Complications of Prostate Cancer
After a patient has been diagnosed with prostate cancer, and treatment options are discussed, some of the most common concerns of the patient pertain to the side effects or potential complications of the treatments. Patients want to know what bearing the treatments that are commonly used will affect their life as the patient presently knows it. Tremendous trepidation exists, however most of these fears are not based on the actual outcomes that most treatments result in today.
Complications can occur intra-operatively or post-operatively. The most feared intra-operative complication is that of excessive blood loss. In the pre-robotic era blood loss was greater than that seen with most robotic approaches however the risk of transfusion still exists for both procedures. Additional complications that can occur as a result of surgery are injuries to adjacent organs or blood clots that can form in the lower extremities (DVT). There are steps that can be taken intra-operatively to limit the risks of thrombosis. If an injury occurs to an adjacent organ, if it is identified at the time of the surgery, it can usually be repaired and the outcome will be favorable.
Urinary incontinence is one of the most-universally feared post-operative complications. Over the last 2 decades, improvements in surgical techniques including a more widespread use of the robotic approach, the incidence of post-operative urinary incontinence has decreased. Despite these advances, patients can still experience post-prostatectomy incontinence. New techniques that utilize the use of a male sling are now being utilized more commonly to treat post-operative incontinence. These techniques utilize a piece of mesh that is placed around the urethra and supported by the pelvic bone. This support structure compresses the urethra and in a vast majority of cases can result in a return to continence.
An artificial urinary sphincter can also be placed post-operatively to help cure severe cases of incontinence. This technique involves the placement of a cuff that compresses the urethra. The cuff is attached to valve that can open the cuff allowing urine to flow when the bladder is full. Automatic closure of the sphincter occurs after a short period of time.
Erectile dysfunction (ED) is another complication that is feared by patients. Its incidence has fallen over the last 2 decades however it continues to be a problem. Better anatomic dissections that have occurred as a result of a more thorough understanding of the anatomy of the nerve supply has led to a greater success rate. The use of the various medications post-operatively to treat ED has resulted in far more post-treatment patients who experience sexual function. The earlier use of these mediations may perhaps result in a "rehabilitation" of the erectile mechanism. Penile prosthetic surgery which involves the implantation of a either a malleable or an inflatable device into the penis will also result in satisfactory erectile function in those patients that do no respond to pharmacotherapy.
Advances in surgical technique, pharmacotherapy and a better understanding of the anatomy, has lead to surgical treatments with results that do not leave the patients disappointed. Those few patients who experience severe post-operative difficulties should pursue treatment and their complications most-often can be overcome.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.