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Surgery of prostate cancer

Radical prostatectomy

Radical prostatectomy (RP) is an established treatment with curative aims. RP includes removal of the entire prostate as well as the prostatic urethra and both seminal vesicles with subsequent anastomosis between the neck of the bladder and the urethra.

The surgery may be performed with open access, but is increasingly performed with robot-assisted laparoscopy.

There is no difference in side effects or postoperative complications of the different methods of radical prostatectomy, and oncological results are considered to be equal.

Local relapse will be more frequent in patients who had unfavorable histology of the operation specimen (pT3 and possibly invasion into margins). A large percentage of these patients will have PSA-relapse within 5-7 years. They should be assessed for adjuvant radiation therapy to the prostate region given about 3 months after surgery. If there is evidence of metastasis to the lymph nodes and/or other metastases, the disease is disseminated and curative treatment is unlikely.

Surgery and lymph node dissection

Staging procedure for intermediary and high risk patients

Since only 38 % of prostate-draining lymph nodes are localized to fossa obturatoria, is isolated removal of lymphatic tissue in this area of limited value. However, in cases where there are indications for surgical N-staging, it is recommended to perform an extended lymph node dissection, in which 63-75% of the draining lymph nodes are localized.

In some hospitals, an extensive lymph node dissection in context with radical prostatectomy is performed in cases where there is a high risk of lymph nodes metastasis. There is also evidence that extensive lymph node dissection may have therapeutic effect.

Palliative treatment

  • Transurethral resection of prostate (TUR-P)
  • Maintain drainage of upper urinary tract (hydroureter, hydronephrosis)
  • Metastasis surgery (for neurological symptoms)
  • Orthopedic surgery (for threatening fractures of metastastatic bones)

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