Radical Prostatectomy Surgery in Delhi, India

If a person is diagnosed with Cancer in the prostate, the doctor may suggest a radical prostatectomy. It will reduce the chances of metastasis of Cancer.

Doctors will ensure that Cancer has not spread beyond the prostate gland. While they cannot be 100% sure, they can predict the risk of spreading by studying biopsy and PSA levels. If the doctor is not satisfied, they can go for tests like CT scans, bone scans, MRI scans, and the PSMA PET CT Scan. Men under the age of 75 with contained prostate cancer who have a life expectancy of 10 more years can undergo this procedure.

Usually, prostate cancer affects older men once they reach 50 years. People with a family history of Cancer should go for these tests earlier. Following exams are done to diagnose prostate cancer:

1. Digital Rectal Exam (DRE): During their complete health check-ups, a digital rectal exam is performed. The doctor will insert a gloved, lubricated finger into your rectum and examine the prostate gland. If the doctor feels any abnormality in texture, shape, or size, further evaluation is performed.

2. Prostate-Specific Antigen Test (PSA test): PSA or prostate-specific antigen is a biological substance produced by the prostate gland. A blood sample is taken from the patient and is checked for PSA levels. If the PSA levels are high or in abnormal amounts, it may show infection, inflammation, or Cancer of the prostate.

To confirm a diagnosis of prostate cancer, the following tests can be done:

• Ultrasound and MRI: But to be sure, a biopsy is performed. Here, a sample of cells is extracted from your prostate gland. A thin needle is inserted into the prostate to collect samples. Then, the tissue sample is sent to pathology to analyse for any abnormality.

When a biopsy confirms the diagnosis of Cancer, the next step is to assess the aggressiveness of the Cancer cells. A sample of your cancer cells is examined in a laboratory to see how much cancer cells differ from healthy cells. A higher grade suggests that the Cancer is more aggressive and likely to spread quickly.

1. Gleason score: The Gleason scale is used to grade prostate cancer cells. The Gleason scores depend on severity and range from 6 to 10. A score of 6 suggests that prostate cancer is of mild severity. A score of 7 suggests that prostate cancer is of medium severity. Cancers with a score of 8 to 10 are severe.

2. Genomic testing: Genomic testing examines your prostate cancer cells to see if there are any gene abnormalities. 

Determining if Cancer has spread

Following tests are done to know if the Cancer is contained or spread out to other tissues:

1. Bone scan

2. Ultrasound – Whole Abdomen/PVR

3. CT scan with or without contrast

4. MRI - Multiparametric

5. PET scan - PSMA

The doctor will decide which test the patient should undergo. If the prostate cancer is contained in the prostate gland and all other criteria are met, the urologist may recommend a radical prostatectomy.

After the diagnosis is confirmed and professionals have suggested going with radical Prostatectomy, a surgeon can conduct the surgery with a variety of procedures, including:

1. Robot-assisted radical prostatectomy: In this procedure, the surgeon makes five to six small incisions in your lower abdomen. They sit at a console and operate instruments connected to computer-assisted mechanical equipment (robot). The robotic equipment enables a more exact response to the surgeon's hand movement.

2. Open Radical Prostatectomy: The surgeon typically makes an incision in the lower abdomen to remove the prostate.

Simple Prostatectomy is rarely advised. Doctors may recommend it for men with benign enlarged prostate glands or severe urinary symptoms. Unlike Radical Prostatectomy, this procedure does not involve the complete removal of the prostate gland. Only a small portion is removed to free urine flow.

Men under the age of 75 with contained prostate cancer who have a life expectancy of 10 more years can undergo this procedure.

The Cancer is in the prostate gland, but the patient is at high risk of metastasis.

Radical prostatectomy surgery may not be the right fit if:

• The patient's health is poor; thus, they can't undergo anaesthesia or surgery
  
• Cancer is growing slowly
• Cancer has spread to tissues other than the prostate gland

Doctors may perform some pre-operative tests to make sure the patient can undergo the procedure with no complications.

• The patient will be cleared for surgery from different departments, such as cardio, neuro, pulmonary, etc.

• The patient should inform doctors about every medication and health supplement they are on. It is crucial if you are on blood-thinning medication and pain relievers such as warfarin and aspirin.

• The patient should inform the staff about allergies. These may be mentioned in medical records, but let the hospital staff know if they've discovered a new one.

• The patient should ideally not drink or eat anything after midnight.

• Patients are informed and given instruments to give themselves an enema. This is done to clean bowels before surgery.

The general risk of surgery are as follows:

• Blood clots

• Breathing problems

• Allergic reactions to anaesthesia

• Bleeding

• Infection

• Heart attack

• Stroke

Complications specific to prostate surgery might include:

• Urinary Incontinence

• Difficulty controlling bowel movements

• A urethral stricture

• Erectile dysfunction

• Injury near the rectum

• The patent will become infertile without loss of pleasure

Complications after Prostatectomy affect less than 10% of men, and they are usually curable or temporary.

• After the surgery, you might stay a day or two under observation. It can change from one person to another depending on their recovery and how the patient tolerated the procedure. The hospital will discharge the patient in a day if everything goes well. 
• The patient will be discharged with a catheter in place. Most men require a urinary catheter for seven to ten days following surgery. Urinary control can take up to a year to recover after surgery.
• After recovering from surgery, you can still have an orgasm, but you won't be able to produce sperm. Complete recovery of erectile function after Radical Prostatectomy can take up to 18 months in some men.
• Monthly blood tests, PSA levels, CT and MRI scans, as well as regular checks are recommended to preserve your health. For the first three years after surgery, PSA levels are typically measured every four to six months.

Reviewed by Dr. Anil Kumar Varshney, Senior Director, Urology on 23-Aug-2022

1. Know more about robotic urology surgery

2. How can you be screened for Prostate Cancer?

3. Increased Prevalence of Urological Disease Due To Ageing Population Affecting Quality Of Life

4. Da Vinci-The Next Level Technology in Surgical Excellence and Patient Safety