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There are three basic types of radical
prostatectomy procedures. Here are some guidelines to
help patients decide if prostate surgery is right for
them:
- Tumor is confined to prostate
gland (stages T1 and T2)
- No regional lymph node metastasis
(stage N0)
- No distant metastasis (stage
M0)
- Under the age of 75
Not meeting all of the above criteria,
however, does eliminate prostatectomy as a possible
treatment option. Read on to find out who’s receiving
what prostatectomy and why. Then speak to a doctor to
see if prostatectomy may be right for you.
Age
and Health of Prostate Cancer Patients
Prostatectomies are generally a good option for those
under the age of 75. For example, based on current data, if a 60-year-old prostate cancer patient has a Gleason score of 7, he can expect to live about 10 more years. Because of the risks and side effects
involved with the prostate surgery, doctors generally
do not recommend prostatectomy unless a patient can
reasonably expect to benefit for another 10 years. The
age of 75, however, is used only as a benchmark. Some
surgeons will not perform a prostatectomy for any patient
over 75, while other physicians are more lenient.
A patient’s age is generally treated as a relative
factor. Younger patients who suffer from other health
problems, especially cardiovascular problems, are poor
candidates of surgery. Radical prostatectomy involves
surgical risks including heart attacks, blood clots,
strokes, and, in rare cases, death. In some instances,
a doctor may feel a patient’s general health disqualifies
him for prostatectomy as prostate
cancer treatment.
Prostate Cancer Stage
During the prostate surgery, the surgeon will attempt
to remove the lymph nodes. During the retropubic prostatectomy,
when the incision is in the lower abdomen and about
8 cm long, the surgeon removes the lymph nodes near
the bladder and gives them to a pathologist. If the
pathologist finds that the cancer has metastasized,
the surgery is stopped. Patients who are in the N1 stage
will not be helped by prostatectomy because the surgery
can remove the disease only when it is confined to the
prostate gland.
Prostate cancer patients, who are
in the M1 stage (distant metastasis to other parts of
the body, usually the bones) are not candidates for
prostatectomy. The removal of the prostate gland will
not slow the progression of the disease. These patients
should consider other treatments. Patients who are in
stages T1 or T2 do not exhibit any extension out of
the prostate gland and should consider prostatectomy.
These patients may also be eligible for the nerve-sparing
technique that can preserve erectile function.
Choosing a Prostatectomy
Patients who suffer from obesity are generally candidates
only for the radical perineal prostatectomy. The perineal
prostatectomy goes through the perineum, and, in obese
patients, perineal prostatectomy becomes much easier
for the surgeon and lowers the risk of complications
for the patient.
Patients who exhibit pubic arch interference may not be good candidates for the perineal
prostatectomy. Pubic arch interference may complicate
perineal prostatectomy. These patients may be better
candidates for the retropubic or the laparoscopic procedures.
The choice of procedure should ultimately
be determined by the surgeon’s experience. If
a surgeon has performed 100 robotic prostatectomies in the last year but no laparoscopic prostatectomies,
the patient should rely on the surgeon’s expertise
as the best bet for a successful procedure.
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