Life after prostate cancer surgery – separating the myths from the facts (UCLH webchat) 

Prostate cancer is the most common cancer in men in the UK, with over 40,000 new cases diagnosed every year. Surgery is a treatment option for prostate cancer but men facing surgery are often worried about what happens afterwards - erectile dysfunction (ED), infertility and bladder problems are common concerns.

Our expert is Mr Prabhakar Rajan, consultant urological surgeon who will be available to answer your questions and separate myths from facts about recovering from prostate cancer surgery and living with the side effects of surgery. If you have any concerns or questions on this topic - whether you have had surgery or are deciding if surgery is the right treatment for you – you can put them to Mr Rajan for an expert opinion.

To join in the conversation, simply visit this page at 10am on Wednesday 25th May. To send your questions in advance, submit to webmaster@uclh.nhs.uk and Mr Rajan will try to answer your question on the day.

Please see a transcript below.


9:30 UCLH: 

Good morning and welcome to our web chat. We will begin at 10:00am, but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 10:00am.

Unfortunately Professor John Kelly has been called away urgently to theatre and will not be able to join us this morning. Luckily, consultant urologist Mr Prabhakar Rajan has kindly stepped in at the last moment and is here ready to take your questions.

You can read Mr Rajan’s consultant profile here.

 
9:59 Mr Prabhakar Rajan: 
Hi, my name is Mr. Prabhakar Rajan, and I’m a consultant urologist here at UCLH. I specialise in robotic surgery for prostate cancer, but I also see patients with prostate cancer at the time of diagnosis as well as before and after other forms of treatment. I undertake scientific research into how prostate cancers can come back after treatment, and have a laboratory at Barts Cancer Institute, Queen Mary University of London.
 
10:03 [Comment From OmololaOmolola: ] 
What are the best ways of managing the effects on the bladder / urinary continence following surgery?
 
10:03 Mr Prabhakar Rajan: 
Thanks for your question Omolola. I presume you mean following surgery where the prostate gland is removed? We place a catheter during surgery, which is removed a couple of weeks later and encourage patients to do pelvic floor exercises as soon as possible thereafter. Patients may need incontinence pads at that initial stage, but most patients’ incontinence will get better with time. There might be a few patients who need additional surgery if things don’t improve.
 
10:06 [Comment From SadiqSadiq: ] 
I recently had my prostate removed surgically. Does that mean there is no chance of the cancer coming back?
 
10:07 Mr Prabhakar Rajan: 
Thanks for your question Sadiq. The chances of your prostate cancer coming back after surgery depends on a number of things, such as the type of prostate cancer you had (Gleason score etc.) and whether the tumour was confined to the prostate gland. If the PSA blood test level becomes undetectable after surgery, then that’s a good sign, but we need to keep an eye on this for several years to check that the levels don’t rise. So to answer your question, unfortunately, there are no absolute guarantees in life!
 
10:11 [Comment From Martin: ] 
I’m having my prostate removed next month. How will I be followed up? What will be the frequency of PSA tests, rectal examinations, repeat biopsies, etc?
 
10:12 Mr Prabhakar Rajan: 
That’s a really good question Martin. Typically, patients are seen for the first time 4-6 weeks after surgery to see how they have recovered from the operation and discuss the results from a cancer removal perspective. We might check your PSA at that stage, but this would normally take place about 3 months after surgery when we would also like to see that your continence and sexual function is improving. Thereafter, your follow up is personalised and tailored to you, depending on the outcome of your surgery. I should add that we don’t normally do repeat biopsies if you have had your prostate removed.
 
10:14 [Comment From John: ] 
What level of success have you had in preserving erection potency in your patients? Any benefits of robotic surgery vs. non-robotic?
 
10:17 Mr Prabhakar Rajan: 
Another great question John! Robotic surgery vs. open surgery is a hot topic in the field! Our recent experience at UCLH is largely with robotic surgery. We discuss all of our patients at a meeting with expert surgeons and X-ray doctors before surgery to decide on whether we think we can spare nerves which control erections. Assuming you have normal erections before surgery, if we can spare the nerves on 1 side of the prostate then, in our experience at UCLH, there is about a 40% chance of being able to get an erection after surgery with drug treatment. This rises to about 70% if we are able to spare nerves on both sides. Unfortunately, we can’t spare nerves on all patients, and this depends on the location of the cancer, and some technical aspects during the operation itself.
 
10:19
If there are no guarantees by removal then what are the advantages with removal over other types of treatments?
 
10:20 Mr Prabhakar Rajan: 
This is a very good question, and one that should be discuss in detail with your specialist when you are choosing which treatment is best for you. This is very personal choice, and so it is important that all the options possible for you are discussed and made available.
 
10:20 [Comment From David: ] 
Since having my surgery I have problems with impotency that I can live with. Are there any longer term side effects that I should be concerned about? I’m worried that I won’t fully recover.
 
10:21 Mr Prabhakar Rajan: 
This is a tricky question to answer in relation to impotence without the full details of your case. The other major side effect of surgery is incontinence, but we would hope that this would improve with time and pelvic floor exercises.
 
10:23 [Comment From Fox: ] 
I’m having the surgery soon. Are there any changes to diet or lifestyle that I should make that can slow prostate cancer growth or that may allow my body to be more healthy after the surgery?
 
10:23 Mr Prabhakar Rajan: 
Thanks for this question. The answer is that you should continue with a healthy balanced lifestyle! Prostate cancer is typically quite slow growing and so there is probably very little that you can do in terms of immediate lifestyle changes that can affect the cancer growth in the short time diagnosis and treatment.
 
10:23 [Comment From Niraj: ] 
What happens if they find cancer outside of my prostate during the surgery?
 
10:29 Mr Prabhakar Rajan: 
Hi Niraj. This is a good question because at the time of surgery, we have an indication, but not an absolute knowledge of whether the cancer is outside the prostate. We base this on the x-ray tests that we do before surgery, which are very very good, but unfortunately these are not perfect (there is no "perfect" test). The final proof is in the analysis of the prostate gland that is removed. Expert pathologists will examine your prostate under a microscope to see if the cancer cells have spread beyond the gland. If that is the case, you might need additional treatment, but this decision is tailored to your own individual case.
 
10:29 [Comment From George: ] 
I have read about a nerve sparing technique that can save my ability to get an erection after surgery, but my consultant hasn’t talked to me about this technique. Can this help all men?
 
10:32 Mr Prabhakar Rajan: 
Can I refer you to the response to John's question above? Not all nerves can be spared on all prostates, but you should definitely ask your surgeon whether nerve-sparing is possible in your case. If you have not been offered a nerve-sparing procedure, then it may not be possible, but there is no reason for you not to ask the question!
 
10:32 [Comment From Iain: ] 
What technique has the best long term outcome? Open, laparoscopic, robotic?
 
10:40 Mr Prabhakar Rajan: 
This is a very interesting question Iain. The first robotic prostate cancer surgery procedures were performed in the US and in Europe in the early 2000’s so we are only just getting to know the longer term outcomes of this technique from the pioneering centres. So, we are only just able to start comparing differences in outcomes over 10 years between different techniques, and there are no head-to-head studies with results over that length of time. There are many advantages to robotic surgery in the short term, and what we do know is that early results are at least as good as the other techniques you describe.
 
10:44 [Comment From Donald: ] 
Should I be worried about preserving urinary and bowel continence? Are there other urinary or bowel side effects that I should be concerned about?
 
10:45 Mr Prabhakar Rajan: 
Hi Donald, We normally don’t expect to see bowel side-effects after robotic surgery and also focal treatments. After robotic surgery, most patients will suffer a degree of incontinence which typically gets better with time and pelvic floor exercises. Bowel side effects do occur in some cases with radiotherapy. You should definitely discuss your concerns about urinary and bowel continence with your specialists when you speak to them about your options.
 
10:49 [Comment From Brian: ] 
What can I expect following the surgery in terms of recovery time? How long will it be before I can return to my normal activities?
 
10:50 Mr Prabhakar Rajan: 
Patient recovery from all types of surgery is very individual, and some people take longer than others. In our experience patients tend to recover quickly after robotic surgery because it is a type of keyhole surgery. We encourage you to be active and take walks, but you should not do any strenuous activities for a couple of months. You should discuss exactly what this means to you with your specialist and whether the operation will affect your ability to work (e.g. if you undertake heavy lifting or manual labour).
 
10:56 [Comment From Alan: ] 
I found my operation very stressful. Will I need more treatment after surgery?
 
10:56 Mr Prabhakar Rajan: 
Hi Alan. I’m very sorry to hear that you found your operation stressful, and hope you have started to recover from your experience. Assuming you had robotic surgery to remove the prostate gland, the final proof is in the analysis of the prostate gland that was removed and your PSA blood test after surgery. You might not need any more treatment, but this decision is tailored to your own individual case.
 
10:56
Ive had radical prostatectomy two years next week. Im still having a problem with ED and also noticed Ive lost a few ins in length. They saved all my nerves on both sides . Used all medication available .Ive had radical prostatectomy two years next week. Im still having a problem with ED and also noticed Ive lost a few ins in length. They saved all my nerves on both sides . Used all medication available. Am I ever going to get full erections back after radical prostatectomy two years ago. Saved all my nerves too.
 
11:01 Mr Prabhakar Rajan: 
I’m sorry to hear that you are still having problems with your erections despite a nerve-sparing procedure and medication. There are ways to get back your erections after surgery, and I think it might be a good idea to see your GP to get a referral to one of our specialist andrologists at UCLH who are world experts in erectile problems.
 
11:05 [Comment From Colin: ] 
What are the likely or possible side effects of the surgery, both short term and long term? Are there delayed side effects that might appear over time?
 
11:06 Mr Prabhakar Rajan: 
Hi Colin, this is a good question and there quite a few points to discuss. In the interests of time, please could I refer you to our UCLH patient information sheet: https://www.uclh.nhs.uk/Pan...
If you have any specific queries, please do discuss these with your specialist when you are exploring the treatment options available to you. I am sorry I am unable to discuss all these points in detail with you in this forum.
 
11:10 UCLH: 
Thank you for joining us today in our live web chat. We received a lot of really interesting questions relating to all aspects of surgery for prostate cancer. We hope you found the chat useful and some of your questions have been answered.

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