What is Radical Prostatectomy?

Radical prostatectomy (or more appropriately titled ‘complete prostatecomy’) is the surgical removal of the entire prostate gland, a walnut-sized organ located just below the bladder. This procedure is often recommended for men diagnosed with localised prostate cancer (localised meaning the cancer is confined to the prostate) and surgery is a viable treatment option.

Why is a Robot Used? When is a Robot Not Used?

Robotic-assisted radical prostatectomy involves the use of a surgical robot to enhance precision and control during the procedure. This approach offers several advantages, including improved precision, smaller incisions, and potentially faster recovery times. However, there are instances where a robot may not be used, such as when there is no access to robotic technology or due to the surgeon’s preference or expertise. The pros of robotic-assisted surgery include enhanced precision, smaller incisions, and potentially faster recovery, while the cons are essentially limited to the increased cost of robotic systems.

Who is it for?

Radical prostatectomy is typically recommended for men diagnosed with localised prostate cancer. The decision to undergo surgery is based on factors such as the stage of cancer, the patient’s overall health, and the potential benefits of surgical intervention.

Are There Any Side Effects?

Like any surgical procedure, radical prostatectomy is associated with potential side effects. These may include erectile dysfunction, changes in ejaculation, incontinence (temporary or permanent), urinary issues, and potential impact on fertility. It’s crucial for individuals considering this procedure to discuss these potential side effects with their healthcare team.

What Happens to a Man After the Prostate is Removed?

The absence of the prostate may impact urinary and sexual function. Regular follow-ups are essential to monitor recovery and detect any potential recurrence of cancer. Patients should openly communicate with their healthcare team about any concerns or changes in their health post-surgery.

The impact of radical prostatectomy on sexual function involves several aspects, including erection, ejaculation, and climax. The surgical removal of the prostate and seminal vesicles affects ejaculation, leading to dry ejaculation as seminal fluid is no longer produced. The division of the vas also prevents the ability to father children. Erection is influenced by cavernous nerves, located close to where prostate cancer commonly arises. While preserving these nerves is possible, it may not always be advisable for cancer removal.

Recovery of erections, if nerves are spared, takes an average of 4 months, with improvement continuing for 2-3 years post-surgery. Despite recovery, erections may be slightly less firm than before, and individual outcomes vary based on age and pre-surgery erectile strength. The likelihood of recovering erectile function is over 80% with good surgical technique and appropriate rehabilitation, as indicated by independent questionnaire-based follow-ups.

How Painful is the Recovery?

While pain levels can vary, discomfort is expected after surgery. Pain management strategies are employed to alleviate discomfort and enhance the overall recovery experience. Patients should follow their healthcare team’s guidance on postoperative care and pain management.

How Does This Affect Life Expectancy?

Generally, the removal of cancerous tissue through radical prostatectomy can contribute to increased life expectancy. However, individual outcomes depend on various factors, including the stage of cancer, overall health, and adherence to postoperative care. Ongoing monitoring and follow-ups are crucial to track recovery progress and detect any potential signs of cancer recurrence.

Radical prostatectomy is a significant step in the treatment of localised prostate cancer. Understanding the procedure, potential side effects, and the recovery process is essential for individuals considering this option. Open communication with healthcare professionals and adherence to postoperative care guidelines can contribute to a smoother recovery and improved long-term outcomes.

For more information about Radical Prostatectomy and how it is performed by Dr Paul Cozzi please refer to this page.

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Our team at Dr Paul Cozzi has been treating Erectile Dysfunction (ED) for over 20 years and in that time we have seen a number of advancements in the field, with one of the more compelling options being Internal Penile Prosthesis (IPP). In our experience, Penile Prosthesis can be one of the most effective long term solutions for ED – particularly when other more conventional methods have already been eliminated. We have written this guide to try and help patients when researching their options regarding ED.

What does a Penile Prosthesis do? 

Put simply, An IPP inflatable penile prosthesis is a three-piece inflatable device implanted in to the penis to support an erection for as long as desired. It effectively allows the user to generate and maintain an erection when needed and then reverse this process when required. The device is easy to use and discrete, it has no visible components once inserted.

Who is a Penile Prosthesis for?

We would typically recommend an IPP to men who are suffering from chronic erectile dysfunction (commonly known as impotence). It is also important to note that, although highly successful an IPP (like all surgical procedures) carries risk and we would recommend that you try less invasive options first.

How does the device work?

• The pump is contained in the scrotum. By squeezing and releasing the pump the device moves fluid from the reservoir into the cylinders. The cylinders are inflated with the fluid and mimic an erection. The cylinders are rigid when inflated. 
• To deflate the device simply push the button on the pump. This will move the fluid back into the reservoir leaving the penis once again soft and flaccid.

How much does it cost? 

The price of a Penile Prosthesis is dependent on a number of factors which are summarized below:

• Surgeon’s fees are generally around $3-5k which includes an assistant if required. 
• Hospital fees are completely covered if the patient carries appropriate private health insurance (PHI) cover.
• The prostheses its self is fully rebated with the appropriate level of PHI. 
• For uninsured patients the device cost would be $10-13,000 depending on the brand and also the hospital the procedure is done at.
• Anaesthetists fees will vary from one anaesthetist to the next. You will be directed on how to obtain a quote from the assigned anaesthetist via your surgeon prior to surgery.

If the patient is uninsured, we recommend obtaining an estimation of fees from the hospital prior to surgery. This estimate of fees can be obtained via the surgeons’ rooms on the patient’s behalf. Alternatively, the patient can request it for themselves. Note: Hospital fees will vary from hospital to hospital for uninsured patients.

What rebates (Medicare) are available? 

The Medicare rebate for this procedure is between $1000-$1500

How long does it last?

The lifetime of an IPP depends entirely on how the device is used (ie how often). As a general guide we have observed that 5-10 years is reasonable with some men still happy with their devices’ function 20 years after the initial procedure. 

Do they increase size?

IPP’s do not increase natural length but implants that provide lengthening properties can assist in addressing the penile shortening that some patients may experience after prostate cancer treatment. 

Can a woman tell if a man has a penile implant?

Most patients report that they are very happy with the natural look and feel of the penile implant when flaccid or erect. Additionally – many partners of patients with IPPs report they wouldn’t know their partner had an implant if they had not known about the surgery. 

Will a penile prosthesis affect ejaculation? 

Generally an IPP does not interfere with ejaculation or orgasm. This is considered a minimally invasive surgery. 

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Professor Paul Cozzi recently presented long term results of surgery for high-risk prostate cancer at prestigious International meeting in Berlin,Germany.

The results of long term outcomes following surgery for High Risk Clinically Localised Prostate Cancer were presented at the Societe International D’Urologie meeting held in Berlinin October.

The address focused on the results of a long term study of the oncologic and functional outcomes of surgery for this group of patients by Associate Professor Cozzi.

Patients undergoing surgery from 2000-2006 were selected from Associate Professor Cozzi’s prospective database of all surgical patients over the last decade, to allow minimum 5 years of observed rather than actuarial follow up to be analysed. The D’Amico classification of high risk disease (Clinical stage >T2c, PSA >20, Biopsy Gleason score 8-10) was used to identify patients for inclusion in the study.

A database of 179 high risk patients was identified with a median age of 63 (44-78); and a mean age of 62.87 was examined  with validated questionnaire-based follow up of functional results and biochemical-free survival examined with a minimum 5 years of observed follow up.

Oncologic outcomes

Patients undergoing adjuvant or salvage treatments were classified as immediate failures. Overall 5 year biochemical free survival (PSA <0.2) was 71.25%. No patient has died from prostate cancer.

10% received salvage radiation with 64 % of these achieving a further durable biochemical response.

Eighty nine patients (50%) had pathological organ confined disease with negative margins achieved in 81%.

Down-staging from cT3 to pT2 disease occurred in 62.5 % with these patients expected to have more than 80% chance of long term cure by surgery alone.

Functional outcomes – potency and incontinence

Of patients who underwent nerve sparing, erectile function was preserved in 74%. Of these, 1/3^rd required PDE-5 inhibitors to achieve an erection. Continence (no pads) was preserved in more than 90% of patients with only 5 requiring a further procedure to improve continence.

Conclusions

Excellent functional and oncologic outcomes can be achieved in experienced units for patients with high-risk clinically localised prostate cancer with almost three quarters achieving long term cancer control with minimal morbidity. Clinical staging is inaccurate and many men may be denied an opportunity for cure. Effective salvage treatments are available for those who are not cured by surgery alone.

These results appear superior to the reported results of  androgen deprivation and radiation therapy for patients with high risk disease.

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NRL commentator, Daryl Brohman and Qantas CEO Alan Joyce both credit a simple PSA blood test for prostate cancer for saving their lives.

While Prostate Cancer is often associated with older men, Joyce was in his early forties and Brohman in his early fifties when they were diagnosed and treated.  Like many men with prostate cancer, neither man had shown any symptoms and consider themselves lucky their cancer was picked up before it was too late.

“We would encourage men to ask their GP about a PSA test for prostate cancer at around age 40,” says leading urological surgeon, Dr Paul Cozzi.

“There is increasing data suggesting that a baseline PSA (prostate specific antigen) blood test for men at around age 40 can predict both lifetime risk of developing cancer and raise a flag for potentially lethal cancers, which can be confirmed by a subsequent biopsy.”

Such an approach could help identify men at high risk who may benefit from early treatment or from an active surveillance regime,” says Dr Paul Cozzi.

Both the Urological Society of Australia and new Zealand and the Royal College of Pathologists  recommend men seek a test from the age of forty in consultation with their GPs.

“The message is now loud and clear that there is growing evidence showing that PSA tests save lives and that early detection is the key to reducing deaths from prostate cancer,” Dr Cozzi said.

Around 3,300 Australian men died from prostate cancer annually.

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