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prostatectomy

Surgical resection of the prostate. Indications: - symptomatic benign prostatic hypertrophy - localized prostate cancer Contraindications: - radical prostatectomy does no better than observation in reducing overall or cancer-related mortality in patients with localized prostate cancer [5,9] Procedure: - transurethral resection of the prostate (TURP) - transurethral incision of the prostate (TUIP) - transurethral US-guided laser-induced prostatectomy (TULIP) - radical prostatectomy - robotic assisted laparoscopic prostatectomy may be the procedure of choice [6], eventually [7] Laboratory: - prostate biopsy, Gleason scoring for prostate cancer - serum PSA - if serum PSA undetectable by ultrasensitive assay 3 years after radical prostatectomy, probablility of prostate cancer recurrence is 0.3%, 0.0% at 5 years [8] - PI16 may serve as a marker following prostatectomy for prostate cancer Complications: - urinary tract infection - urinary incontinence at 5 years [9] - sexual dysfunction at 5 years [9] - postprostatecomy urinary incontinence - robotic surgery associated with a higher rate of urinary incontinence than radical prostatectomy [4] - at 12 years, risk of urinary or sexual complications is 7-fold greater after prostatectomy vs men without prostate cancer [10] Management: - prophylactic antibiotics started the day prior to catheter removal appears to reduce risk of urinary tract infection - ciprofloxacin [2] - pelvic muscle exercises & bladder retraining techniques reduce postprostatecomy urinary incontinence by 50% [3]

Specific

photoselective vaporization of the prostate (PVP) transurethral incision of the prostate (TUIP) transurethral resection of the prostate (TURP) transurethral US-guided laser-induced prostatectomy (TULIP)

General

genitourinary surgery (urogenital surgery) surgical resection (excision)

References

  1. Stephenson AJ et al Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol 2009 Sep 10; 27:4300 PMID: 19636023
  2. Pinochet R et al. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy. Urol Int 2010 Dec; 85:415. PMID: 21099192
  3. Goode PS, Burgio KL, Johnson TM 2nd, et al. Behavioral therapy with or without biofeedback and pelvic floor electrical stimulation for persistent postprostatectomy incontinence: a randomized controlled trial. JAMA 2011; 305(2):151-159 PMID: 21224456
  4. Barry MJ et al. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of Medicare-age men. J Clin Oncol 2012 Feb 10; 30:513. PMID: 22215756 - Cooperberg MR et al. Outcomes for radical prostatectomy: Is it the singer, the song, or both? J Clin Oncol 2012 Feb 10; 30:476. PMID: 22215744
  5. Wilt TJ et al Radical Prostatectomy versus Observation for Localized Prostate Cancer N Engl J Med 2012; 367:203-213, July 19, 2012 PMID: 22808955 - Thompson IM and Tangen CM Prostate Cancer - Uncertainty and a Way Forward N Engl J Med 2012; 367:270-271July 19, 2012 PMID: 22808963
  6. Mulcahy N. 'End of Controversy': Robotic Prostatectomy Is Winner. Medscape. Jun 23, 2016. http://www.medscape.com/viewarticle/865241
  7. Yaxley JW, Coughlin GD, Chambers SK et al Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. July 26, 2016 PMID: 27474375 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30592-X/abstract
  8. Matsumoto K, Komatsuda A, Yanai Y, et al. Determining when to stop prostate specific antigen monitoring after radical prostatectomy: The role of ultrasensitive prostate specific antigen. J Urol 2017 Mar; 197:655. PMID: 27590477 http://www.jurology.com/article/S0022-5347(16)31195-8/abstract
  9. Hoffman KE, Penson DF, Zhao Z et al Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA. 2020;323(2):149-163> Jan 14 PMID: 31935027 https://jamanetwork.com/journals/jama/article-abstract/2758599
  10. Bassett M Prostate Cancer Treatment Associated With Long-Term Complications. Researchers say inadequate understanding of risks may lead patients to regret treatment decisions. MedPage Today November 7, 2024 https://www.medpagetoday.com/urology/prostatecancer/112785 - Unger JM, Till C, Tangen CM et al Long-Term Adverse Effects and Complications After Prostate Cancer Treatment. JAMA Oncol. Published online November 7, 2024 Not yet indexed in PubMed https://jamanetwork.com/journals/jamaoncology/fullarticle/2826069