Prostate Cancer Procedures

1- Surgery to remove the prostate

Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Ways the radical prostatectomy procedure can be performed include:

Using Robotic assisted surgery. During robotic laparoscopic surgery, the instruments are attached to a mechanical device (robot). The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Using a robot during laparoscopic surgery allows the surgeon to make more precise movements with surgical tools than is possible with traditional laparoscopic surgery.

See benefits of Robotic assisted radical prostatectomy under Disciplines in Urology
Robotic assited laparoscopic surgery

Laparoscopic prostatectomy. During a laparoscopic radical prostatectomy, several small incisions are made in the abdomen. The doctor inserts special surgical tools through the incisions, including a long, slender tube with a small camera on the end (laparoscope). The laparoscope sends images to a monitor in the operating room. The surgeon watches the monitor while guiding the instruments. Laparoscopic surgery offers a shorter hospital stay and quicker recovery than traditional surgery.

Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen. Compared with other types of prostate surgery, retropubic prostate surgery may carry a lower risk of nerve damage, which can lead to problems with bladder control and erections.

Making an incision between your anus and scrotum. Perineal surgery involves making an incision between your anus and scrotum in order to access your prostate. The perineal approach to surgery may allow for quicker recovery times, but this technique makes removing the nearby lymph nodes and avoiding nerve damage more difficult. Discuss with your doctor which type of surgery is best for your specific situation. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type and your overall health.

2- Radiation therapy

Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways:

Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. Most external beam radiation uses X-rays to deliver the radiation, but doctors are studying whether using protons may reduce the risk of side effects.
Radiation placed inside your body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop giving off radiation and don't need to be removed.

Side effects of radiation therapy can include painful urination, frequent urination and urgent urination, as well as rectal symptoms, such as loose stools or pain when passing stools. Erectile dysfunction can also occur. There is a small risk of radiation causing another form of cancer, such as bladder cancer or rectal cancer, in the future.

3- Hormone therapy

Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause cancer cells to die or to grow more slowly. Hormone therapy options include:

• Medications that stop your body from producing testosterone.
• Medications that block testosterone from reaching cancer cells.
• Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. The effectiveness of orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but orchiectomy may lower testosterone levels more quickly.

Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy. This can make it more likely that radiation therapy will be successful. Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any cancer cells left behind.

Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Hormone therapy also increases the risk of heart disease and heart attack.

4- Chemotherapy

Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to distant areas of their bodies. Chemotherapy may also be an option for cancers that don't respond to hormone therapy.

Prostate Biopsy procedures

prostate biopsyA prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in men that produces fluid that nourishes and transports sperm.
During a prostate biopsy, also called a core needle biopsy, a fine needle is used to collect a number of tissue samples from your prostate gland. A prostate biopsy is done by a urologist, a doctor who specializes in the urinary system and men's sex organs. Your urologist may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam (DRE), suggest you may have prostate cancer.
Following a prostate biopsy, tissue samples from the prostate biopsy are examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it's likely to grow and spread, and to determine your best treatment options.

Why it's done

A prostate biopsy is used to detect prostate cancer. Your doctor may recommend a prostate biopsy if:

• Results of a prostate-specific antigen (PSA) test are higher than normal for your age.
• Your doctor found lumps or other abnormalities during a digital rectal exam.
• You've had a previous biopsy that was normal, but you still have elevated PSA levels.
• A previous biopsy revealed prostate tissue cells that were abnormal but not cancerous.


Common risks associated with a prostate biopsy include:

Infection. The most common risk associated with a prostate biopsy is infection. Rarely, men who have a prostate biopsy develop an infection of the urinary tract or prostate that requires treatment with antibiotics.
Bleeding at the biopsy site. Bleeding is common after a prostate biopsy. Don't start taking any blood-thinning medications after your biopsy until your doctor says it's OK.
Blood in your semen. It's common to notice red or rust coloring in your semen after a prostate biopsy. This indicates blood, and it's not a cause for concern. Blood in your semen may persist for four to six weeks after the biopsy.
Difficulty urinating. In some men prostate biopsy can cause difficulty passing urine after the procedure. Rarely, a temporary urinary catheter must be inserted.

How you prepare

To prepare you for your prostate biopsy, your urologist may have you:

• Stop taking medication that can increase the risk of bleeding, such as warfarin (Coumadin), nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), and certain herbal supplements for several days before the procedure. • Do a cleansing enema at home before your biopsy appointment.
• Take antibiotics 30 to 60 minutes before your prostate biopsy, to help prevent infection.

Types of prostate biopsy procedures

Prostate biopsy samples can be collected in different ways. Your prostate biopsy may involve:

• Passing the needle through the wall of the rectum. This is called a transrectal biopsy, and it is the most common way of performing a prostate biopsy.
• Collecting a tissue sample through the tip of the penis. This way of performing a prostate biopsy is called a transurethral biopsy. A long, thin tube equipped with a camera is passed through the opening (urethra) at the tip of the penis in order to access the prostate.

What to expect during transrectal prostate biopsy
In most cases, the urologist performs a transrectal prostate biopsy. For this procedure, your doctor will start by having you lie on your side, with your knees pulled up to your chest. In some cases, you may be asked to lie on your stomach.
After cleaning the area and applying gel, your doctor will gently insert a thin ultrasound probe into your rectum. Transrectal ultrasonography is used to create images of your prostate using sound waves. Your doctor will use the images to identify the area that needs to be numbed with an anesthetic injection, if one is used. The ultrasound images are also used to guide the prostate biopsy needle into place.
In most cases, an injection of a numbing medication is used to reduce the discomfort associated with the prostate biopsy. A needle is used to inject the anesthetic at various points near the base of the prostate.
Once the biopsy device is situated, your doctor will retrieve thin, cylindrical sections of tissue with a hollow, spring-propelled needle. The procedure typically causes a very brief, uncomfortable sensation each time the spring-loaded needle takes a sample. Your doctor may target a suspicious area to biopsy or may take samples from several places in your prostate.
In most cases, doctors will take 10 to 12 tissue samples. The entire procedure usually takes about five to 10 minutes.

After the procedure

After a prostate biopsy, you'll probably need to take an antibiotic for a few days. You may feel slight soreness and have some light bleeding from your rectum. You may have blood in your urine or stools for a few days. You may also notice that your semen has a red or rust-colored tint caused by a small amount of blood in your semen. This can last for several weeks. Call your doctor if you have:

• Prolonged or heavy bleeding.
• Pain that gets worse.
• Swelling near the biopsy area.
• Difficulty urinating.

In rare cases, a prostate biopsy can lead to infection. If you have any signs of infection, call your doctor. Signs and symptoms of infection include:

• Fever.
• Pain when urinating.
• Discharge from your penis.