Enlarged prostate surgery is a very common type of surgery that many have to undergo nowadays. An enlarged prostate causes many health problems including urinary tract obstructions and urinary tract infections. It may also lead to the passing of blood via urine. Thus, enlarged prostate must be treated as soon as possible as neglect may lead to prostate cancer and its associated health issues. There are various types of prostate surgeries that a doctor performs on his/her patients. However, of late, radical prostatectomy is the most popular of them all.

What is Radical Prostatectomy?

This process can be handled in two ways. Firstly, the prostate can be reached through an incision in the abdomen. This would help the doctor work with precision and carefully avoid all the other nerves and muscles in the area the operation take places. The prostate is examined and any nodule or lymph formed over it is carefully removed. The advantage of this surgery is that the patient is less likely to suffer from any erectile problems post- surgery. The second option would be to make an incision between the scrotum and the anus. This process is best for those who are obese. The surgery is performed quickly and there is less loss of blood. Furthermore, the healing time is less too.

How To Recover From The Surgery?

Like most other prostate operations, even in radical prostatectomy, you would have to wear a catheter till you recover completely. For a few days post the surgery your urine would be collected through a urine bag attached to the catheter. One might feel a little sore in his/her genitals after the surgery, but that is quite normal to occur. The soreness is caused due to the surgery and the incisions made and would heal in a matter of a few days. Interestingly, since the urethra plays an important role in this surgery, the catheter has to be in place for at least two to three weeks but the patient can be discharged after a two to three night stay at the hospital. It is advised that the patient takes ample rest. But this does not mean all rest and no work. In fact, it is seen that patients can walk a little and even go back to a normal diet within a week to ten days of the operation. But regular checkups, till the urethra is healed, are compulsory.

Hence, these are some of the recovery procedures after an enlarged prostate surgery. Such surgeries are quite common and heal quickly.

What To Expect Post An Enlarged Prostate Surgery?

In recent years, there has been the emerging trend of resorting to customized treatment for different types of cancer. These treatments vary from individual to individual, depending on the severity of their condition. PSMA PET scan and DOTA scan are two such procedures used in the treatment of prostate cancer.

Before identifying the benefits of these scans, let us have a look at the risks of prostate cancer.

Prostate Cancer- What is it?

Prostate cancer shows up in the prostate gland of men, which produces the fluid that transfers and nourishes the sperm. It is a very commonly occurring condition in men and early treatment can cure it completely.

Symptoms of Prostate Cancer:

Prostate cancer starts showing its symptoms from the middle stages. One should seek medical help if he observes the following warning signs-

  Pain while urinating
  Bone pain
  Reduction in force of urine
  Erectile Dysfunction
  Presence of blood in semen

With increasing age and obesity, there remains a high chance of developing prostate cancer.

What is PSMA PET scan?

It is an effective and reliable mode of diagnosis to identify the extent of prostate cancer. It is also known as Prostascint scan. This scan is recommended for patients in the early stage of cancer and to determine whether the disease has spread to the pelvic lymph nodes.

In this process, the patient is injected with an antibody and a radioactive material that can be detected by cameras. The doctor then sees a three-dimensional picture of the affected area on the monitor. The complete process takes three days to finish.

Benefits of PSMA PET scan:

  Helps to determine the position and range of a tumour
  Helps the doctor to plan effective methods of treatment to eradicate a tumour completely
  Helps to predict the result of treatment up to a certain extent, unlike other imaging tests

What is DOTA scan?

It is a highly advanced scan used to detect the spread and sensitivity of tumours concerning prostate cancer. The molecules injected during the scan attaches itself to the neuroendocrine tumours known as carcinoids.

Benefits of DOTA scan:

  Helps to detect the exact location of a tumour
  Helps the doctor to plan for effective radioactive therapies
  Helps to identify the exact stage of a cancerous tumour

Both PSMA and DOTA scans are the fruits of modern scientific research and go a long way in eradicating cancerous cells from the body. Early detection of the disease with these scans increases the chance of being cured of the disease.

Prostate Cancer - Knowing The Importance Of PSMA PET Scan & Dota Scan!

One of the most common issues with old age in men is the enlarged prostate. Any difficulty with urination (no constant stream, difficulty initiating, or incomplete emptying of the bladder for instance), and the first suspect is an enlarged prostate. These symptoms are followed by a digital rectal exam to check for an enlarged prostate. Once confirmed, the next step is to check for levels of prostate-specific antigen (PSA). If both the exam and the PSA are positive, it could mean prostate cancer. As with any cancer, it is believed that sooner it is diagnosed and the treatment is started, the better.

Historically, the best way to rule out the prostate cancer had been to do a prostate biopsy. This is a minor invasive procedure, wherein biopsies are taken from various regions of the prostate which are known to develop cancer (about 12). A disadvantage of this procedure includes missing out on the front part of the prostate which can also develop cancer. Secondly, it is not a very pleasant experience and given a chance, most men would not want to have it done.

There is good news for these men who would like to avoid prostate biopsies. The first is the multiparametric MRI which uses no x-rays and is considered very safe with extremely accurate results. This MRI exam requires about an hour, and once the images are obtained, the doctor will analyse these images and check for several parameters to assess for prostate cancer. The absence of cancer can be confirmed with up to 90% accuracy, which is far greater than with usual biopsies. If there is a possibility of cancer, then a biopsy can be done to confirm it. 

Also, these images indicate the exact region where cancer likely is, and this guides the doctor to biopsy only where absolutely essential. The chances of false positive and false negative results are reduced drastically. The one disadvantage here is that MRI detected biopsies usually tend to be of a higher grade which requires immediate treatment.

Another way to reduce chances of the biopsy by 30% to 50% is by the 4K test. It helps detect a variety of prostate issues including cancer. It can be used once higher levels of PSA is identified and before going for a biopsy. It combined 4 prostate-specific biomarkers with clinical information to accurately provide men with a risk of developing prostate cancer. It can be used even after negative biopsies to confirm the diagnosis of prostate cancer.

These two measures can drastically reduce the incidence of prostate biopsies, which is neither pleasant for the patient nor very effective for the doctor.

Prostate Biopsies - Ways You Can Avoid It!

One of the most common problems faced by ageing men is benign prostatic hypertrophy. Prostate is the gland at the base of the urethra near the bladder and when it enlarges it can lead to symptoms, mostly related to urination.

1. Frequent urge to pass urine
2. Prolonged urination
3. Frequent nocturnal visits to the toilet
4. Intermittent urination
5. Difficulty to start urinating
6. Inability to completely empty the bladder
7. Urinary tract infections

There are medications available to manage this, but offer only temporary relief. Many men therefore prefer to have the surgery undergone to manage these bothersome symptoms. However, like any surgery, the risks and benefits need to be considered along with other conditions like age, overall health status, other comorbid conditions, etc.

Surgical removal of the enlarged prostate gland is a more definitive approach to manage these symptoms. In addition to providing a quick cure, it also is used in the following cases:

1. Patients who do not respond to medications
2. Presence of blood in the urine
3. Associated bladder stones
4. Frequent infections of the urinary tract
5. Associated damage to the kidneys

Procedure of Surgery
During the procedure, a tube is passed through the tip of the penis into the urethra towards the bladder neck. Once it is in the desired position, laser is passed through it to deliver energy that acts on the prostate to either completely or partially destroy it. There are two methods by which laser acts on the enlarged prostate and making way for free flow of the urine.

1. Ablation: Excess prostate tissue is melted away by the laser by using photosensitive vaporization of the prostate. This is also known as Greenlight laser therapy or KTP laser vaporization. Alternately, Holmium can be used as the source of laser energy to ablate the prostate tissue.

2. Enucleation: Excess prostate tissue is cut and teased out through the urethra. Holmium laser is used to resect the prostate into smaller pieces, which are then removed out through a resectoscope. Another technique uses a tissue morcellator which grinds the enlarged prostate into smaller pieces to enable easy retrieval.

More men now opt for laser prostate removal as it has the following advantages:

1. Reduced risk of bleeding: This becomes essentially important in patients who are on blood thinners.
2. No hospitalization: This can be done either as an outpatient or with minimal one day stay at the hospital
3. Immediate symptom relief: As compared to medications, the relief is felt almost immediately after the surgery
4. No catheter: With laser surgery, a catheter may be required for less than 24 hours unlike in open surgical cases.

As noted above, as with any surgery, once enlarged prostate symptoms set in, have a detailed discussion with your doctor to identify if you are a suitable candidate for laser surgery.

Know About Laser Prostate Surgery

Causes and symptoms of enlarged prostate

The problem of an enlarged prostate or benign prostate hyperplasia is a very common occurrence as you grow older. It's known to strike men above the age of 50, with more than 50% of men after the age of 60, having this complaint.

Causes of enlarged prostate

A non-cancerous condition, enlarged prostate makes the passing of urine from the bladder through the urethra difficult. The multiplication of the prostate cells causes an enlargement of the gland, leading to a buildup of pressure on the urethra, affecting the discharge of urine from the body. The narrowing of the urethra, due to this benign condition, forces the bladder to contract more vigorously so as to push urine out of the body.

As time passes, the muscles of the bladder get significantly affected, causing them to become extremely sensitive, thicker and stronger. As a consequence, the bladder begins to contract, even if the amount of urine in the organ is negligible, causing episodes of frequent urination. Gradually, the bladder fails to completely empty itself of urine due to the constriction of the urethra. This can give rise to a number of health problems including the formation of bladder stones, urinary tract infections, blood in the urine and so on.

How can you identify the signs of the condition?

Signs of enlarged prostate are very easy to identify and include:

- A slow or weak urine flow
- Difficulty in initiating urination
- Instances of frequent urination
- A feeling of not completely emptying one's bladder
- Frequent urination during the night
- Exerting a lot to urinate
- Instances of dribbling
- Urgency to pass urine
- A feeling of urinating again minutes after doing so
- Urination that starts and stops



What Leads to an Enlarged Prostate?

The prostate is a vital organ that located between the penis and the bladder. The prostate is involved in the release of the prostate fluid that keeps the sperm properly nourished. Prostate cancer, as the term indicates, is characterized by the abnormal and uncontrolled growth of cancerous cells in the prostate. Though the incidences of prostate cancer are low in India, necessary precautions and diagnostic steps should be carried out to prevent the condition from jeopardizing our lives.

Prostate screening includes two tests known as the Digital Rectal Exam (DRE) and Prostate-Specific Antigen test (PSA). PSA combined with DRE helps to identify prostate cancer at a very early stage. If any of the tests show an abnormality, a doctor might prescribe an ultrasound such as MRI Fusion or Prostate Biopsy to confirm the diagnosis.

Immediate treatment may not be necessary
For low-risk prostate cancer, doctors often recommend active surveillance that includes periodic blood tests, rectal exam, and biopsies.
Active surveillance helps a doctor to continuously track the growth of cancer cells and the possibility of their spread to other areas of the body.
Surveillance is fit for those who are already suffering from a serious condition or for those patients who are above the age of 60.
A surgical procedure to remove prostate cancer
Surgery is considered when the cancer has metastasized to surrounding tissue and the lymph nodes. There are two kinds of surgeries that a patient can go through- a Robot-Assisted surgery and a Retropubic surgery.
Radical Prostatectomy might have risks involved. It is, therefore, wise to discuss the pros and cons of the surgery with the doctor well in advance.
Understanding the treatment options

Radiation therapy: Radiation therapy involves the use of high-powered and high-frequency energy beams to kill cancer cells. Radiation therapy is often used to shrink the size of the cancer cells. There could be two types of radiation therapy-Brachytherapy and External beam radiation. Radiation therapy too can have its side effects. Doctors prescribe several medicines during therapy.
Hormone therapy: Hormone therapy helps to stop the production of a male hormone known as testosterone. This treatment option includes medication that completely stops the production of testosterone, the medications may also block the flow of testosterone on the cancer cells, and surgery to remove the testicles. Hormone therapy is used in advanced cancer stages.
Chemotherapy: Chemotherapy is a drug that goes into the body and kills rapidly growing and metastasizing cancer cells. It is administered through IV (intravenous), or orally as pill or both. This treatment option is employed when cancer spreads to a remote body location and does not respond to hormone therapy.
Biological therapy: Biological therapy involves the usage of the body s immune system to fight cancer. A type of biological therapy known as the sipuleucel-t is used to treat patients with advanced cancer stage and recurring cancer as well.

Prostate Cancer - How Biological Therapy Will Help?

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