Content Warning: This blog discusses topics involving cancer and cancer treatments.
If you’ve made your way to this blog, you are probably curious about prostate removal, or more specifically, prostatectomy—and if you may be a potential candidate for one.
Whether your doctor mentioned it, or you are just doing research on your own about it, it never hurts to be more informed!
Like with any other surgical procedure, prostatectomy is not typically the first choice of treatment for any prostate-related condition. Other treatment options are always explored first, and if a patient’s needs require it, surgery may be considered afterwards.
It is important to know that prostatectomy and treatments for prostate-related conditions are highly tailored to the patients needs and the progression of their symptoms. Every person’s individual situation and needs will differ, and even when prostate removal is deemed necessary, the type of procedure an individual may receive can vary as well.
With all that being said, let’s look at some reasons why prostatectomy may be necessary below.
Reasons Prostate Removal May Be Necessary
Prostate Cancer
Prostate cancer refers to the growth of cancerous cells that start in the prostate. It is one of the most common types of cancer, but most people have successful treatment.
Prostate cancer is usually categorized into different stages based on size, location, rate of growth, and many other individual characteristics. All of these different aspects can determine what form of treatment may be best for each unique case.
In addition to the type and severity of the cancer, there’s also the question of whether a patient is a good surgical candidate to begin with. Current life expectancy, age, and overall health (including pre-operative erectile or urinary function) are all factors considered when deciding if a patient makes a good candidate for prostate removal.
Prostate cancer varies from person to person, and not everyone may need the same treatment options. As mentioned before, prostatectomy is usually only considered after other treatments, or if a patient has certain contraindications to other treatment options.
Most often, prostate removal can be used to completely remove localized cancer, usually in the early stages. However, there are other situations where prostatectomy may be used outside of this more common scenario. Other examples of when prostatectomy may be considered for treating prostate cancer include the following:
- If other treatments or less invasive procedures fail
- If the cancer becomes recurrent (such as after radiation)
- If the cancer is confined to the prostate or extending just outside of the prostate
- If the cancer begins to cause significant symptoms, such as those relating to the kidneys or urinary functions
- If the cancer is aggressive or high-risk
Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia is a very common problem experienced by people with a prostate. It simply refers to the enlargement of a person’s prostate.
As a person ages, their prostate naturally grows bigger. While the exact cause of this isn’t known, some studies suggest it may be due to changes in hormones. Most people with a prostate will experience gradual enlargement over time.
At a certain point in life, this enlargement may begin to create problems with urination. As the prostate becomes larger, it puts pressure onto the bladder and urethra, narrowing both organs and preventing effective urination. This can cause a variety of symptoms, such as:
- Difficulty starting a urine stream
- Frequent urination
- Painful urination
- Dribbling / leakage after urination
- Urinary infections
- Pain after ejaculation
- Urinary urgency
- Nocturia
- Changes in urine color or odor
It’s important to note that BPH can vary from person to person, and some individuals with BPH live with very mild symptoms or none at all.
Benign prostatic hyperplasia isn’t necessarily curable, but can be managed very well with a variety of treatments. However, in some cases leaving BPH untreated or unmanaged can worsen symptoms and lead to complications like frequent UTIs, urinary retention, gross hematuria, bladder stones, and kidney damage.
Prostatectomy may be considered for BPH in these cases, as well as in situations where other minimally invasive treatments show no progress or symptoms are very severe.
Other
Prostate cancer and benign prostatic hyperplasia are the most common reasons a person would need a prostate removal, but there can be other rare scenarios that may make the procedure necessary, such as:
- Rare congenital abnormalities affecting the prostate
- A traumatic injury to the prostate
- Kidney damage from chronic urinary obstruction
- Recurrent UTIs caused by obstruction
- Prostatic abscess that is unresponsive to antibiotics
- Stubborn lower UTI symptoms
- Hydronephrosis from obstructive uropathy
Any of these situations may cause significant dysfunction or problematic symptoms that may make prostatectomy a necessary form of treatment.
The Main Types of Prostatectomy
There are different types of prostatectomy, which are often categorized into two major groups: simple prostatectomies and radical prostatectomies. These surgeries vary in many ways, such as the type and location of the incision, what tissues are removed, and what kind of patient needs are suitable for each.
There are actually different kinds of radical and simple prostatectomies (laparoscopic, open, robot-assisted, and more), but if we dove into all of them here, the blog would become pretty long and complicated! So for now, we’ll just cover the basics.
Despite their differences, each type of prostatectomy can cause post-surgical symptoms and long-term effects. The most common effects are complications with sexual and urinary function, such as erectile dysfunction and urinary incontinence.
To help you better understand how these post-surgerical symptoms occur, each type of prostatectomy has been defined below.
Simple Prostatectomy
A simple prostatectomy is a procedure that removes the inner portion of the prostate while leaving the outer portion intact. The inner portion of the prostate is removed because it is the area that disrupts the urethra the most when the prostate is enlarged.
This surgical procedure is used to treat symptoms from a very enlarged prostate, such as with BPH, but is usually only considered when other less invasive treatments do not provide relief. This type of prostate removal is not used to treat prostate cancer.
As with any surgery, simple prostatectomies can cause post-surgical symptoms that vary from person to person.
While some symptoms are to be expected immediately after surgery, it is very important to follow your doctor’s guidance and engage in proper rehabilitation to prevent long-term conditions. Otherwise, conditions and symptoms such as the following are possible:
- Erectile dysfunction
- Painful urination
- Incontinence
- Scar tissue
- UTIs
- Frequent urination
- Difficulty starting a urine stream
Radical Prostatectomy
Radical prostatectomy is a procedure that removes the entire prostate gland as well as other structures as necessary. These other structures can include the seminal vesicles (glands that help produce semen and allow for ejaculation), lymph nodes, and vas deferens (sperm ducts that connect to the seminal vesicles).
When these structures are removed, ejaculation no longer becomes possible (as there is no ejaculation fluid being made). However, you can still experience an orgasm without the presence of this fluid, which is known as a dry orgasm.
This type of prostate removal is typically used for prostate cancer. However, radical prostatectomies can vary greatly by patient needs and the characteristics of their prostate cancer. These aspects can also influence the symptoms one may experience post-surgery.
This is because the amount of tissue that needs to be removed can directly affect the nerves needed for normal function of the surrounding muscles and other structures. Therefore each person will have different results depending on the unique type of radical prostatectomy chosen for their condition.
If the nerves in the area are able to be spared (meaning they are not too close to cancerous tissue), it is referred to as a nerve-sparing prostatectomy. This kind of procedure is not always possible, but may help retain sexual function post procedure.
The possible long-term effects of a radical prostatectomy are similar to that of a simple prostatectomy; however, urinary incontinence and sexual dysfunction are the most notable symptoms for those who undergo any form of prostate removal.
Managing Your Symptoms After Prostatectomy
No matter the type of prostatectomy you may need, one thing for certain is that there will be a healing period where you may experience a variety of symptoms. This is typically because surgical procedures weaken the surrounding muscles—and in the case of a prostatectomy, the surrounding muscles are your pelvic floor muscles.
The pelvic floor is a very important group of muscles found in your pelvis. These muscles allow you to use the restroom and enjoy sex, even if you don’t even realize they are there! They also provide important support to your pelvic organs as well as your body’s overall stability and balance.
Prostate removal can significantly impact your pelvic floor’s health, resulting in urinary and sexual dysfunctions that may become long term if not addressed properly.
While prostatectomy procedures can affect or remove certain nerves and structures that may influence post-operation symptoms, pelvic floor physical therapy can provide great support along the way.
By engaging in physical therapy before and after your prostatectomy, you’ll have a better starting point before your muscles are affected by surgery as well as a care plan to get your pelvic floor in good shape afterwards.
If you’d like to get started with pelvic floor physical therapy or learn more about whether it’s a good fit for your needs, book a discovery call!
