William Aiken

Any decision regarding treatment of early prostate cancer must take into account details of the treatment modalities available. Important considerations are the treatment's ability to permanently cure the condition, the expected period of convalescence, its common side effects and possible complications and how these may impact the man's sexual function and quality of life.

Radical surgery

Regarding ability to permanently cure the condition, given early cancer, radical prostatectomy in which the prostate gland and seminal vesicles are completely removed, has the longest track record of durability of cure but is very invasive (although laparoscopic or keyhole surgery has minimised this aspect of treatment thereby shortening the period of convalescence).

With open radical prostatectomy, an average hospital stay of three to six days can be expected and convalescence at home, before return to major activities, is approximately six weeks. The catheter placed at surgery to drain the bladder while the joining between the urine passage and bladder heals can be expected to remain for five days to three weeks depending on the surgeon's preference and the method of rejoining used.

Common side effects (greater than five per cent) include minor urine leakage that is usually short lived (the operation inherently involves completely removing one of the two muscles which control the urine and shortening the remaining one) and erectile dysfunction. The risk of the latter is related to the patient's age (the younger the better), pre-surgery erectile function (the better it is before, the better it is after) and whether the nerves that transmit erectile impulses to the penis are spared. In reality, a nerve-sparing operation is usually performed unless otherwise contraindicated but despite this, nerve conduction may be impaired after the surgery for different reasons and full nerve recovery may take up to 18 months.

Inject the penis

There is no advantage of laparoscopic prostatectomy (robot assisted or not) where post-operative urinary control and erectile function are concerned. During this period oral agents such as Viagra, Levitra or Cialis may speed return of erectile activity and for intercourse, the patient can be taught to inject a drug directly into the penis which gives firm erections.

A patient can expect to have a dry orgasm after surgery and perhaps som orgasmic sensation. He can also expect to be infertile and this is especially important to know when the man diagnosed with prostate cancer has not yet started a family. It would be prudent for him to impregnate his wife prior to treatment (prostate cancer cannot be sexually transmitted, a frequently asked question by concerned female partners) rather than undergo expensive and invasive assisted conception techniques after the surgery.

Complications of surgery include total loss of urinary control, a stricture or narrowing of the joining between the urine passage and the bladder; clots forming in the limb or pelvic veins which may travel to the lungs and cause death - this dreaded complication is minimised by early mobilisation after surgery, chemically 'thinning' the blood and applying mechanical devices to the legs to keep the blood in the calves flowing during and immediately after surgery.

Heavy blood loss during surgery is sometimes encountered but, once controlled, the patient's own blood (taken off prior to surgery) is returned to him close to the end of the procedure. This preoperative 'self-donation' of blood significantly reduces the risks associated with blood donated by someone else.

What can a patient do prior to surgery to optimise the outcome? Lose weight if overweight, stop smoking, stop taking aspirin tablets or herbal supplements 10 days prior to surgery, see an internist to help optimise preoperative health, and learn to do pelvic floor muscle (Kegel's) exercises preferably with the aid of a physiotherapist.