Stage I or II Prostate Cancer Treatment
Possible Problems With Prostatectomy
Radical prostatectomy is a complicated and demanding procedure that typically requires general anesthesia and takes 2 to 4 hours. Patients stay in the hospital for about 3 days, and need to wear a tube (catheter) to drain urine for 10 days to 3 weeks. About 5 percent to 10 percent of patients experience surgery-related complications, such as bleeding, infection, or cardiopulmonary problems. There is a small risk of death from surgery; it is less for men who are young and healthy than for men who are older and frail.
Prostatectomy also carries the risk of serious long-term problems, notably:
The procedure also makes it unlikely for a man to father children, since little ejaculate is produced without the prostate.
Most men experience urinary incontinence following surgery. Many continue to have intermittent problems with dribbling caused by coughing or exertion. A few men permanently lose all urinary control. Some men can be helped with an artificial urinary sphincter, surgically implanted, or with injections of collagen to narrow the bladder opening.
Infrequently, men may develop stool or fecal incontinence after radical prostatectomy. Fecal incontinence is the loss of normal muscle control of the bowels. Muscle damage can occur during rectal surgery. Stool incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum.
At one time, prostatectomy almost invariably resulted in sexual impotence. Today, the risk of impotence may be reduced by nerve-sparing surgery. This technique carefully avoids cutting or stretching two bundles of nerves and blood vessels that run closely along the surface of the prostate gland and that are needed for an erection.
Nerve-sparing surgery is not possible for everyone. Sometimes, the cancer is too large or is located too close to the nerves. Even with nerve-sparing surgery, many men -- especially older men -- become impotent. Most men will lose a degree of sexual function. (If a man has trouble with erections prior to treatment, nerve-sparing surgery is probably not indicated.) Depending on age, extent of disease, and type of surgery, the chances of impotence vary widely -- somewhere between 20 percent and 90 percent.