma, and head cancer. It is injected intravenously and the dose depends upon various factors such as age, weight, height, stage of cancer, and type of cancer.

• Eligard (Leuprolide Acetate): It is a palliative treatment of advanced prostate cancer. It is a prescribed drug that is injected intravenously.

• Enzalutamide: Enzalutamide 40 mg is a type of hormonal therapy used in the treatment of metastatic prostate cancer that has spread to other parts of the body.

• Erleada (Apalutamide): It belongs to a class of drugs known as anti-androgen which works by inhibiting the production of the male hormone. This drug is generally used in the case of Advanced prostate cancer.

• Firmagon (Degarelix):  it belongs to a hormonal therapy class drug that is used for the treatment of hormone-sensitive prostate cancer. It is a GnRH antagonist drug that has the ability to reduce serum testosterone.

• Flutamide: It is a nonsteroidal antiandrogen (NSAA) used in the treatment of androgen-dependent problems such as high androgen levels, excessive hair growth, and acne. It is consumed orally 3 times a day.

• Goserelin Acetate: This medication used to suppress the production of sex hormones (testosterone and estrogen), specifically for treating breast and prostate cancer.              Goserelin acetate should be administered by subcutaneous injection as an implant every 28 days for the duration of treatment. 

• Cabazitaxel: Cabazitaxel (Jevtana) is a semi-synthetic derivative of a natural taxoid. Jevtana together with the prednisone is recommended for treating hormone-refractory prostate cancer after treatment with docetaxel.

• Leuprolide Acetate: Leuprorelin (leuprolide acetate), is a manufactured version of a hormone used in order to treat prostate cancer. This drug should be given by injection into a muscle or under the skin. 

• Mitoxantrone Hydrochloride: Mitoxantrone (Novantrone) is basically an anthracenedione antineoplastic agent. Mitoxantrone together with the prednisone is approved as a second-line treatment for metastatic hormone-refractory prostate cancer.

• Nilutamide: Nilutamide, a NSAA drug (nonsteroidal antiandrogen drug) recommended for treating male patients with prostate cancer.                                                                      Nilutamide acts as the selective antagonist of the androgen receptor, in order to prevent the effects of androgens like testosterone and DHT (dihydrotestosterone) in the body. Because maximum prostate cancer cells rely on these hormones for growth and survival, nilutamide has the potential to slow down the progression of prostate cancer and extend the life in men with this disease. 

• Darolutamide: Darolutamide, an antiandrogen drug recommended for the treatment of male patients with the nmCRPC (non-metastatic castration-resistant prostate cancer). It is primarily approved in order to treat the non-metastatic castration-resistant prostate cancer (nmCRPC) in conjunction with the surgical or medical castration.

Note:- All the information given above is only for information purposes. Before taking any medication please consult with your Doctor.

Read:- Detailed on Prostate cancer medication 

List of Prostate Cancer Medications

Prostate cancer is the development of cancer in the prostate, a specific kind of gland that exists in the reproductive system of males. Most of the prostate cancers usually grow slowly. However, a few grow relatively very quickly.
Initially, there are often no signs and symptoms. When signs and symptoms do appear, they may be like BPH or an enlarged prostate. Prostate cancer may also cause signs and symptoms unrelated to BPH. In case of urinary problems, a respective patient should be instructed to talk with their healthcare professional about them.
Symptoms of prostate cancer can be:

• Dull pain in the lower pelvic area
• Frequent urination
• Trouble urinating
• Pain or  burning while urinating
• Weak urine flow
• Blood in the urine  
• Painful ejaculation
• Loss of appetite
• Loss of weight
• Bone pain 
• Pain in the upper thighs
• Pain lower back or hips

There are several drugs that are useful in the treatment of prostate cancer. These medicines are either used in combination with chemotherapy drug for targeted therapy

1. Abiraterone Acetate: This drug belongs to the CYP17 inhibitor class. It is combined with prednisone for the treatment of patients suffering from metastatic castration-resistant prostate cancer who have at least received any wire chemotherapy combined with docetaxel. This medicine is an inhibitor of CYP2D6 ( hepatic drug metabolism enzyme). This prostate cancer medicine is not co-administered with CYP2D6.
Abiraterone is available in a concentration of 250 mg and is prescribed to take daily or twice daily with or without food.
Some common side effects of Abiraterone 250 mg include diarrhea, cough, joint swelling, hypokalemia, muscle discomfort, hot flush, hypertension, urinary frequency, edema, and nocturia.

2. Enzalutamide: This drug is basically an androgen receptor inhibitor that is recommended to use for the metastatic castration-resistant prostate cancer treatment, for patients who have received docetaxel therapy.
This drug is present in capsule form of strength 40 mg which is administered orally with or without food. The capsule should be swollen whole.
Some common adverse reactions of this drug are lower respiratory infection, upper respiratory infection, peripheral, peripheral edema, headache, musculoskeletal pain, muscular weakness, tiredness, Insomnia, dizziness, hypertension, anxiety, spinal cord compression, paraesthesia, and fatigue.
Enzalutamide 40 mg is not recommended to be used in pregnant women as it may cause embryo-fetal toxicity.

3. Docetaxel: This drug is a microtubule inhibitor that is used for the treatment of hormone-refractory prostate cancer (HRPC). It is one of the most common chemotherapies in the UK of men having advanced prostate cancer.
This drug is available in injection form of multiple-dose vial strength 20mg/2ml, 80mg/8ml, and 160mg/16 ml.
Some common side effects of this drug are dizziness, weakness, paraesthesia, hypertension, insomnia, musculoskeletal pain, headache, edema, and upper respiratory tract infection.

4. Cabazitaxel: It belongs to the microtubule in a better class that is combined with other medications for the treatment of hormone-refractory metastatic prostate cancer. It is generally used in the patient who has received previous therapy of docetaxel containing treatment.
This therapy is offered when the patient stops responding to docetaxel. It is available in a single vial containing 60mg/1.5ml.
Some common adverse reactions of this injection include vomiting, nausea, diarrhea, neutropenia, anemia, back pain, abdominal pain, pyrexia, peripheral neuropathy, and leukopenia.

5. Darolutamide: This drug belongs to the androgen receptor in a better class drug that works for the treatment of non-metastatic castration-resistant prostate cancer.
It is available in tablet form of concentration 300mg which is administered twice daily.
The most common side effect of this medication is fatigue, pain, and discomfort

6. Olaparib: This drug is used for the treatment of prostate cancer that is castration-resistant and metastasis which has a mutation in several genes involved in the homologous recombination repair pathway. It is generally used in a patient whose condition has worsened after the treatment of abiraterone or enzalutamide.
Some common side effects include nausea, nausea, decreased hemoglobin, abdominal pain, decreased white blood cell count, upper respiratory tract infection, anemia, and fatigue.

7. Apalutamide: It refers to androgen receptor inhibitor class medication. This drug is used in the therapy of non-metastatic castration-resistant prostate cancer as well as metastatic Castration sensitive prostate cancer.
 It is available in a tablet form of concentration 60 mg which is administered orally once in a day, with or without food.
Some common adverse reactions of this drug are hair loss, depressed mood, bloating or swelling of face, muscle cramps, muscle pain, husky voice, muscle stiffness, and feeling cold.

8. Degarelix: It is a GnRH receptor antagonist in the treatment of patients suffering from advanced prostate cancer.
This drug is injected intravenously and is available in a single vial of concentration 80 mg and 120 my.
Some common reactions of this medication are weight gain, hot flashes, redness and swelling in Eyes, injection site pain, and an increase in some liver enzymes.

9. Bicalutamide: It is used in the treatment of stage D2 metastatic carcinoma of the prostate. It belongs to the androgen receptor inverter class truck that is combined with luteinizing hormone-releasing hormone analog.
It is available in tablet form of concentration 50 mg. This tablet is consumed once in a day, with or without food. This drug is contraindicated to be used in pregnant women and patients suffering from hypersensitivity.
Some common adverse reactions of this medication include blood in urine, bloating and swelling of body parts, headache, difficulty in breathing, cough producing mucus, congestion, dryness of throat, and weight gain.

10. Leuprolide: This medicine is a gonadotropin-releasing hormone used for the treatment of advanced prostatic cancer.
It is available in dual-chamber serials of concentration 7.5mg, 22.5mg, 30mg, and 45mg.
Some common side effects of this drug are hot flashes, weight gain, mood change, headache, testicle in body, body pain, redness in eyes, and decrease testicle size.

11. Nilutamide: Nilutamide specifically is a nonsteroidal antiandrogen (NSAA) which is prescribed in order to treat prostate cancer. 

Nilutamide comes in the form of tablets, acts as a selective antagonist of the androgen receptor (AR), in order to prevent the effects of androgens like dihydrotestosterone (DHT) and testosterone in the body.

Certain side effects in men include breast tenderness and enlargement, hot flashes, sexual dysfunction, and feminization. Nausea, visual disturbances, vomiting, alcohol intolerance, elevated liver enzymes, and lung disease may occur in the both sexes.

12. Rucaparib Camsylate: Rucaparib is used for treating adult patients with a deleterious BRCA mutation linked with mCRPC who have been taken treatment with androgen receptor- directed therapy as well as a taxane-based chemotherapy. 

Rucaparib comes in the form of tablets. The recommended dosage needs to be given orally twice in a day either with or without food.

Some most commonly reported adverse reactions of Rucaparib among patients with BRCA-mutated mCRPC include: rash, nausea, fatigue, anemia, ALT/AST increased, decreased appetite, constipation, thrombocytopenia, vomiting, and diarrhea.

13. Goserelin Acetate: As an injectable gonadotropin releasing hormone agonist (GnRH agonist), Goserelin used in order to suppress the production of the sex hormones (testosterone and estrogen), particularly in the treatment of prostate cancer. 

Goserelin comes in order to be administered subcutaneously. 

This medication may cause hot flashes, bone pain, headache, depression, stomach upset, difficulty urinating (isolated cases), weight gain, swelling and tenderness of breasts, decreased sexual desire and decreased. 

NOTE: The piece of information mentioned about "List of Prostate Cancer Medications" in this article is just for the informational purposes and is not served as a substitute for medical treatment, consultation, diagnosis of a qualified doctor.

Related:- How do you know if you have prostate cancer?