The prostate is part of the male reproductive system. It is a walnut-sized gland located in front of the rectum and below the bladder. It connects the bladder with the rest of the urethra (the tube that carries urine from the bladder). The prostate is responsible for producing and propelling a fluid that is present in male ejaculate or semen.
Benign prostate hyperplasia, also called BPH or enlarged prostate, is a non-cancerous condition that can cause urinary problems. On the other hand, prostate cancer is a potentially life-threatening condition. If not managed in the early stage, prostate cancer can spread to other parts of the body.
Scientists don't yet know what causes prostate cancer. What we do know is that men with certain risk factors are more likely than others – but not guaranteed – to get prostate cancer. These risk factors include:
- Age. The chance of getting prostate cancer increases with age.
- Family history. Your risk of getting prostate cancer is higher if the men in your immediate family (father, uncle, brother or son) had prostate cancer.
- Race. Prostate cancer is more common among African-American men than in Caucasian or Hispanic/Latino men. It's less common among Asian/Pacific Islander and American Indian/Alaska Native men.
A man with prostate cancer may or may not have symptoms. Common symptoms include:
- Not being able to pass urine
- Having trouble starting or stopping the flow of urine
- Frequent urge to urinate, especially at night
- Weak flow of urine
- Urine flow that starts and stops
- Pain or burning during urination
- Difficulty getting an erection
- Blood in the urine or semen
- Frequent pain in the lower back, hips or upper thighs
It's important to note that these symptoms could be caused by prostate cancer, BPH or other benign prostate or bladder conditions. If you experience any of these symptoms, it's best to consult with a urologist, who can help diagnose and treat them. Even if you don't experience any symptoms, your doctor can still check for prostate cancer.
The American Cancer Society recommends that men should talk to their doctor about screening for prostate cancer at age 50. Men with higher risk factors should start at age 45.
There are two common tests that screen men for prostate cancer. Ask your doctor whether one or both are right for you.
- Prostate-specific antigen (PSA) blood test: Prostate-specific antigen (PSA) is a protein produced by the prostate gland. The PSA test is a simple blood test. A high PSA level can be caused by several conditions, including BPH, infections or prostate cancer.
- Digital rectal exam: Your doctor feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas, which can be a sign of prostate cancer.
Each of these tests can detect a problem in the prostate, but further testing is necessary to determine whether the problem is cancer or another condition. If the PSA is high or the prostate exam is abnormal, the usual next step is to get a biopsy.
A biopsy is obtaining tissue samples to look for cancer cells. This is usually done in the office and is an outpatient procedure. In a prostate biopsy, the doctor will inject local anesthetic to numb the prostate. A thin ultrasound probe will be placed into your rectum to help the doctor see where to take samples. A thin, hollow needle will be inserted into the prostate to collect samples from the entire prostate. The whole procedure usually takes about 20 minutes. The samples will be sent to a lab, where a pathologist will check for cancer cells.
Grading and Scoring
If cancer cells are found, the pathologist will identify the two most common patterns of cancer cell growth and assign them a grade of 1 (most like normal cells) to 5 (most abnormal). The two grades are then added together to get a final Gleason Score. For example, if the most common pattern is graded as a 3, and the next most common pattern is graded as a 4, the Gleason Score would be 3+4 = 7. Gleason Scores generally fall between 6 and 10, with higher scores indicating tumors that tend to grow faster and spread more quickly than those with lower scores. Some cancers can be monitored, depending on factors such as age, Gleason score and volume of cancer.
If the biopsy is positive for cancer, the next step is to determine how far the cancer has progressed. This process is called staging. Staging involves taking images of the body to find out if the cancer has invaded nearby tissues or metastasized (spread) to other parts of the body. There are several imaging tests that can provide this information.
- Bone scan: A radiologist will inject a small amount of a radioactive dye into your bloodstream, which will collect in your bones. A machine will measure the radiation and create a picture that can show whether the cancer has spread to the bones.
- CT scan: A CT machine takes a detailed series of X-rays of your body. These scans show whether the cancer has spread to lymph nodes and other areas. You may also receive an injection or drink a dye that helps radiologists see abnormal areas more clearly.
- MRI: An MRI machine uses a strong magnet to take detailed pictures inside your body. These images can show whether the cancer is confined to the prostate or spread to the lymph nodes or surrounding structures. Contrast material can also help the radiologist identify abnormal areas more clearly.
There are many treatment options available for men with prostate cancer. These options include active monitoring, surgery, radiation therapy, hormone therapy or a combination of these.
- Active monitoring: Active monitoring (watching how the cancer grows and changes over time) is an option for men for whom the risks and side effects of treating prostate cancer may outweigh the benefits. This generally includes men with early stage prostate cancer, slow growing cancer, older men, or men with other serious health problems.
- Surgery:Surgery to remove the prostate (and the lymph nodes, if they have been invaded by prostate cancer) is an option for men with any stage of prostate cancer. Surgery is the only option to completely remove cancer from the body. There are several types of surgery.
- Open surgery: The surgeon makes a large incision into the body to remove the prostate, either through the abdomen or between the scrotum and anus.
- Laparoscopic prostatectomy: The surgeon uses small cuts and a laparoscope (camera and tools attached to a small tube) to remove the prostate.
- Robotic laparoscopic surgery: The surgeon uses small cuts and robotic assistance to remove the prostate.
- Cryosurgery:The surgeon makes a small cut between the scrotum and anus, and inserts a tool that freezes and kills prostate tissue.
- Transurethral resection of the prostate (TURP): The surgeon inserts a long, thin scope through the urethra. A tool at the end of the scope removes tissue from the inside of the prostate.
- Radiation therapy: Radiation therapy is an option for men with any stage of prostate cancer. It uses high-energy X-rays to damage cancer cells and limit their ability to reproduce. Radiation therapy can be used for men with early stage prostate cancer instead of surgery, or it can be used after surgery to destroy any cancer cells that remain. It can also be used to alleviate pain in men with later stages of prostate cancer.
- Hormone therapy: Hormone therapy is an option for men before, during or after radiation therapy. It can also be used to treat prostate cancer that has returned after treatment. Hormone therapy works by preventing prostate cancer cells from getting the male hormone (testosterone) they need to grow, either through medication or by surgically removing the testicles (the male organ that produces most testosterone).
The treatment that's right for one man may not be right for another. Factors to take into account when choosing a treatment option are age, the grade and stage of the tumor, your symptoms and general health. Your doctor can discuss your treatment options, expected results of each and the possible side effects, and help recommend a treatment plan that is right for you.
Preparing for Robotic Radical Prostatectomy
Scheduling Surgery and Pre-operative Tests
Patients will receive detailed instructions, including the date of surgery, at the time of their office visit. If you have questions about the surgery or need to reschedule, please contact your surgeon's office staff. In most instances, you will not know the time of your surgery until the day before surgery.
You must complete certain tests and get clearance from your primary care doctor a few days before surgery. This helps ensure you are healthy enough for the operation and allows enough time to receive additional testing, if necessary. This includes:
- Blood work (CBC, PT/PTT/INR coagulation profile and biochem profile)
- Chest X-rays
- Complete physical and medical clearance from your primary care physician
- Cardiac clearance, if you have a cardiac history or condition
Please have all results and medical clearance faxed to your surgeon's office. If you have any questions, call your surgeon's office staff.
NOTE: YOUR SURGERY COULD BE CANCELED IF YOUR SURGEON DOES NOT RECEIVE THIS INFORMATION BEFORE THE DAY OF SURGERY.
Preparing for Surgery
Once you have scheduled your surgery, read through this list to give you time to prepare. Some preparations can take days or weeks. Others require you to purchase medications or items to help make you more comfortable after your surgery. Click here for more information.
Frequently Asked Questions
Am I a candidate for robotic prostatectomy?
Most patients who are healthy and have prostate cancer are candidates for robotic prostatectomy.
What side effects can I expect following surgery?
Common side effects immediately following surgery include bloating, constipation, bruising or draining around incisions, and penile and scrotal swelling and bruising. Wearing soft, loose-fitting clothing helps ease this discomfort. Patients may also experience fatigue or notice blood in their urine. These side effects are normal and should subside in the weeks following surgery. The two most common long-term side effects are incontinence (loss of urinary control) and impotence (inability to get erections).
How long will incontinence last?
Incontinence is temporary in most cases. Most patients will recover bladder control in three to six months.
When can I expect to resume sexual activity?
Impotence can be temporary or permanent, and depends on several factors such a baseline sexual function before surgery, type of nerve sparing procedure performed and other medical conditions such as diabetes.
When should I call my doctor?
It's important to call your doctor if you experience:
- Fever greater than 101 degrees Fahrenheit
- Nausea or vomiting
- Dark red urine that does not clear with rest or fluid intake
- Severe abdominal cramps or spasms
- Calf pain or swelling in one leg
- Difficulty or pain with breathing
- Chest pain or shortness of breath
What kind of immediate postoperative care do I need after surgery?
Before you are discharged from the hospital, your doctor will give you a list of post-surgery instructions to follow when you get home. Most of the care after surgery is related to the foley catheter. This involves emptying the drainage bag frequently and changing it when needed. The incisions don't usually require any special care. Patients can shower 48 hours after surgery and keep incisions clean and dry.
What are the dietary restrictions following robotic prostatectomy?
Most commonly patients feel bloated or feel constipated a few days after surgery. It is recommended that patients take over-the counter stool softeners and drink plenty of fluids. It's best to start with foods that are soft, low in fiber, lightly seasoned and easy to digest. Eating small, frequent meals and avoiding carbonated beverages is also helpful. If constipation continues, patients can take a laxative, such as Milk of magnesia (magnesium citrate).
What are the activity restrictions following surgery?
Most patients are walking and are able to perform activities of daily living right after surgery. Patients can resume driving after the catheter is removed. Patients are restricted from lifting heavy weights or doing any kind of strenuous activity for six weeks following surgery.
What happens to the prostate after removal?
The prostate is sent to a pathologist for a final review. This gives further information on the aggressiveness of the cancer and can help determine the need for further treatment.
Are lymph nodes removed during the surgery?
Depending on biopsy results and prostate-specific antigen (PSA) levels before surgery, patients may require removal of pelvic lymph nodes to keep the cancer from spreading to other areas of the body.
What are possible complications of lymph node removal?
There could be temporary swelling of the scrotum, penis and even the lower extremities. This usually resolves in a few weeks. Rarely, a large fluid collection can form in the pelvis that might require additional procedures.
When do I see my doctor for a follow-up visit?
You should have new blood work drawn and visit your surgeon approximately three weeks after your surgery. This allows your doctor to monitor your progress and address any questions or concerns you have. You will also need to see a doctor for yearly follow-up appointments and radiology tests to ensure that your body responds well to the surgery over time.
Where can I get additional information about prostate cancer or find support groups?
You don't have to face a cancer diagnosis alone. You can get more information on the National Cancer Institute's Website or by calling their Cancer Information Service at 1-800-4-CANCER. You can even chat with a representative on their LiveHelp Website.
If you are referred to Mount Sinai's Comprehensive Cancer Center for further treatment, you will also have access to our multidisciplinary support team, which includes pain specialists, psychologists, social workers and nutritionists who work together to ensure that you receive the most comprehensive, effective care for treating prostate cancer.