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.
Back to topWhat 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.
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.
Back to topWhat 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.
Back to topWhat 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. 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.
Back to topComments
William
Nov 6, 2017 • 2:15 PM
JAMES L SCROGGS
Nov 13, 2017 • 1:51 AM
Memorial Sloan Kettering
Nov 13, 2017 • 9:03 AM
In reply to My surgeon is changing… by JAMES L SCROGGS
Dear James, we’re sorry to hear that you’re doing through this. If your surgeon is no longer available because he/she is changing practices, we recommend that you discuss this with someone else in his or her practice who has access to your records and is able to give you an examination. Thank you for your comment, and best wishes to you on your recovery.
Jim
Nov 18, 2017 • 3:10 PM
I had prostate surgery in March '17. First 2 PSA tests after surgery were <0.1, most recent test was 0.2. I have stage 3, scores of 4-3. What does the increased test number mean? Is it serious? I'm seeing my doctor next week, will we be asked to make decision on next treatment path, or will this be a wait and see process. I'm 74, in reasonably good shape.
Thanks
Jim
Dear Jim, we recommend you discuss this with your surgeon. If you would like to come to MSK for a consultation, 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.
VINCENT DOHERTY
Nov 21, 2017 • 4:07 PM
Eight months ago I got my first prostate infection and after a 30 antibiotic it was appeared to clear up. After a couple of months it returned and I had to have antibiotic and shots and rest and it somewhat cleared but not the inflamation which caused frequent urination. Now I am on my third round with Cipro, and prenazone and shots etc. and this will not clear up. I have a family history of prostate cancer with brother father and uncle. I am 75 years old and need to get this out of my body and healed but do not want to look forward to it coming back. Do they ever perform surgery and remove the prostate when it isn't cancerous???? I can't have a biopsy until the infection is totally gone but I want a permanent solution???? Please advise. I also have had mild divaticulitis for years but all this bacteria killing is going to mess that up also. I am concerned about now being immune to the standard treatment and can they go direct line to kill the bacteria in the prostate???
Memorial Sloan Kettering
Nov 22, 2017 • 8:54 AM
In reply to Eight months ago I got my… by VINCENT DOHERTY
David Booth
Dec 5, 2017 • 2:21 PM
I had a radical prostectomy last year and as far as that surgery everything went well with few problems. Of course I'm still recovering sexually but even that is slowly returning. The reason for this inquiry is that I have been having upper gastric problems. I've did some online research but haven't seen any topics that directly address this subject. My prostate surgery was done with davinci and during the surgery your placed head down so your organs are oriented to your upper abdominal area so the surgeon has a clear area to perform the surgery. My question is that my regular doctor has done chest xrays and says my esophagus is way out of place and slightly twisted and likely I now have a hiatal hernia where the stomach has partially pushed up through my diaphram causing displacement of my esophagus. Could this be a result of having been placed head down during my prostate surgery? Otherwise I can't figure out how my esophagus go so far out of place. It's caused pain in my left chest area which was initially thought to be heart problems but they have since been ruled out. Ever heard of this?
Memorial Sloan Kettering
Dec 6, 2017 • 8:30 AM
In reply to I had a radical prostectomy… by David Booth
Art Kimmel
Dec 26, 2017 • 6:19 PM
I am scheduled for Robotic prostate surgery next month and am most worried about unary incontinence. I am 73 years old and have an large prostate. I have been taking Doxazosin and Finasteride for years. My question is does my age and enlarge prostate increase my chances of unary incontinence after the surgery. My surgeon has done over a 1000, is that a good number.
Memorial Sloan Kettering
Dec 28, 2017 • 10:24 AM
In reply to I am scheduled for Robotic… by Art Kimmel
Dear Art, we recommend that you discuss your concerns about side effects with your surgeon. If you are interested in getting a second opinion or learning more about how to choose a surgeon, you may find this information from the Prostate Cancer Foundation useful:https://www.pcf.org/c/how-to-find-an-expert-surgeon/
Thank you for your comment, and best wishes to you.
Alice
Feb 18, 2018 • 8:19 AM
My husband at 53 had a successful robotic prospectively, and a very good recovery with follow up test of 0 PSA counts. One year later he died instantly of a heart attack from what we believe was a blood clot. Is there any correlation between the two health issues and treatments that may have prevented this? Could he have gone back to his work too soon in 6 weeks?
Katie
Mar 14, 2018 • 6:50 PM
THEODIS Young
Mar 25, 2018 • 2:55 AM
I had robotic cancer surgery about 3 months ago I’m 59 years old since the surgery I have a lot of pain in my abdomen to the point where I caint sit up for a long period of time because of the pain and cramping and having a bowel movement is almost unbearable is this normal and how long is the healing process after this type of surgery.
Memorial Sloan Kettering
Mar 26, 2018 • 11:37 AM
In reply to I had robotic cancer surgery… by THEODIS Young
Willia
Apr 9, 2018 • 3:37 PM
My father is 75 years old, in excellent health and on no medications. He has been diagnosed with Stage 2A prostate cancer that has not spread beyond the prostate. His Gleason score is an 8 on three of twelve cores taken. He wants to have prostate surgery. The oncologist was initially concerned with his age upon his first appointment but in reviewing his case, the oncologist team and urologist have decided to give him the option of surgery. I can't find any statistics on the number of men 75 and older that have the surgery. Is it normal for men his age in excellent health to be offered the option of surgery with successful outcomes?
Dear Willia, we’re sorry to hear about your father’s diagnosis. We sent your question to Dr. Eastham, who responded that most men your father’s age are treated with radiation therapy, although surgery is certainly an option.
He said in appropriately selected men undergoing surgery at this age the immediate surgical complication rate is no higher than younger men, but longer term the rated of urinary incontinence and erectile dysfunction are higher in older compared to younger men.
If your father would like to come to MSK for a consultation, he 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 both of you.
Al D.
Apr 25, 2018 • 10:40 PM
I'm 61 with new Dx of Prostate CA. and have 5 out of 14 core samples positive with Gleason 6. Most professionals i've spoke to recommend surgery as the best course of action. However there seems to be more literature coming out that seem to advocate waiting and active surveillance. Stating that with my age and type of cancer i'm likely to die of something other than prostate cancer.
Do you know of any evidence based studies that would support this.
Dear Al, we’re sorry to hear about your diagnosis. To learn more about MSK’s approach to active surveillance, you can go to this page: https://www.mskcc.org/cancer-care/types/prostate/treatment/active-surve…
If you’d like to arrange a consultation with an MSK expert to learn more, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment, and best wishes to you.
Notgivingup1
May 14, 2018 • 12:55 AM
Hi had robotic prostatectomy almost two years ago. Went to therapy to be able to urinate but was put back in the hospital for pulmonary embolism and diabetes. 4 months later. Now I am still in depends and have no desire nor can perform for sex, had 48 radiation treatments, and are still on cancer pills for a few more months. I also have a indentation or kind of a hole where the prostate was removed. I have to pull it out to urinate. Have you ever heard of it and will I ever be able to function again sexually after the pills? Married 35 years and confused.
Memorial Sloan Kettering
May 14, 2018 • 4:42 PM
In reply to Hi had robotic prostatectomy… by notgivingup1
Thank you for reaching out. If you are interested in speaking with one of our specialists in these types of complications, we suggest you contact John Mulhall, Director of MSK’s Male Sexual and Reproductive Medicine Program.
To make an appointment, you can call 646-497-9068. You can also learn more here:
Joe
Jul 2, 2018 • 4:48 PM
After active surveillance for six years, my latest biopsy shows localized Gleason 3+4, very large prostate, over 100 cc's I believe. I'm a healthy active 77 year old (swim 3/4 mile laps 3x wk, light weights 2x), with no other current health problems. Primary Urologist rec is radiation, still have to consult with radiologist to see if I'm good candidate, but not terribly enthusiastic about radiation even if I am, because of possible rectal side effects. Wondering if your folks think I'm too old for da vinci robotic surgery.
Understand that without consult, any response is speculative, primary concern about whether I'm too old. Just thought I'd ask.
Dear Joe, we consulted with Dr. Eastham, and he said there is no age cutoff for robotic versus open surgery. If you are interested in coming to MSK for a consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment, and best wishes to you.
Nettie Spicer
Aug 2, 2018 • 1:28 PM
My Husband had the robotic surgery two weeks ago, the biopsy came back with the cancer being in 3 percent of the prostate doctor said stage 2. does this mean he needs treatment? also he's been having lower back pain for the past 2 days and still has the burning when he urinates (which is every 5 to 10 minutes) it's so bad he has to bite down on a towel when he goes.
Memorial Sloan Kettering
Aug 2, 2018 • 4:59 PM
In reply to My Husband had the robotic… by Nettie Spicer
Nettie, we are sorry your husband is going through this. We suggest you and he discuss his condition with his medical team. If you are interested in consulting with an expert at MSK, you can call 800-525-2225 to schedule an appointment for a consultation. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information or to request an appointment online. Thank you for your comment, and best wishes to you.
Robert
Aug 7, 2018 • 10:27 AM
I had a PSA of 7 which lead to having a MRI then biopsy which identified a gleason score (7) of 3+4 so I was on active survelliance. A second MRI biopsy 8 months later which showed a gleason score of 7 but 4+3. So it was advised some action should be done. I decided to do Da Vinci surgery. The pathology came back and identified a gleason score of 6 (3+3). So I am curious why such a difference between pathology results and why less after a surgery! Did the 2 MRI/Biopsy at top places in NY and the surgery at a top places in NY. Why the discrepancy between pathology reports escpecially after the surgery?
Dear Robert, this is something you should discuss with your medical team, but in general different samples (or “cores”) may have different scores because they are taken from different parts of the tumor. Tumors are usually not the
same throughout. The highest score is usually used for making treatment decisions. Thank you for your comment, and best wishes to you.
Peter
Aug 7, 2018 • 10:31 AM
Dear Peter, this is something you should discuss with your medical team, but in general different samples (or “cores”) may have different scores because they are taken from different parts of the tumor. Tumors are usually not the same throughout. It’s also possible there may be more than one tumor. The highest score is usually used for making treatment decisions. Thank you for your comment, and best wishes to you.
Steve Crowder
Sep 16, 2018 • 4:27 PM
I had a radical prostatectomy four and a half weeks ag, which removed all traces of cancer.
A week after surgery the catheter was removed without incident, but over the next week I noticed a numbness on the right side of my groin and going down about 8 inches on my right leg. It got really bad after a week and after another week has started to subside, but there is still a hard knot in the muscle high up in the groin on that same site, as well as a weaker numbing sensation, plus i’m still incontinent when I try to do any kind of work around the house that doesn’t involve sitting or laying down.
My question: is this common with my procedure
Alfred
Nov 3, 2018 • 3:07 PM
Dear Alfred, we’re sorry to hear you’re experiencing these side effects. We recommend you discuss this with your medical team. If you are interested in coming to MSK for a consultation, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment, and best wishes to you.
Tom
Jan 29, 2019 • 1:58 PM
64 yo old underwent radical prostatectomy 19 months ago via laparoscopy by an experienced surgeon. the catheter was removed 8 days post-op with disruption of the anastomosis. urologist replaced catheter (wire-guided) which stayed in place for an additional month. I have good bladder control but no return of sexual function even with oral meds. could the disruption of the anastomosis also disrupted the nerves? If so, is there anything that can be done now?
Dear Tom, we’re sorry to hear you’re going through this. If you would like to arrange a consultation with one of our experts to find out about treatment options, 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.
Ramona
Feb 21, 2019 • 6:59 AM
Husband had DaVinci prostate removal in March 2016. PSA began to rise and had 37 radiation treatments beginning Feb 2018. PSA has now doubled in a 6 month period. Drs want to start hormone therapy. Your thoughts on hormone therapy vs Orchiectomy. He recovered well from both the surgery and radiation. No incontinence and can get an erection. He is very active, works long days, has NO other health issues.
Dear Ramona, we’re sorry to hear your husband is going through this. Unfortunately we are not able to make treatment recommendations on our blog. If he is interested in coming to MSK for a consultation, the number to call is 800-525-2225. You can go to https://www.mskcc.org/experience/become-patient/appointment for more information. Thank you for your comment and best wishes to both of you.
E.d.
Feb 24, 2019 • 12:10 PM
Don Kamlager
Mar 21, 2019 • 4:11 PM
have been on terazosin(10MG) and finasteride(5MG) for 8 years due to a large prostate, no sign of cancer or enflamation, just a large prostate.
Have been find, no urinary problems but lately the old problems have started to occur, late night, and night time need to urinate, researching side effects of surgery appear effects are worse than the discomfort I am having.
Could the dosage of finasteride be increased. I am 75 and in good health, all blood tests and urine tests indicate no [problems
Memorial Sloan Kettering
Mar 22, 2019 • 9:44 AM
In reply to have been on terazosin(10MG)… by don kamlager
Dante
Apr 12, 2019 • 12:01 PM
Do the MSK robotic prostate cancer surgeons operate on patients for bph also or do they only treat for prostate cancer? Do they also perform simple robotic prostatectomies that would apply for bph? Do they have experience treating patients that have both bph and chronic prostatitis by removing their prostates either doing robotic radical or robotic simple prostatectomies?
Dear Dante, MSK does have a surgeon who performs surgery for BPH, including minimally invasive surgery with or without robotic assistance. If you are interested in arranging a consultation to learn more, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.
Mark Raper
May 24, 2019 • 12:04 PM
I will soon be having a biopsy on my prostate to check for cancer. Two PSA tests came out at 10.5. The urologist (20+ years experience) has talked about robotic surgery (DaVinci) as a possibility of the biopsy shows cancer. I am also concerned about some other health problems I've had and how it might be effected by surgery. March 2018 - extremely high BP (controlled now with meds), lower left thalmic stroke, Type II Diabetes diagnosed (controlled with meds). Is prostate removal surgery more concerning with these issues? What should I ask my doc??
Dear Mark, we’re not able to make individual treatment recommendations on our blog. If you’re interested in arranging a consultation with one of our experts, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.
Gerry
Jun 7, 2019 • 2:45 AM
I can't find anything anywhere on the internet about my situation. June 4th I had surgery for a RRP. I woke up and barely remember being put into my recovery bed. My wife was there and the Dr. showed up soon afterwards. I still had my prostate. I was so angry! I am sure my doctor would have done more for me if he had been able to. My prostate was small and it was deeper into my pelvic cavity than usual. This made it impossible to safely perform my RRP. Another doctor was asked to exam it for the potential of performing an ORP, but he did not want to risk it either. So, here I sit with seemingly only a radiation option; which quite frankly scares the hell out of me.
Dear Paul, we’re sorry to hear that you’re going through this. You may be interested in joining Connections, our online support group for cancer patients and their caregivers. It is open to people both inside and beyond MSK. You can learn more at https://www.mskcc.org/experience/patient-support/counseling/groups/conn…. Thank you for your comment, and best wishes to you.