By Dr. Dhiren Dave
After scouring the Web for information on prostate cancer, many of my patients are often left feeling unsure about the tests they need to have done, the results they should listen to and the steps they should take moving forward after a cancer diagnosis. I’ve had many patients come in, terrified from the results of their online search and afraid to ask the questions on their minds, since many of them are sensitive about this topic and embarrassed to ask the important questions.
In recognition of September being Prostate Cancer Awareness Month, I’ve decided to address the top questions men are afraid to ask their doctors about their prostates, but to which they need to know the answer. I urge patients to discuss these difficult questions with their physicians to make sure they have all the information they need to comfortably make the right treatment choices.
How often do I need to get tested, and what does the test involve?
Screening for prostate cancer involves a digital rectal examination (DRE) to feel the prostate, as well as a blood test to check for PSA (prostate-specific antigens) once a year, starting at the age of 50. As men age, they are at a greater risk of developing prostate cancer. However, African American men and men who have a direct family history of prostate cancer are strongly recommended to take a proactive approach and begin testing at the age of 40, as they are considered to be at higher risk for the disease.
What symptoms should I be most worried about?
Prostate cancer often does not cause symptoms, except in its advanced stages when it can cause difficulty with urination, blood in the urine, or bone pain due to spread of cancer to the bones. However, common symptoms related to the prostate gland, which include frequent or nighttime urination, difficulty starting the urinary stream, slowing of the urinary stream, and having to rush to urinate, can signal problems that warrant further evaluation from a physician.
What are the differences between traditional surgery methods and robotic surgery for prostate cancer?
As opposed to traditional surgery, where a large open incision is made in the lower abdomen and the prostate is removed using the surgeon’s hands, the robotic approach uses the advantages of minimally invasive techniques using small incisions and the insertion of a stereoscopic camera and robotic instruments to facilitate prostate removal. The high resolution, magnified 3-D view inside the patient’s body, combined with the enhanced instruments that have a range of motion greater than the human hand allows, enables the surgeon to perform a very precise and meticulous surgery that significantly reduces the risk of bleeding. The smaller incisions give patients the added advantages of a shorter hospital stay, significantly reduced pain, and a faster return to work and daily activities, compared with open surgery.
What are the real side effects from having my prostate removed?
There are a number of side effects that can accompany having the prostate removed, but significant advancements have been made to reduce any effects that can follow surgery:
- Urinary incontinence – Though leakage of urine is common immediately after surgery, 95% of patients will regain full urinary control upon recovery.
- Erectile Dysfunction – Men may experience a decrease in erectile function following surgery due to damage to critical nerves and/or blood vessels around the prostate which contribute to erectile function. Risk of dysfunction depends on numerous factors, including age, baseline function, and whether nerve preservation was performed during surgery. Approximately 50-70% of potent men undergoing nerve preservation at the time of prostate removal can expect to see return of erectile function following surgery.
- Loss of fertility – After prostate removal, men will not be able to father a child using conventional methods. If a man is interested in still having children after surgery, it is recommended that he carries out sperm banking prior to the surgery.
Dhiren Dave, M.D. is a board-certified urologist and robotic surgeon at Somerset Medical Center.