Prostate cancer surgery: Difference between revisions
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===Prostatectomy=== | ===Prostatectomy=== | ||
Surgical removal of the prostate, or [[prostatectomy]], is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. The most common type is [[radical retropubic prostatectomy]], when the surgeon removes the prostate through an abdominal incision. Another type is [[radical perineal prostatectomy]], when the surgeon removes the prostate through an incision in the [[perineum]], the skin between the [[scrotum]] and [[anus]]. Radical prostatectomy can also be performed laparoscopically, through a series of small (1cm) incisions in the abdomen, with or without the assistance of a surgical robot. | |||
[[Radical prostatectomy]] is effective for tumors which have not spread beyond the prostate;<ref name="pmid15888698">{{cite journal |author=Bill-Axelson A, Holmberg L, Ruutu M, ''et al'' |title=Radical prostatectomy versus watchful waiting in early prostate cancer |journal=N. Engl. J. Med. |volume=352 |issue=19 |pages=1977–84 |year=2005 |pmid=15888698 |doi=10.1056/NEJMoa043739}}</ref> cure rates depend on risk factors such as PSA level and Gleason grade. However, it may cause [[nerve]] damage that significantly alters the quality of life of the prostate cancer survivor. | |||
Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications. | Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications. | ||
Laparoscopic radical prostatectomy, LRP, is a new way to approach the prostate surgically with intent to cure. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy does not require a large incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment. | |||
In the hands of an experienced surgeon, | In the hands of an experienced surgeon, robotic assisted laparoscopic prostatectomy (RALP) may reduce positive surgical margins when compared to [[radical retropubic prostatectomy]] (RRP) among patients with [[prostate cancer]] according to a retrospective study.<ref name="pmid17936849">{{cite journal |author=Smith JA, Chan RC, Chang SS, ''et al'' |title=A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy |journal=J. Urol. |volume=178 |issue=6 |pages=2385–9; discussion 2389–90 |year=2007 |pmid=17936849 |doi=10.1016/j.juro.2007.08.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(07)01979-9}}</ref> The [[relative risk reduction]] was 57.7%. For patients at similar risk to those in this study (35.5% of patients had positive surgical margins following RRP), this leads to an [[absolute risk reduction]] of 20.5%. 4.9 patients must be treated for one to benefit ([[number needed to treat]] = 4.9). The relative merits of RALP and benefits over open radical prostatectomy are an area of intense research currently in urology and no definitive data, that has been widely accepted by the broader urological community, exists to say it is superior to a open radical retropubic prostatectomy. | ||
[[Transurethral resection of the prostate]], commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis ([[urethra]]) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument ([[cystoscope]]) is placed into the penis and the blocking prostate is cut away. | [[Transurethral resection of the prostate]], commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis ([[urethra]]) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument ([[cystoscope]]) is placed into the penis and the blocking prostate is cut away. | ||
Revision as of 19:41, 16 April 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
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Surgery
Prostatectomy
Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. The most common type is radical retropubic prostatectomy, when the surgeon removes the prostate through an abdominal incision. Another type is radical perineal prostatectomy, when the surgeon removes the prostate through an incision in the perineum, the skin between the scrotum and anus. Radical prostatectomy can also be performed laparoscopically, through a series of small (1cm) incisions in the abdomen, with or without the assistance of a surgical robot.
Radical prostatectomy is effective for tumors which have not spread beyond the prostate;[1] cure rates depend on risk factors such as PSA level and Gleason grade. However, it may cause nerve damage that significantly alters the quality of life of the prostate cancer survivor.
Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival. Surgery may also be offered when a cancer is not responding to radiation therapy. However, because radiation therapy causes tissue changes, prostatectomy after radiation has a higher risk of complications.
Laparoscopic radical prostatectomy, LRP, is a new way to approach the prostate surgically with intent to cure. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy does not require a large incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment.
In the hands of an experienced surgeon, robotic assisted laparoscopic prostatectomy (RALP) may reduce positive surgical margins when compared to radical retropubic prostatectomy (RRP) among patients with prostate cancer according to a retrospective study.[2] The relative risk reduction was 57.7%. For patients at similar risk to those in this study (35.5% of patients had positive surgical margins following RRP), this leads to an absolute risk reduction of 20.5%. 4.9 patients must be treated for one to benefit (number needed to treat = 4.9). The relative merits of RALP and benefits over open radical prostatectomy are an area of intense research currently in urology and no definitive data, that has been widely accepted by the broader urological community, exists to say it is superior to a open radical retropubic prostatectomy.
Transurethral resection of the prostate, commonly called a "TURP," is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument (cystoscope) is placed into the penis and the blocking prostate is cut away.
In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth. (See hormonal therapy, below).
The most common serious complications of surgery are loss of urinary control and impotence. Reported rates of both complications vary widely depending on how they are assessed, by whom, and how long after surgery, as well as the setting (e.g., academic series vs. community-based or population-based data). Although penile sensation and the ability to achieve orgasm usually remain intact, erection and ejaculation are often impaired. Medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may restore some degree of potency. For most men with organ-confined disease, a more limited "nerve-sparing" technique may help reduce urinary incontinence and impotence.[3]
Cryosurgery
Cryosurgery is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures.[4] It is less invasive than radical prostatectomy, and general anesthesia is less commonly used. Under ultrasound guidance, a method invented by Dr. Gary Onik,[5] metal rods are inserted through the skin of the perineum into the prostate. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −186 °C (−302 °F). As the water within the prostate cells freeze, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid. Cryosurgery generally causes fewer problems with urinary control than other treatments, but impotence occurs up to ninety percent of the time. When used as the initial treatment for prostate cancer and in the hands of an experienced cryosurgeon, cryosurgery has a 10 year biochemical disease free rate superior to all other treatments including radical prostatectomy and any form of radiation.[6] Cryosurgery has also been demonstrated to be superior to radical prostatectomy for recurrent cancer following radiation therapy.
References
- ↑ Bill-Axelson A, Holmberg L, Ruutu M; et al. (2005). "Radical prostatectomy versus watchful waiting in early prostate cancer". N. Engl. J. Med. 352 (19): 1977–84. doi:10.1056/NEJMoa043739. PMID 15888698.
- ↑ Smith JA, Chan RC, Chang SS; et al. (2007). "A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy". J. Urol. 178 (6): 2385–9, discussion 2389–90. doi:10.1016/j.juro.2007.08.008. PMID 17936849.
- ↑ Gerber, GS (1996). "Results of radical prostatectomy in men with clinically localized prostate cancer". JAMA. 276 (8): 615–9. doi:10.1001/jama.276.8.615. PMID 8773633. Unknown parameter
|month=ignored (help); Unknown parameter|coauthors=ignored (help) - ↑ PreventProstateCancer.info: A Brief Overview of Prostate Cancer [1]
- ↑ "Cryosurgical system for destroying tumors by freezing". Retrieved 1994-08-02. Check date values in:
|accessdate=(help) - ↑ Bahn, DK (2002). "Targeted cryoablation of the prostate: 7-year outcomes in the primary treatment of prostate cancer". Urology. 60 (2 Suppl 1): 3–11. doi:10.1016/S0090-4295(02)01678-3. PMID 12206842. Unknown parameter
|month=ignored (help); Unknown parameter|coauthors=ignored (help)