Do I need any additional treatment?
Usually, you will not need any additional treatment after a radical prostatectomy. You and your physician will make a decision on the need for additional treatment based on the pathology report and your PSA level after surgery. Your PSA should drop to undetectable levels after surgery. Patients with cancer in the lymph nodes, T3 cancers, high-grade cancers and positive margins are at an increased risk of recurrence and should discuss the type and timing of any additional treatment with their doctors.
On occasion, radiation, hormonal therapy or any one of a number of new agents being evaluated in clinical trials may be given if the cancer removed was extensive or recurs in the future. All patients should have regular check-ups including PSA (prostate specific antigen) blood tests, and in selected cases imaging (bone scan, CT scan, MRI, etc) tests.
How often do I need to see my doctor?
You will see your doctor initially to be sure that your recovery and return of urinary continence is occurring normally. For those who are sexually active and have not regained potency, your doctor will discuss various options for management. The frequency of doctor visits and serum PSA tests will be determined based on the risk of cancer recurrence. Most often, serum PSA is obtained at 4 to 6 month intervals for the first 3 years. Serum PSA is measured less frequently thereafter.
The diagnosis of prostate cancer and its treatment evokes strong emotions in patients and their loved ones. It is important that you share your concerns, fears and frustrations with your doctor, support group and those around you. Good communication is important to recovery. You may find participation in a support group very helpful.
Bleeding in the urine . Bleeding in the urine is common and it may be intermittent. One should cal their physician for any of the following: 1) passage of large blood clots (longer than an inch), 2) very bloody urine (like burgundy wine or so thick that one cannot see through the urine in the clear urinary drainage tube or bag, 3) blocked catheter whereby the urine fails to drain.
Cloudy urine . This is common and will resolve once the catheter is removed and healing occurs. You should drink plenty of fluids each day, at least 8 glasses.
Constipation . Constipation is a common side effect of pain medications and surgery. During the time that you are taking them, be sure to increase your fluid intake (at least 8 glasses of water a day), take stool softeners (i.e. Metamucil or Colace), and eat lots of roughage (whole grains, fruit and vegetables). Use laxatives only as a last resort. If constipation occurs, try a gentle laxative initially (Milk of Magnesia, 2 tablespoons). This can be repeated, if necessary
Contacting your doctor . Minor problems or concerns can be relayed to your doctor during daytime office hours. Frequently, a call to his or her nurse will suffice. Any major concerns should be transmitted immediately. Major problems are rare. However, all doctors should have 24-hour contact telephone numbers. If your doctor is not immediately available or you have need of emergency treatment, contact your local emergency room or dial 911. Doctors at your local hospital or emergency room will contact your doctor as well. You should have copies of your doctor.s office number (daytime and 24 hour) readily available.
Diarrhea . A change in bowel habits is common after surgery. Although you may notice an increase in the frequency of our bowel movements, diarrhea (frequent liquid bowel movements) is uncommon. This can be due to an infection. Consult your doctor if you have persistent diarrhea, especially if it is accompanied by increasing abdominal pain, swelling or fever.
Diarrhea due to infection can be treated with oral antibiotics.
Difficulty getting or maintaining erections . Return of sexual function (erections) following surgery is dependent on many factors including surgical technique (whether one or both neurovascular bundles were saved), patient age, preoperative function and overall health (presence of diabetes, a history of smoking, high cholesterol levels, etc. which increase the risk of sexual dysfunction following the procedure). If your erections were good before the procedure and your surgeon was able to spare the nerves and blood vessels responsible for normal erections, your erections are likely to return over time.
To facilitate the return, your doctor will prescribe either Viagra, Levitra or Cialis or other techniques (self-injection, urethral suppositories, and vacuum devices). The return of erections may take several months. Your ability to have orgasm (climax) should remain intact.
You will not be able to ejaculate as the prostate and seminal vesicles have been removed. You may produce some secretions as small glands in urethra remain following surgery. If your doctor was unable to spare the neurovascular bundles, you should discuss options for treatment. You should remain sexually active with treatment.
Diet . There is n specific diet following radical prostatectomy. Patients are able to drink liquids immediately and progress to solid foods within 24 hours in most cases. Patients are encouraged to eat a well-balanced diet. There is no need to eat large meals, many patients find that ingestion of small meals is satisfying after surgery. On occasion, iron, to replenish blood cells is taken. Ask your doctor whether this is necessary. Eat a diet that you find satisfying and palatable. Normal dietary habits will return as healing occurs and you resume normal physical activity.
Exercise . Walking after the procedure is encouraged. The amount of walking may be limited for the first 2 or 3 days after the procedure but should increase thereafter. There is no specific restriction, but one should restrict activity due to pain or fatigue. Most patients are walking a block or two within 4 to 7 days. Activity increases progressively, especially once the catheter is removed. Lifting (more than 15 or 20 pounds) should be avoided for the first 7 to 10 days.
Heavy abdominal exercise (i.e. sit-ups) and cycling on an upright bicycle should be avoided for approximately 6 weeks. Patients can return to jogging, swimming, golf, etc. when they feel comfortable with these types of exercise.
Excessive drain fluid . A drain is frequently left in after the procedure, The drainage should be either clear or blood-tinged. It usually decreases and the drain removed before discharge from the hospital. On rare occasion, it persists and you will be discharge home with the drain in place. You will be asked to record the drainage daily. The drain will be removed, once the drainage is limited in amount (usually less than 50 to 100 cc in 24 hours).
Fever . A persistent temperature above 38 C (101 F) is not normal. If you have a fever call your doctor.
Leakage around the catheter . Passage of small amounts of blood or urine or thick secretions around the catheter is common and no cause for alarm. Wash the area with soap and water daily.
Pain . Pain along the incision is to be expected, but it should be effectively managed by use of pain medication. Call your physician if it is not. On occasion, patients with catheters in place may develop .bladder spasms. These are characterized by intermittent episodes of pain just above the pubic bone, often radiating down the penis, and often associated with passage of urine around the catheter. These will resolve once the catheter is removed. If they occur frequently or are very painful, contact your doctor who can prescribe medication (Detrol or Ditropan) to control them. The medication should be stopped just before the catheter is removed.
Poor urinary flow . The caliber of the urinary stream often varies after the procedure. Most often, it is stronger than before the procedure. On occasion, it may appear to be weaker. Rarely, the anastamosis (the area where the urethra was sutured together after prostate removal) will narrow making urinate difficult. This can be managed with dilation, gentle stretching, of the urethra. Call your doctor if the caliber of the urinary stream narrows whereby the stream becomes intermittent, you have to strain to urinate, or fell that you are not emptying the bladder completely.
Redness along the incision . some degree of redness is expected during the healing process, but it should not be excessive (extending beyond the incision for more than a few millimeters) or expanding. Call your doctor if you note increasing redness, certainly if it is associated with fever, increasing pain in the area or thick, purulent (pus) drainage.
Swelling or bruising of the scrotum or penis . swelling or bruising of the scrotum and penis occurs commonly after the procedure. It is usually limited and will resolve within 7 to 10 days of the procedure. On occasion, elevation of the scrotum with a rolled towel while in bed will be helpful.
Swollen leg(s) . Some patients may notice mild swelling of the ankles after surgery due to the large amount of fluid they may receive during surgery. However, more substantial swelling of the calf or thigh is unusual, especially if it associated with pain or occurs in one leg. If such swelling occurs, contact your doctor. Rarely, patients may develop blood clots in the leg after almost any type of surgery.