A radical prostatectomy is a surgical intervention that involves removing the entire prostate gland and seminal vesicles to treat the prostate cancer. The aim is to eliminate the tumour and offer prospects of a cure when the cancer is localised or locally advanced.
At the Willy Grégoir Prostate Cancer Centre this procedure is carried out exclusively by experienced surgeons using robot-assisted methods.
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A radical prostatectomy is recommended for patients with a life expectancy of more than 10 years who present a prostate cancer of intermediate or high risk. Also for certain low risk patients who want a treatment that aims to achieve an immediate cure. All patients are potential candidates provided they can tolerate a general anaesthetic.
There is a structured pathway for a radical prostatectomy that ensures optimal preparation, a secure intervention and appropriate follow-up.
Preoperative evaluation
Before the surgery there are a number of essential stages that must be respected:
- Extension assessment: if necessary, a bone scan/ scintigraphy or a PSMA PET-CT scan are carried out to evaluate the extent of the cancer.
- Surgical consultation: discussion on whether or not an associated lymph node dissection is indicated, risk of urinary incontinence and the reasons, and the possibility of conserving the erectile nerves.
- Anaesthetic consultation: assessment of risks associated with the anaesthetic and preparation for the surgery.
- Perineal preparation: muscle strengthening exercises with a specialised physiotherapist to limit risks of urinary incontinence following the operation.
Surgery
The surgery is carried out under general anaesthetic:
- Duration of surgery: 2 to 4 hours depending on the complexity of the case.
- Placing of a bladder catheter that is removed after 5 to 7 days.
- ¨Possible placing of an abdominal drain, removed in the days following the operation.
Hospitalisation
Patients are generally hospitalised for between 1 and 5 days for the purposes of:
- Pain management in the interests of patient comfort.
- Measures to prevent complications, such as the administering of anticoagulants if necessary to avoid thromboses
- Planning of post-surgery consultations.
Follow-up
Post-prostatectomy follow-up is crucial for assessing the results and monitoring any complications:
- PSA test at 6-8 weeks after surgery, then every 3 to 6 months during first years.
- Discussion on the need for further treatment in the event of recurrence or identified risk factors.
- Monitoring of functional complications (urinary incontinence, erection problems) and putting into place of appropriate rehabilitation if needed.
A radical prostatectomy offers the prospect of a total cure for patients with a localised or locally advanced prostate cancer. By removing the entire prostate and neighbouring tissue this surgery eliminates the tumour and reduces significantly the risk of the cancer progressing further or recurring.
One of the major benefits of a prostatectomy is that it makes it possible to obtain precise information on the real aggressiveness of the cancer on the basis of an anatomopathological analysis of the removed prostate. This detailed evaluation helps adapt the follow-up and, if necessary, to plan further treatment (radiotherapy, hormone therapy).
In addition, a radical prostatectomy facilitates precise monitoring thanks to the PSA test, with levels that should be undetectable after successful surgery. Any possible return of the cancer can therefore be detected rapidly.
Although curative, a radical prostatectomy does bring certain risks and complications, whether immediately or in the long term.
At the functional level, urinary incontinence is a frequent complication in the months following surgery, affecting around 10% of patients persistently. This incontinence often improves over time and with an appropriate perineal rehabilitation. Erection problems are also frequent, especially if the erectile nerves cannot be preserved. These side effects can have an impact on quality of life but therapeutic options do exist to reduce them.
At the surgical level, immediate complications can occur, such as bleeding, infections, a deep vein thrombosis and pulmonary embolism or, more rarely, damage to neighbouring organs
The importance of expertise in robotic surgery
Robotic systems are exceptional tools, permitting surgery of millimetre precision. However, the technology alone is not sufficient! Expertise in robotic surgery is crucial to guarantee optimal results from a radical prostatectomy. Command of this technique requires not only specialised training but substantial experience, generally acquired over at least 250 cases and an annual volume of at least 50 surgical interventions. This experience equips the surgeon to better manage complex situations and adapt the surgical methods to the specificities of each patient, this contributing to a higher overall success rate.
Studies have shown that the surgeon’s expertise and the annual volume of cases have a direct impact on the postoperative results of patients. These include:
- Reduction of complications: Reduced risk of complications such as urinary incontinence and erection problems, due to a better command of nerve conservation techniques and management of neighbouring tissue.
- More rapid recovery: More precise and more rapid interventions with shorter period of hospitalisation.
- Less local recurrence of cancer: Better surgical removal of tumour tissue with reduced risk of the cancer returning.
Surgeons at the Willy Grégoir Prostate Cancer Clinic meet all the criteria necessary to guarantee quality care. With more than 50 surgical interventions a year and more than 250 to 1000 cumulated cases, our surgeons specialised in robotic surgery have the necessary experience and skills to provide optimal results while minimising risks and complications.