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How long does it normally take to return to work after prostate surgery?

Notes:

My urologist performed a radical retropubic prostectomy on Tuesday, Jan 6th and I was back working on Monday Jan 12th. I’m fortunate enough to telecommute, so I’m working from home for a while. [Source]

You should not plan to go back to work for 2 to 3
weeks after surgery. This will depend on the kind
of work you do and how fast you heal. Your
surgeon can tell you more about going back to
work. [source]

After prostatectomy, take it easy for the first few weeks. Do not lift anything over 10 pounds or engage in any strenuous activity, as this could cause serious, long-term complications. If you have a desk job, you should be able to return to work after three to four weeks. prostate cancer survivors who return to work are as productive on the job as other workers. [source]\

Most men get back to normal a few weeks after the prostate surgery and you should be able to return to work within six to eight weeks. This will depend on the physical demands of your job. Take your doctor’s advice about when you are ready. [Source]

Some people take five months to return to work [Source]

You may feel surprisingly good after the surgery, but don’t go overboard. “Too many patients want to prove their manliness,” Thrasher says. “They need to rest and give their wounds a chance to heal.” He tells patients not to lift anything heavier than 10 to 15 pounds for at least six weeks. Many patients can quickly return to work, as long as it’s not too strenuous, he says. [Source]

As soon as you’re free of the catheter you’ll probably feel fine being back at work. [Source]

 

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How is the prostate removed through a hole in robotic surgery?

The holes in robotic surgery are quite small (generally 5 cuts/ holes)

“a few small holes in the skin, each roughly the size of a dime. A small plastic tube known as a “port” is inserted in each hole to keep a channel open for laparoscopic Port Placement image tools to reach through.” [Source]

The prostate is a largish organ. How is it removed through these small holes?

It appears the removed prostate is put into a metallic mesh bucket at the end and sucked out by the machine through the hole. Presumably some cancer cells might get pushed off during this process?

The video below shows some portions of material being dumped into a “bucket” at 53 minutes 45 seconds or so.

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Focal laser therapy + Nanoknife for prostate cancer in Australia

“What we are doing with prostate cancer now is like using a sledgehammer to kill a flea.” [Source]

“This focal therapy provides a middle ground for men to choose between radical prostatectomy and active surveillance, between doing nothing and losing the prostate,” Marks said. “This is a new and exciting concept for prostate cancer treatment.” [Source]

Focal therapies are less invasive than prostatectomy and therefore carry fewer risks and side effects are greatly reduced: – Fewer complications (such as bleeding, infection, injury to other organs, risk of death), reduced pain, shorter recovery along with reduced aftercare and rehabilitation.

Focal therapies are new methods of treatment which have recently been made possible through more precise diagnostics and improved MRI technologies. The idea behind this technique is that only the cancerous tissue is treated so that as much healthy prostate tissue as possible is retained. [Source]

Laser ablation generates intense heat that completely encompasses the targeted area. [Source]. Also see this.

IN AUSTRALIA

Macquarie University

NANOKNIFE – $30,000

http://www.smh.com.au/national/health/prostate-cancer-patients-zapped-with-electricity-in-new-treatment-20151118-gl1ybg.html

BUT CANCER RETURNS QUITE A BIT: “in a study of 25 patients, in 76 per cent of cases the cancer had not returned after eight months.”

 

 

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Any proven way to reduce the spread/ metastasis of prostate cancer?

CLINICAL TRIAL

http://trials.cancervic.org.au/details.aspx?ID=vctl_actrn12612000523808

 

This is a cut paste. Analysis later.

CARROTS

Contains amygdalin [Source] – assuming it works!

  • bean sprouts
  • beans
  • raw almonds

CUT WEIGHT!!!

obese men with prostate cancer are more likely to have aggressive tumours.  prostate cancer cells were more likely to invade nearby tissue when mice were obese  – this was due to the presence of more fat tissue. [Source]

ASPIRIN – MEDICAL OBSERVATIONAL STUDY

“We found that regular aspirin intake after prostate cancer diagnosis decreased the risk of prostate cancer death by almost 40 percent,” Among men with prostate cancer, regular aspirin use after diagnosis was associated with a 39 percent lower risk of dying from prostate cancer.  [Source]

Allard speculated that aspirin’s ability to suppress platelets in the blood — which is why aspirin can cause bleeding as a side effect — might help explain how aspirin could prevent the lethal progression of prostate cancer.

“Platelets probably shield circulating cancer cells from immune recognition,” he said. “By depleting those platelets, you’re allowing the immune system to recognize the cancer.”

Allard added that aspirin likely helps prevent the cancer from spreading to other areas of the body, such as the bone.

In the study, men without a diagnosis of prostate cancer who took more than three aspirin tablets a week had a 24 percent lower risk of getting a lethal prostate cancer.

NATIONAL CANCER INSTITUTE RECOMMENDATIONS ON DIET

foods and dietary supplements to lower the risk of developing prostate cancer or for treating prostate cancer,

  1. pomegranate
  2. processed tomato
  3. Vitamin D
  4. Selenium

OMEGA-3

eating a diet rich with omega-3 polyunsaturated fatty acid could stop the spread of prostate cancer, but omega-6 fatty acids appear to promote the spread [Source] = READ THIS STUDY IN FULL.

freeze-dried black raspberries and strawberries [Source].

UNPROVEN

B17

Patients’ story: https://cancercompass.com/message-board/message/all,31581,0.htm

CUT DOWN ANIMAL FATS??

Arachidonic acid (AA) – a type of omega-6 fatty acid found in meat and fish. Cancer cells exposed to AA became rounder in shape and sprouted projections which helped them squeeze through gaps in surrounding tissue. But treating the cells with statins prevented the changes, says a report in the British Journal of Cancer. [Source]

ANTI-DEPRESSANTS [Source]

 

vascular-targeted photodynamic therapy (VTP),

In a broad clinical trial at 47 treatment sites across 10 different European countries, 49 percent of patients with early prostate cancer that were treated with VTP went into complete remission, compared with 13.5 percent in the control group. [Source]  – but this is not necessarily superior.

Focal Laser Ablation

Focal Laser Ablation

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Decision regarding the surgery

Having ruled out active surveillance and radiation therapy, the final decision I needed to take was about the type of surgery and the timeline. I initially thought that I could wait a few weeks, but new information received on 23 May has prompted me to be a bit more aggressive about the surgery date.

However, various circumstances mean that the date is broadly as predicted, in mid-July.

I initially thought I’d undertake surgery in the public system, but finally decided on robotic surgery for a single reason.

I undertake open (not robotic) surgery in the public system at the earliest date (allowing around 4-6 weeks for recovery from the biopsy) and to undertake any feasible portion of the trip to Europe/India before the surgery.

QUALIFICATION: Given that I knew nothing about prostate cancer till 18 May, and have learnt everything I know about it in the past week, I will change my decision if new and more persuasive information comes in.

Reasons

1. Type of surgery

I will undertake open surgery (not robotic) given there is no difference in outcomes between the two, particularly after the first three months.

2. Timeline for the surgery

a) Waiting for biopsy surgery to heal

It is a good thing to wait 6-8 weeks for the biopsy surgery to heal (details here).

b) Going only my biopsy results and PSA, it is OK to get surgery within 75 days from biopsy

The table, below, from a major study on this issue is very useful (Study: Delay From Biopsy to Radical Prostatectomy Influences the Rate of Adverse Pathologic Outcomes William T. Berg,1 Matthew R. Danzig,1 Jamie S. Pak, et al. -PDF is available online)

The table above shows that PSA is more influential in determining the severity of the cancer than the Gleason pattern score, alone. Further PSA is more reliable (being objective, compared with Glaeson scores which are subjective). My cancer is ranked Gleason 7 (but 3+4, not 4+3). Since this is a milder form of Gleason 7, a delay of between 105 and 150 days should be OK.

But even if biopsy has been poorly done and a portion of the tumour with Gleason 8 was accidentally excluded, I have up to 75 days.

Data from the biopsy suggest that a delay of 75 days is ACCEPTABLE (i.e. till 25 July 2017, given the biopsy took place on 11 May 2017. Surgery between 5 July and 25 July should not meaningfully impact the spread of cancer.

c) Relevant data: My tumour is located in the transitional zone and is pushing the edge

My MRI report is shows that the cancer is located in the transition zone (abutting it for 1 cm) and is causing a slight bulge in the body of the prostate.

 

There is evidence in the literature [see this] the the location of a cancer is related to the prospects of metastasis. Although there may be some time, I should not wait unnecessarily.

d) Relevant theory: At my age the cancer may become aggressive

It is a fact that even after radical surgery, prostate cancer returns (having probably spread prior to the surgery). All it takes is one aggressive cell to get out.
An oncologist from Mumbai told me that at relatively younger ages, cancer can mutate into the aggressive varieties more quickly, compared with what happens in one’s 70s and 80s. This, too, suggests, not waiting unnecessarily. 

There is contrary evidence that “in the vast majority the cancer is born with a particular Gleason score.”  “You might see progression in an individual, but we think that it’s uncommon,” she says. “We just can’t rule out this possibility in our study.” [Source]

“advanced cancers [that have spread] are not being found as much because PSA testing has identified them earlier, but aggressive cancers (high Gleason score) are being found at the same rate. The aggressive cancers are being found early (i.e., when they are “born”), rather than transforming into aggressive cancers over time.” [Source]

However, on balance, the logic does suggest that there remains a risk of metastasis given my age profile. Medical science doesn’t have all the answers.

CONCLUSION

I am now processing the surgery in the public system (which is free compared with $10,000 or so for robotic surgery through private health insurance). There is a wait time of around 30 days for prostate surgery in Victoria (such as here).

This is likely to take some time and might allow me to undertake a part of the planned trip.

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MRI report for prostate

My MRI report dated 20 April 2017

MRI PROSTATE

Clinical Notes: Elevated PSA 3.95.

Report: Routine multi-parametric 3T imaging of the prostate. Prostate volume 35ml.

There is a large PIRADS 5 lesion centred within the right anterior transitional zone involving the mid gland apex. This measures 20 x 8 x 15mm in size (AP x CC x trans). Anteriorly, this abuts the anterior fibro-muscular stroma, with subtle bulging of the capsule but no visible tumour extending beyond the gland. The tumour has more than 10mm of abutment of the capsule and has at least moderate likelihood of microscopic extra capsular extension. The left side of the transitional zone shows mild nodular change and BPH, with no suspicious lesion.

The peripheral zone shows mild diffuse low T2 signal change without a focal nodule or restricted diffuse and there is no lesion involving the peripheral zone.

The prostate contour remains smooth and the recto-prostatic angles are preserved.

The seminal vesicles are normal. There is no pelvic lymphadenopathy. Bone marrow signal within the imaged field is normal.

Conclusion: 20mm PIRADS 5 lesion, right anterior transitional zone in mid gland and apex. There is capsular abutment with minor bulging and abutment of the anterior fibro-muscular stroma. Moderate likelihood of ECE.

Seminal vesicles, lymph nodes and bone marrow are normal.

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Which is better for prostate surgery – open surgery or robotic?

CONS OF USING ROBOTIC SURGERY

This doctor does not recommend robotic surgery http://www.drcatalona.com/qa/faq_initial-treatment.asp

Reasons: “it is far more difficult to get consistently good results because it does not afford the surgeon as much control as with the traditional operation. Also, it does not provide tactile feedback, and it is more difficult to suture laparoscopically.  The surgeon cannot tell how hard the robot is grasping tissue, or, if the angle of the needle is wrong and if the needle does not pass through the tissues easily, the robot continues to “muscle” its way through. With tactile feedback afforded by open surgery, the surgeon would “feel” the mistake and make the necessary adjustment.

Having seen laparoscopic and robotic surgery performed by most of the world’s most experienced experts, I don’t believe it allows nerve-sparing to be performed with the same degree of fine control without risking thermal damage to the neurovascular bundles, and I do not believe removal of the cancer is as consistently complete.

STUDY

the most significant outcomes (cure, continence, and potency) are no better with LRP or RALRP than with conventional ORP. Therefore, in experienced hands, ORP remains the gold standard procedure [ Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US  experience – Julia Finkelstein, BSc, Elisabeth Eckersberger, MPA, Helen Sadri, MD, Samir S Taneja, MD, Herbert Lepor, MD, and Bob Djavan, MD, PhD]

STUDY IN AUSTRALIA – no real difference in outcomes

Expensive robotic prostate surgery, marketed as “ground breaking”, “revolutionary” and “nerve sparing”, has been found to be no better at preserving men’s urinary continence and sexual function than traditional surgery. A landmark Australian study made the finding after comparing the advanced surgery, which can cost more than $10,000, with traditional open surgery three months post operation.  Patients who had the open surgery lost more blood during the procedure but none of them needed transfusions. Patients who had open surgery had a longer hospital stay post surgery and experienced more pain doing day to day activities one week after the operation but, on average, both groups spent the same number of days off work.

President of the Urological Society of Australia and New Zealand Mark Frydenberg said the study, published in The Lancet medical journal on Wednesday, showed both techniques were “equally effective”.

Professor Frydenberg said “patients without access to robotic surgery should not feel in any way disadvantaged or be concerned they will have an inferior outcome”.

“Our view is that both robotic and open surgery are very valid treatments for prostate cancer but what is of most relevance to outcomes is the skill and experience of the surgeon,” he said.

[Source]

MY CONCLUSION

Robotic is new and potentially OK, but because there is no longer term difference in outcomes, I think open is OK. At least at this stage, when surgeons trained in open surgery are still available. In the future such surgeons may become fewer and fewer.

ADDENDUM

But there is a major issue that has low probability of occurring but can cause real problems. Scar tissue can be formed due to poor healing, causing enormous problems.

http://urology.jhu.edu/newsletter/prostate_cancer825.php

Worse thing is that the problem returns every three months once it starts:
Apparently, this is less of a problem with robotic surgery since it can apply a running suture (12 stitches). The manual surgery (open) is only able to apply seven, and not very well.
It has a few other advantages as well: “Cutting and putting in stitches is easier with the robotic assistance” (Source), recovery is quicker, etc.
As a result I’ve gone for robotic.

Comparison of Prostatectomy Surgical Options: Open, Laparoscopic, and Robot-Assisted Laparoscopic

  Open Surgery* Robot-Assisted Laparoscopic*

 

Surgery Time 3 1/2 Hours 3 1/2 Hours
Hospital Stay 2 Days 1 Day
Total Incision Length 5 inches 2 inches
Estimated Blood Loss 375 cc 116 cc
Visualization 3 D 3 D
Magnification of Visualization up to 3X with magnifying glasses 10-12 X (utilizing a pair of high resolution cameras)

 

Instrument Handling Normal Normal (Optional Micro-precision)
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How much to wait between biopsy and prostate surgery. Ideal duration between biopsy and prostatectomy.

STUDIES SUGGEST A SMALL WAIT CAN IMPROVE SOME OUTCOMES

“Those who had a TP within six weeks of the biopsy were less likely to have a bilateral nerve sparing procedure.” [Source]  [Source is credible – a paper called Total prostatectomy within 6 weeks of a prostate biopsy: is it safe? by Kishore T. Adiyat; Manoharan Murugesan; Devendar Katkoori; Ahmed Eldefrawy; Mark S. Soloway of the Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA]

“Open RP shortly after prostate biopsy does not adversely influence surgical difficulty or efficacy, but RARP relies solely on visual cues rather than tactile sensation to determine posterior surgical planes of dissection. Our data suggest that RARP should be delayed after prostate biopsy; RARP within 6 weeks of biopsy was associated with a greater risk of complications even when controlling for disease and patient characteristics.” [Source] – NOTE: THIS LIMITATION DOES NOT APPLY TO OPEN SURGERY [paper: Interval from prostate biopsy to robot-assisted radical prostatectomy: effects on perioperative
outcomes by George L. Martin, Rafael N. Nunez, Mitchell D. Humphreys, Aaron D. Martin, Robert G. Ferrigni, Paul E. Andrews and Erik P. Castle Urology, Mayo Clinic Arizona, Phoenix, AZ, USA]

DOCTORS WHO BELIEVE IN 6-8 WEEKS DELAY AFTER BIOPSY

Q: How long do I need to wait after my biopsy to undergo a robotic prostatectomy?
A: Dr. Miller recommends a minimum waiting period of 8 weeks following biopsy prior to proceeding with robotic prostatectomy.  Significant inflammation occurs after a prostate biopsy resulting in temporary distortion of the anatomy (particularly when operating under such extreme magnification).  Since prostate cancer is such a slow growing disease, this relatively short wait does not impose an appreciable risk.” [Source]

“repeated biopsies can make it more difficult to perform nerve-sparing surgery.” [Source] – meaning that biopsies do impact the ability to identify nerves.

The doctor below suggests 6 weeks (for inflammation to be healed).

What should you do during this six weeks?

KEGEL exercise should be conducted prior to the surgery [Source]

common sense:

This is a slow growing cancer so a few weeks here and there will make no difference now. If it turns out after the op that it has spread, it has in all likelihood already done that – and not in the few weeks since your pSA test. Cancer doesn’t wait quietly until it is diagnosed and then go on the rampage [Source]

 

how long to wait between biopsy and prostate surgery?

how long to wait for surgery after prostate biopsy?

Safe waiting time from biopsy to prostate surgery

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Which is better for prostate cancer – surgery or radiation therapy?

Resources: Prostate cancer institute | Targeting Cancer |

 

NEED TO BUY THIS ARTICLE: Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer: Helping Decision Making for Patients and Their Physicians

 

see: http://www.jstor.org.ezp.lib.unimelb.edu.au/stable/pdf/27736511.pdf?refreqid=search%3A453d76b3a293d97e6e920d13f26280ad

using a time horizon of 10 to 15 years, less than 3% of men diagnosed with Gleason score 6 and classified as low risk will die as a result of prostate cancer whether treated or not [Source]

Many former Gleason score 6 tumors are now reclassified as Gleason score 7 in the modified system. [Source]

Gleason score 4 + 3 = 7 demonstrates worse pathological stage and biochemical recurrence rates than 3 + 4 = 7 [Source]

Most cancers detected as a result of PSA screening are Gleason 6 (3 + 3) or 7 (3 + 4). [Source]

ACTIVE SURVEILLANCE

While surveillance may be stressful for some
men, the reality is that most patients with prostate
cancer, whether treated or not, are concerned
about the risk of progression. Anxiety about PSA
recurrence is common among both treated and
untreated patients. Patients who are educated to
appreciate the indolent natural history of most
good risk prostate cancers may avoid much of
this anxiety. [Management of Prostate Cancer – Eric A. Klein J. Stephen Jones
Editors]

patients should consider that if they wait
to treat the cancer until the tumor grows, the bigger tumor may mean either an
increased risk of side eff ects (because it requires more extensive surgery) or it may
mean a shift from curable to incurable disease.

Men under 60, for example, are better candidates if
they fulfill the Epstein criteria for insignificant
prostate cancer  – In my case this criteria is not fulfilled. Hence I am not suitable for active surveillance.

Further, “untreated, the… likelihood of disease progression is about three times greater than those without Gleason 4 pattern”  [Management of Prostate Cancer – Eric A. Klein J. Stephen Jones Editors]

In my case there are two small sections with Gleason 4 pattern. Therefore, again, active surveillance is ruled out.

To be a candidate for active surveillance, the
patient must meet certain criteria (as in a study from the Royal Marsden Hospital
in London): 2
• Ages between 50 and 80 years
• Gleason’s score less than or equal to 7
• Clinical stage T1 or T2 disease
• Total PSA less than 15
• PSA score doubling time less than 2 years
• 50 % or less of the biopsy samples positive for cancer
• A reasonable state of health with no other major medical problems [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

 

RADICAL SURGERY

About 40 % of the men who are diagnosed with prostate cancer undergo either
radiation or have radiation combined with surgery.    [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

Victoria has a Prostate Cancer Registry and the most accurate data available about which treatment patients are choosing. Victorian data from 2014 showed that 48 per cent of men in the state with prostate cancer chose surgery compared with just 18 per cent who chose radiation therapy. [Source]

The 5-year biochemical risk-free survivals for the 5 Grade Groups based on radical prostatectomy were – Grade Group 1 – 96.6% –

Grade Group 2 – 88.1%

Grade Group 3 – 69.7% –

Grade Group 4 – 63.7% –

Grade Group 5 – 34.5 % • (p < 0.001)

 

There is a real (albeit small) risk of prolonged illness or death would occur with surgery  [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

Removal of the prostate gland — a procedure called a prostatectomy — can offer patients the best chance to permanently cure their cancer. [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

One of the principles of any cancer surgery is that all tissue within a half an inch of the cancer should be cut out to ensure all the cancer cells are removed. [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

after removal of the prostate, when a man has sex, he will still have orgasm and all the good feelings that happen with sex, but he will not have the emission of any fluid. Th at means that during post-prostatectomy
sex, he will “shoot blanks” or have dry orgasms. [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

I often recommend perineal surgery for all my patients because it can be done
rapidly (within 70 to 90 minutes) and with little bleeding. In general, you want
your surgery to be over quickly, because the longer you are under general anesthesia,
the higher the chance of complications. Also, a quicker surgery can mean a
shorter recovery time. From a surgeon’s point of view, the perineal approach
also provides a better angle to view the bladder and urethral area after the removal
of the prostate gland.   [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

  1. radical retropubic prostatectomy. – through abdomen
  2. radical perineal prostatectomy, – near anus – Th is is a more direct route yet is currently less common —
    only 4 % of prostatectomies are done through the perineum — because most urological surgeons have not been trained in the approach.

Robotic surgery can be more likely to be nerve sparing given the higher magnification and ability to see. robotic-assisted radical prostatectomy has virtually supplanted the laparoscopic
prostatectomy. Men who have the laparoscopic, robotic,
or perineal surgery can return to work and daily living faster — usually within
2 weeks — because there is less pain with the smaller incisions. With a traditional
radical retropubic procedure, it might take the full 6 weeks.

 

urinary incontinence persists in up to 15 % of men 2 years after surgery.
Th e incidence of the incontinence is higher among older men who have surgery.

Your unique anatomy
also plays a role as the nerves can be in slightly diff erent positions in diff erent
people, and on some people more than others, it may be harder for the surgeon to
avoid touching them or possibly nicking them when removing the cancerous tissue.
Because nerves don’t show up on scans, this is one of the factors that the surgeon
faces in the operating room, and thus cannot predict with absolute certainty
whether there will be any nerve damage in your case. [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

For those particularly concerned
about urinary continence after surgery, I might steer them toward robotic or
perineal surgeries as these aff ord the best possible view of the urethral-bladder area
so the surgeon can have the best possible chance of joining the urethra and bladder
tightly and smoothly.  [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

PREPARATION:

In the weeks or months leading up to the operation,
I usually suggest increasing the amount of exercise, such as walking or swimming,
to be as strong as possible going into surgery. Th e physical training will help
with breathing and muscle tone and perhaps will help you to lose a few unnecessary
pounds of weight — all of which will help your recovery. Th ere are other exercises
that may prove even more important to your recovery: pelvic fl oor exercises.
When started in the weeks before surgery, these exercises can help your body
regain urinary continence faster after the prostate is removed ( see page 98).

 

The two muscles that affect the control of urine are the bladder neck, which
is not under your voluntary control, and the external urinary sphincter. Th e latter
muscle can shut off the urinary fl ow while you are urinating. To help with control
of the starting and stopping of urination, the muscle needs to be strengthened as
if you were weight-lifting. Th e more lifting, the stronger the muscle. Of course
there are no tiny weights to lift, but muscle strength can be increased with repetitive
exercise like a Kegel exercise. Th e best program is starting and stopping the
urinary stream. Th is can be started long before surgery. Each time you urinate,
stop the stream several times. Th at action will increase the strength and size of the
sphincter muscle and help with control after the surgery.

When the prostate gland is
completely removed, as happens with radical prostatectomy, that buff er is also
removed and control of urine leakage becomes dependent on the muscles of the
pelvic fl oor, known as the external urinary sphincter. By strengthening this muscle,
you can lower your chances of post-operative incontinence, or if you strengthen
post-surgery, you will increase your chances of returning to full continence.

Generally the best case for urinary control is THREE MONTHS after surgery

OPTION TO USE RADIATION

For men who experience a recurrence of their cancer after surgery (meaning that
some cancer cells remained in the body after surgery and reproduced), then radiation
known as salvage radiation is the best course.

GOOD TO UNDERTAKE RADIATION JUST AFTER SURGERY

http://www.medscape.com/viewarticle/842346

 

Costs

There is a debate between the benefits of robotic tools vs traditional surgery. Costs are quite different.

For a high-end operation in a top private hospital in Sydney men can expect to pay $7,000 to $30,000. In a public hospital the same operation can cost just $200. The out-of-pocket expenses of an open operation in a private hospital ranges from $3000 to $5000. [Source]

those with private health insurance tended to have double the out-of-pocket expenses than their public patient peers. [Source]

At Epworth, where most of Victoria’s private robotic surgery is performed, they’ve taken steps in past year to reduce its costs.” Moon says notes that paying for treatment for an early cancer can be far cheaper than paying for an advanced one. In Victoria, the average out of pocket cost for early treatment is $5000 compared to $14000 for advanced cancer. [Source]

There are major cost differences between the two main treatments, with surgery costing more than $20,000 in private hospitals, while radiation therapy is free in public hospitals. [Source]

it was not until after he told the surgeon he could not afford the operation that he was informed he could receive free radiotherapy in a public hospital.[Source]

After analysing claims data for the 12 months to last November, Bupa found 17 per cent of radical prostatectomies were fully covered but 28 per cent carried gap fees of $5001-$10,000 and 35 per cent gap fees of $2001-$5000. [Source]

CHOOSING THE PUBLIC HOSPITAL

The gender gap for Victoria was biggest at Geelong Hospital a comparison of wait times provided on the government’s MyHospital website shows. Prostatectomies, used in the treatment of prostate cancer in Geelong had a median wait time of 94 days compared to 7 days or breast cancer surgery — a difference of 87 days. [Source]

 

RADIATION

Because prostate cancer cells can be relatively resistant to radiation, high doses of energy are often used to kill the prostate cancer. Unfortunately these dosages can also cause damage to normal cells in the rectum and bladder. [After Prostate Cancer A WHAT-COMES-NEXT GUIDE TO A SAFE AND INFORMED RECOVERY –  Arnold Melman, M.D. and Rosemary E. Newnham]

A recent study of more than 2,000 Australian prostate cancer patients, published in the Journal of Medical Imaging and Radiation Oncology, found no major difference in cure rates between each treatment. [Source]

UNDERSTANDING BRACHYTHERAPY FOR PROSTATE CANCER

risk of cancer recurrence in the robotic and laparoscopic prostatectomy patients was 3 times higher than in standard open radical prostatectomy patients. [Source]

brachytherapy, external beam radiation therapy and open radical prostatectomy were successful in the majority of patients. This was true for all risk groups, but higher dose radiation (EBRT + Brachytherapy) appeared to have better relapse-free survival outcomes in the higher risk and higher grade cancers.

patients in the surgical (radical prostatectomy) arms are typically younger and healthier before treatment than those in the EBRT or brachytherapy arms

the average age and health of the surgically treated patient (before surgery) is more favorable than the average age and health EBRT or brachytherapy patient. Multiple studies prove that younger, healthier patients recover from virtually any type of treatment better than older, sicker patients. So, all these studies have a built-in bias favoring the surgically treated patients.

patients treated with surgery suffer higher rates of incontinence and impotency than those treated with either seed implantation or IMRT radiation.

Those treated with radiation have higher rates of (usually temporary) increased urinary frequency and bowel frequency.

 

 

 

 

troubling is the higher rate of side effects associated with the radioactive seeds. Investigators from the Pacific Northwest Cancer Foundation reported that following interstitial brachytherapy, 5.1 percent of patients were incontinent, and in 1.7 percent, the incontinence was so severe that the men required a urinary diversion– attachment of a bag, worn under the clothes, to collect urine. Three other patients also required the urinary diversion procedure because of severe strictures or urinary retention. [Source]

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