Prostate Surgery Complications: What Patients Should Know

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Smiling physician speaking with patient.

Prostate cancer surgeon James Eastham says complication risks are greatly affected by the type of procedure being performed.

Surgery has proved to be a very effective treatment for prostate cancer. One of the standard therapies for men with this disease is radical prostatectomy, a procedure that removes the entire prostate gland along with some surrounding tissue.

This operation is very complex, however, and requires a high level of technical precision, as the prostate is surrounded by nerves and structures important to normal urinary and sexual function. Many prostate cancer patients are understandably concerned about the possibility of complications that may occur as a result of this surgery.

James Eastham, Chief of Memorial Sloan Kettering’s Urology Service, has performed approximately 3,000 radical prostatectomies in his surgical career. Here, he explains the side effects of prostate cancer surgery and clarifies how a number of factors specific to each patient affect his overall risk of complications.

When you meet with patients who have opted for prostate cancer surgery, what complications seem to cause the most anxiety?

Patients are usually concerned about longer-term quality-of-life issues, such as urinary control — also called urinary continence — and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.

The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period — perhaps several months or a year after surgery — in which they do not have complete control.

For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, it’s not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.

You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. That’s true only for a very select group of patients,  usually those who are younger and had full erections prior to surgery.

Side Effects of Radical Prostatectomy (Prostate Cancer Surgery)
Prostate cancer and its treatments can cause problems, including urination problems and erectile dysfunction (ED). Learn about the side effects of prostate cancer surgery and how experts at Memorial Sloan Kettering can help minimize complications.
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What typically increases the risk of complications from prostate cancer surgery?

Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.

Complication rates go up dramatically when we do surgery on patients who have failed other prostate cancer treatments.

Radiation is a very effective treatment for prostate cancer, but it doesn’t work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment — a procedure called salvage prostatectomy — is potentially curative.

Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures — which is a narrowing of the urethra that blocks urine flow — or injury to adjacent structures like the rectum.

MSK is a referral center for many patients whose radiation therapy did not work. Patients know that we have a high level of expertise in salvage prostatectomy, so this procedure makes up a significant portion of prostate surgeries at MSK compared with some hospitals. I treat a large number of these difficult cases — as do my colleagues here — and this can result in complication rates that are higher than if we had a more typical patient population.

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What is a common misconception you find in patients regarding complications that might occur after prostate cancer surgery?

I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, “I have a 75 percent chance of returning to my baseline function.” It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because — as is usually the case — the devil’s in the details.

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What advice would you give to a patient who wants to keep the risk of surgical complications as low as possible?

There are some things that patients can’t control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance — a method we’ve pioneered very successfully here at MSK.

For patients opting to undergo radiation therapy or surgery, it’s critical to know the outcomes of the individual doctor.

For patients opting to undergo radiation therapy or surgery, it’s critical to know the outcomes of the individual doctor. It’s well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.

These therapies are very effective. It’s always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.

Ultimately it’s all about finding a surgeon or a radiation oncologist with whom you feel comfortable — someone who sets realistic expectations based on your situation as a patient.

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Comments

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My brother is 64 and was just diagnosed with prostate cancer he had 12 biopsies, 6 were positive and his Gleason score is 3+3-6. Now, I know that I read that MSK only does removal of the prostate when the situation is life threatening, but what about a patient with chronic pain due to prostatitis. Would that fit the criteria for a patient with that score to have the prostate removed and do you think he should schedule a consultation? Thank you.

Dear Jodi, we are sorry to hear about your brother’s diagnosis. Every patient is unique and we would not be able to make a treatment recommendation without knowing more about your brother, his health, and his cancer. If he would like to make an appointment with one of our specialists to discuss possible treatment options, please ask him to call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Just was diagnose with the last month. I had my first appt with MSKCC today. I cried a bit but the doctor was just so personable and great, thanks MSK. I'm going to proceed with my treatment at your facility and know that I'm in good hands. Thanks again
Jerome

Dear Jerome, we are sorry to hear about your diagnosis but are glad to know that you have felt well-cared for by your oncologist thus far. We wish you well as you continue with your treatment. Thank you for sharing your thoughts and experience on our blog.

My recent biopsy was positive for prostate cancer in 2 out of 14 cores, with a Gleason score of 6 and PSA of 4.9. I have decided on active surveillance based on the low-risk nature of my cancer and my fear of incontinence and/or impotence with surgery. At the same time, however, I have rather severe BPH and extreme difficulty with urination that significantly impacts my current quality of life. Is it possible to undergo a TURP procedure now to address my urinary problems while I'm in active surveillance mode?

Charlie, thank you for reaching out. In general, TURP has proven to be a safe procedure in men with urinary symptoms and low-risk prostate cancer.

You can learn more about prostate cancer treatment at Memorial Sloan Kettering here:

https://www.mskcc.org/cancer-care/types/prostate

Husband(age 74 and has ED and can't take meds for it) has prostate cancer. Has PSA 8.3 and biopsied with score of 8 on 5 of the 12 biopsies, and 6-7 on others. 11 of the 12 biopsies show cancer. The radiation oncologist recommended hormone therapy followed by radiation. The urologist was going to do the hormone shot but after discussing side affects and the long term potential risks of radiation, my husband decided to have the prostate removed. No concerns about losing sexual function. Surgery would be robotic. However, one issue for us is the experience level of the dr. When asked how many times he had done this surgery, he said about 100 times. Now that I am reading the SKMCC site, I am feeling like 100 times is not much experience. We are located in Maine and are being told there are only 2 places in the states where he can have this done robotic. Does it sound like we should be looking at the other location to see if the doctors have more experience?

Dear Valerie, we are sorry to hear about your husband’s diagnosis. You may be interested seeking out a physician at a comprehensive cancer center (CCC), which often have the most experienced and skilled surgical oncologists and other cancer specialists. You can search for a CCC via the National Cancer Institute’s website: https://www.cancer.gov/research/nci-role/cancer-centers/find. If you would like to consult with a surgeon at MSK, please contact our Physician Referral Service to make an appointment at 800-525-2225. Thank you for reaching out to us.

I had prostate surgery and about a month afterward, I started having numbness and tingling sensation from my groin all the way down to my foot. They told me this would go away, but it hasn't, it's been 2 years. What could be wrong? Thank you

HI Donald, we recommend that you discuss this with your healthcare team. Thank you for your comment.

Had the Davinci procedure 8/2012. My last erection was prior to the SX none post-op to date. Also have had scar tissue build-up at the bladder head. Urine flow is a trickle with incomplete bladder emptying. Have outpatient SX procedure once and repeated "stretching " techniques utilizing these medevil rods thrust into my bladder... Normal urine flow resumed each time but trickle returned after 3 months each occurrence as scar tissue built up. Is there a new procedure to correct this?

Dear William, we are sorry to hear about the side effects you are experiencing from surgery. You may find the following information helpful.

For Urination Problems after Cancer Treatment, MSK Surgeons Can Help:
https://www.mskcc.org/blog/urination-problems-after-treatment-msk-surge…

Male Sexual & Reproductive Medicine Program
https://www.mskcc.org/experience/living-beyond-cancer/services-survivor…

If you would like to make an appointment with one of our specialists, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

Thanks for your earlier answer regarding the TURP procedure in low-risk patients. As a follow-up, does having a TURP make a prostatectomy more difficult or complicated if I elect to have it at a later date?

Charlie, we consulted with Dr. Eastham who responds, “A prior TURP should not increase the difficulty of a radical prostatectomy.”

Thank you.

During the "watchful waiting" period, what is the latest thinking on how often to perform a biopsy? Are there any research-based best practices? What does Sloan recommend?

Neal, thank you for your question. We consulted with urologic surgeon Behfar Ehdaie, who responds:

“Every 3 years if MRI and PSA remain stable. We base this on empirical data from long-term studies at MSK, Toronto, Europe and Johns Hopkins who all have varied biopsy periods but very similar outcomes. The risk of infections with frequent biopsies is the risk that drives our policy.”

My husband had robotic surgery to remove his prostate on January 10th. He had serious complications after the surgery. He was in the hospital for 8 days after surgery. He was in extreme pain with distended abdomen. The doctor said it was paralytic ileus and that the air that was inserted for the surgery did not come out. They finally inserted a tube into his abdomen to release the air. He also had to be fed through a picc line. Now, 6 weeks after the surgery, he still cannot sit or stand for more than a few minutes due to extreme pain and spends most of the day lying down on the bed. On our last visit to the doctor, he said it was “normal healing” and that he is experiencing perineal pain. The cancer only covered 10% of the prostate and he is not receiving any chemo or radiation. My husband went into surgery a very healthy 74 year old on no medication, and now cannot even stand for any length of time and has lost 20 pounds. My guess is he really did not need this surgery. We do not know what to do at this point (medically not legally). I do not respect this doctor’s opinion and recommendations at this point. I realize you cannot diagnose over an e-mail, but I would like your opinion and maybe a recommendation of what to do at this point. We live in Georgia, so we would not be able to travel to NY for a second opinion. Thank you for your time.

Dear Deborah, we’re very sorry to hear your husband is going through this. If you’re interested in getting a second opinion or seeking out care from another doctor, we recommend that you find a National Cancer Institute-designated cancer center in a location that is convenient for you. You can find a list at: https://www.cancer.gov/research/nci-role/cancer-centers Thank you for your comment, and best wishes to you and your husband.

Does obesity make a prostatectomy more difficult or more likely to result in complications?

Dear Charlie, we sent your question to Dr. Eastham, who replied, ’”Obesity does increase the difficulty in performing radical prostatectomy, but surgery is still commonly used in this setting. My impression is that robotic-assisted surgery makes the procedure a bit easier than with open surgery (both for the surgeon and patient). Generally obesity has been suggested as increasing the risk of wound infection and developing a blood clot (deep venous thrombosis) but the studies have mixed results and there is no consensus.”

Thank you for your comment.

My husband is 42 and was diagnosed with prostate cancer on both sides of his prostate. he had surgery July 12, 2016. His doctor told us that, there was a chance that a piece of the cancer might get left behind due to him trying to spare his nerve. Well that did happen, when he went to his first follow up appointment his PSA level was going down. When he went back this time he was told that his PSA level was up. I'm really worried about this. Can you tell me what this might mean.

Dear Tonya, we’re sorry to hear about your husband’s diagnosis. We are not able to offer medical advice on our blog. We recommend you discuss your concerns with your husband’s medical team. If you’re interested in making an appointment to discuss this with a doctor at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you.

5 months after robatic prostate surgery,had a ct scan. an infection caused the swelling-neg. for hernia.What caused infection?and will it return?

Dear Gary, we’re very sorry to hear that this happened to you. We recommend that you discuss your concerns with your healthcare team. Thank you for your comment, and best wishes to you.

I had a radical prostatectomy using the DaVinci method In April, 2016. I am now impotent and incontinent despite doing the Kegels daily. My catheter was in 7 weeks. My doctor used another catheter recommend by another doctor to help connect the bladder and urethra. I had blood transfusions and multiple hospitalizations. Surgery was performed to remove scar tissue because I could not urinate.This was done 5months after the prostatectomy. Five months later I have the same problem urinating. Do I spend the rest of my life having scar tissue removed twice a year? Is the impotency and incontinentency permanent? How do I get a second opinion without having to travel from St Louis to New York?

Dear Michael, we’re very sorry to hear that you’re experiencing these side effects. We recommend that you ask your surgeon for a referral to a urologist who specializes in treating with these issues. Thank you for your comment, and best wishes to you.

I am 67 years old and few years ago i had prostate surgery done since the operation i am having erection problem can you tell me if that is normal. Thank you

Dear Angelo, these problems are quite common after prostate surgery. We recommend that you discuss your concerns with your doctor. Thank you for your comment, and best wishes to you.

I had a ruptured brain aneurysm, craniotomy and shunt 11 months ago. I'm healthy and doing well. I just found out last month I have prostate cancer . Prolaris genetic testing results indicated higher aggressive score than my Gleason 3+3=6 . Could in have the robotic prostate surgery in the incline position with my feet up for the 4 hour surgery? Have you done a prostate removal surgery on someone with my condition? Would an open be better? Thanks for your consideration,
Bill

Bill, thank you for reaching out. We recommend you consult with your physician on this particular issue. Unfortunately, we are unable to address specific medical questions on our blog, as every individual case is affected by many factors. If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment

Thanks for your comment.

i had robotic prostatectomy on may 3rd no side effects other than urinary dribbling how long can i expect this to last?

i had robotic prostatectomy onmay 3rd no side effects other than urinary dripping how long will this last?

Dear Gerard, we recommend you discuss your concerns with your healthcare team. Thank you for your comment and best wishes to you.

I had a robotic prostatectomy three months ago. Everything is going well, but it seems that I have bowel movements much more frequently than before the surgery. Is this just a coincidence or is it possibly related to the surgery?

Dear Henrik, we recommend that you discuss your concerns with your surgeon. Thank you for your comment.

Having had prostate surgery 2 yrs ago i can tell you what all I experienced.
1 having lost sexual function for about a yr, and having time to recover, it changes your mental outlook. I lost my identity. People who relied on me i felt didn't need me anymore. It nearly destroyed my marriage.

2 my energy level was reduced greatly and my patience level was reduced. So i was and am always tired, and lose my temper easily.

3 sexual intimacy was limited and if sexual intimacy is important to you i suggest rethinking it.

Of course the Dr says it's the prostate or death, but quite honestly death on your own terms going out as the man I was in many ways is better than living tired, unappreciated, and frustrated that you can't do what you once did.

Over the last 2 yrs i often wish I would have died.

Dear Jeff, we’re very sorry to hear that you feel like this. We recommend that you ask your doctor for a referral to a therapist who specializes in working with cancer survivors. Thank you for your comment, and best wishes to you.

Dear Doctor:

I am 68 years old. had 2 heart attacks and have 4 stents placed, the latest in, January 2013. I was diagnosed with prostate cancer Gleason 7 ( 4+3), Stage IIb/IIC. How my heart condition is going to affect my surgery. I read that I am placed with the legs up. Please advice. Thank you

Dear Constantin, we recommend that you discuss this with your surgeon. Thank you for your comment, and best wishes to you.

My husband had robotic radical prostatectomy with lymph node dissection 4 weeks ago. He is still not feeling well, feeling achy, feverish, and pain in his abdomen and headaches. Is this normal or should he be seeing someone? The fever is random and not always there.

Dear Cheryl, we’re sorry to hear your husband is having these side effects. We recommend that you discuss these concerns with his surgeon or nurse. Thank you for your comment, and best wishes to you and to him.

I have had an enlarged Prostate for over 30 years and I am 61. I have had 2 TURP procedures done in the last 3 years. I have had two biopsies both negative until now. My last PSA was 4.48 with my Free PSA at .42% so they sent me for an MRI which showed a mass in my Prostate and cancer in my Prostate. They are setting up a needle Biopsy to determine if it is malignant. Since I have had so many issues with my prostate already I concerned I may have little possibility to have any functionality for being able to control my urine ever. I really still do not have a great flow even with the two surgeries.

I am sure I already have accumulated scar tissue from the other surgeries plus I was fixed during the first surgery as I was getting married and she had issues and did not want to get pregnant due to the risk of cancer which ended up complicating my Prostate issues.

Do you have any advise for me, once I find out the results from the needle Biopsy? I feel like whatever it is, they will probably want to remove the Prostate due to my prior TURP procedures.

Thanks, for your help!

Dear Robert, we’re sorry to hear you’re going through this. We recommend that you discuss your concerns with your doctor. If your biopsy is positive and you are interested in a consultation at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment, and best wishes to you.

Have had 3 MRI's, Bone Scan, Biopsy, X-Rays. Gleeson score of 8, aggressive cancer. Told it has not spread out of the prostrate. Urologist recommends radiation because of my age, 70. Oncologist recommends total removal. Struggling with choice. Help

I am 60 years old and during the last week of March and the first week of April this year I was treated for a serious UTI (I was hospitalized for 3 days) A stent was inserted as a result of a large kidney stone . The stent was inserted to allow treatment of the infection prior to removal of the stone. The Urologist removed the stent 13 days later along with the large stone and a smaller stone he observed. I've had no post UTI problems. In August I went for my annual physical, which includes a PSA test. My PSA score jumped to 3.6 from the 0.7 test last year ( my PSA score over the last 13 years has consistently been 0.7 and there is no family history of prostate cancer). Per my Urologist I am getting a 2nd PSA test in September prior to my visit with him. Is it possible that all of the work that was done to clear the UTI and remove the Kidney stones, 4 months prior to my PSA test contributed to the increase in my PSA? I plan to ask the same question of my Urologist when I see him. Thanks.

Dear Bob, we’re sorry to hear you’re going through this. It would be best for you to discuss it with someone who is familiar with your medical history, as you are already planning to do. Thank you for your comment, and best wishes to you.

I had a robotic protatectomy in March this year. I am a very fit, 60 year-old and I start exercising moderately after about 2 months without problem. However, in July (so 4 months post-op) and since then, when I push myself in exercising, I have haematuria, which lasts about 12 hours. I also get ongoing pain in my left lower abdomen, I have had bladder tests when I reported this to my surgeon, which show that is all clear, and my clinicians seem a bit puzzled.
Any thoughts? Many thanks

Dear Simon, we’re very sorry to hear you’re going through this. If your doctor is not able to figure out what’s going on, you may want to consult with a specialist in this area. Thank you for your comment, and best wishes to you.

was recommended for prostatectomy due to intermediate risk gleason score 7 tumor found through biopsy-to be honest, I was all for it until reading these posts--please, someone share one positive experience after having a prostatectomy besides being alive!!