Where is the prostate gland and what is its function?
The prostate makes up part of the male reproductive system. It surrounds your urethra (urine tube which carries urine from the bladder during urination, and seminal fluid during ejaculation) and is located at the base of your bladder and in front of your rectum. Your prostate makes up and stores seminal fluid.
What is prostate cancer?
Prostate cancer is the most common cancer in men. Cancer can develop when cells start to grow in an uncontrolled way. If this happens in the prostate gland, prostate cancer can develop.
PSA blood test (Prostate Specific Antigen)
This is a protein produced by the prostate gland. This can be raised in many conditions such as inflammation of the prostate, enlargement of the prostate, infection or prostate cancer. This is a simple blood test which indicates if any further investigations are necessary.
If your PSA is abnormally elevated your consultant will carry out further investigations. This could include Digital Rectal Examination, Transrectal ultrasound scan or Transrectal ultrasound and biopsy of your prostate.
Digital Rectal Examination
This procedure consists of the examiner inserting a gloved, lubricated finger into the rectum to feel the size, texture and shape of your prostate. This will indicate any abnormalities of your prostate which may need further evaluation.
TRUS & Biopsy of the Prostate
Trans-Rectal Ultrasound Scan uses sound waves produced by a narrow probe inserted into the rectum to create images onto a screen of the prostate and surrounding tissue. The scan allows the consultant to measure your prostate and check for any possible abnormalities. This is carried out in the outpatient clinic and is a very quick examination.
What is a biopsy of the Prostate?
A biopsy of your prostate is when a sample of tissue is taken from your prostate and sent off to the laboratory for testing. This procedure is carried out in the outpatient clinic under local anaesthetic. You will stay awake during the procedure and the anaesthesia will help to ease any discomfort. The procedure takes approximately 10-15 minutes. You will need to lie down on your side with your back to your surgeon.
This procedure is carried out using a fine needles attached to the ultrasound probe. This is then guided through the rectum up to the prostate when tiny samples of your prostatic tissue will be taken.
Do I need to prepare for the procedure in any way?
You will be given a prescription for antibiotics to start taking before your procedure to help protect you against the risk of infection associated with biopsy. This is usually a 5-7 day course and you should continue and complete this course of antibiotics.
You may eat and drink normally on the day of the procedure.
If you are taking Warfarin or Aspirin, please ensure you stop this one week prior to the procedure as there is an increased risk of bleeding associated with biopsy. If you are under the care of a Cardiologist, you should contact them for their advice on this.
What should I expect after the procedure?
You should not experience any pain after your biopsy. If you do, it is recommended that you take paracetamol regularly to help with any discomfort. You will be given an anti-inflammatory at the time of your biopsy. The results of your biopsy should be available within one week and you will need to make an outpatient appointment to discuss the results with your urologist.
Following the procedure you will be able to go home straight away provided you are feeling well and are passing urine.
Side-effects
These are the unwanted but mostly temporary effects of a procedure.
Common side-effects of prostate biopsy include:
- slight discomfort in rectal area
- blood-stained urine or faeces – this can last up to a week or two
- blood-stained or discoloured semen – this may last for six weeks
- difficulty in passing urine – this usually improves quickly
Because the biopsies are taken from the rectal area, there is a risk of infection (sepsis) and urinary retention (difficulty passing urine) after the biopsy in approximately 1-2% of patients.
It is important to contact your GP or consultant immediately if you develop any of the following:
- severe pain or pain that lasts for more than 48 hours
- difficulty in passing urine
- burning sensation on passing urine or if your urine starts to smell
- increasing blood in urine
- high temperature or ‘flu-like’ symptoms
MRI Scan
If you are diagnosed with prostate cancer, you may need to have one or more
scans to find determine if the cancer is still confined to the prostate or not.
An MRI uses magnets rather than x-rays to create details pictures of your prostate and surrounding tissues and lymph nodes.
Bone Scan
A bone scan is used to find out whether any cancer cells have spread from the prostate to the bone. You may have a bone scan if your consultant has any concerns that the cancer may have spread outside the prostate, or if he wants to be sure that it has not spread.
Radical Robotic Laparoscopic Prostatectomy
Once you have consulted Mr Ogden, discussed and decided on your treatment please and a surgery date has been confirmed with you by Mr Ogden’s secretary, a booking form will be sent through to the Royal Marsden’s reservations team. Your surgery date is then confirmed in writing to you by the hospital and all of your admission times and instructions are included in this.
Pre-anaesthetist Assessment
Prior to surgery all patients are scheduled to attend the Royal Marsden for a pre-anaesthetic assessment. This is carried out by the nurses and the anaesthetic team and a number of tests such as ECG, chest x-ray and blood tests are undertaken to ensure the patient is fit to undergo a general anaesthetic. You need to allow a few hours for this and will go home the same afternoon. The pre-assessment team will take a detailed note of your medical/family history and any medications you are taking.
At this time you will have an opportunity to ask any questions with regards to your surgery and admission. You will also be informed of any preparations such as diet restrictions and medications.
Admission day
On the day of your admission you will be asked to report to main reception on your arrival where you will be met by on the admissions team staff. You will be asked to complete and sign some documents with your personal details and your payment/insurance details. You will then be escorted to your room where the nursing staff will help you prepare for your procedure and answer any questions you have.
Prior to your procedure the anaesthetist and Mr Ogden will come and see you in your room to assess you and consent you for your procedure.
Do I need to bring anything with me?
It is important to bring with you any medications you are on.
You should bring along a toothbrush and any toiletries to help make your stay more comfortable.
Please bring slippers, night-clothes and a dressing gown and some loose fitting comfortable clothes to wear during the day and to go home in.
You may also like to bring a good book or reading materials along with you.
What can I expect after surgery?
Directly following your procedure you will be taken through to recovery and if necessary, once you are alert after the anaesthetic, you will be given any painkillers to manage any discomfort. Once you are feeling alert, you will be taken back to your room to rest.
You will have a drain (Robinson’s drain) inserted into your abdomen during the procedure to help drain any fluid away from your wounds and prevent the build-up of pressure. This usually remains in for one to two days following the procedure and is removed prior to your discharge.
Because the prostate is very close to the bladder a catheter is inserted to allow drainage of urine into a collection bag. This prevents leakage and allows your bladder to stabilise following the procedure. On your discharge you will be given full catheter care advice from the nursing staff. The catheter will remain in place for approximately ten days following the procedure and you will then return to the hospital as a day patient to have your catheter removed and your wounds checked. Please be aware that you may remain in hospital all day as it is important for the team to assess your bladder function and for you to see Mr Ogden before discharging you.
You may require a pad to fit insider your underwear to prevent any leakage. Most patients experience difficulty with urinary control initially and to help recovery of your bladder function, you will be instructed on pelvic floor exercises by a Nurse Specialist to carry out following the removal of your catheter. Most patients will achieve reasonably good bladder control with one to three months of the procedure.
It is important to continue these exercises at home to help strengthen your pelvic floor muscles certainly until full continence is achieved.
You will be discharged home as soon as you are mobilising well and eating and drinking normally and your bowels are functioning.
You will be given contact details should you experience any problems or have any concerns once you get home.
On your discharge, you will be informed of when you need to return to hospital to have your catheter taken out.
Some postoperative symptoms you may develop
Abdominal swelling or constipation-You will be advised to take a laxative/stool softener and will be prescribed these on your discharge from hospital. This should help your bowels return to normal and any abdominal swelling should subside fairly quickly. It is recommended to increase your water and fibre consumption to help prevent constipation.
Leakage or oozing at the wound or drain site-Changing your dressing regularly (as necessary) and keeping them clean and dry will help prevent infection.
Bladder Spasms-If you do experience these spasms and they are quite severe or painful, and you feel the need to urinate frequently, you should contact Mr Ogden’s secretary or team as an anti-spasmodic medication may be prescribed to help alleviate with these symptoms.
Leakage around the catheter-this is common and can also occur when straining. If this happens, do not worry, it may help to wear a small pad in your underwear to prevent leakage.
Blood in the urine or around the catheter-This is not uncommon and usually happens following a bowel movement. There can be intermittent bleeding in the urine even following the removal of catheter. However, this should be pale red. If you are concerned about this, please contact Mr Ogden’s office or his team as it is important to rule out a urinary tract infection which can sometimes happen if a small amount of bacteria enters the bladder.
Frequently asked questions following surgery
Should I expect to be in much pain after my procedure?
As robotic surgery is laparoscopic and small incisions are made, most patients experience minimal pain and discomfort and you will be given painkillers to take regularly if required.
Are there any specific restrictions on exercise or driving following surgery?
It is recommended to take light exercise such as walking following surgery to keep your circulation moving and to build up your strength and energy levels. After 2-3 weeks and following your catheter removal, more concentrated exercise is permitted such as jogging. Within about a month postoperatively you may return to your usual exercise regime, but please check with Mr Ogden prior to this so he can assess your recovery.
When can I drive?
You may drive again following your surgery as soon as you feel comfortable to do so and as soon as you can perform an emergency stop safely and can wear a seatbelt comfortably. However, following a general anaesthetic it is certainly not advisable to drive for 24 to 48 hours.
When can I bathe or shower?
The nursing staff will advise you of wound care and washing on your discharge from hospital but generally it is advised to pat yourself completely dry with a clean towel following a bath or shower to prevent infection.
When can I return to work?
Patients usually feel fit enough to return to work within two to three weeks of surgery. However, it is advisable to check with Mr Ogden if your work involves any heavy lifting and strenuous exercise.
Follow up arrangements
An appointment will be scheduled for you to see Mr Ogden for him to review you and to discuss your histological results from your operation (if it is ready), usually this is on the same day of your catheter removal for convenience.
Mr Ogden will then inform you of your follow-up arrangements and when he needs to see you next. Usually, this is four to six weeks following your procedure to check on your progress and you are then reviewed three months post-operatively with your first PSA blood test result.
Depending on your histology results and post-operative PSA, patients are usually reviewed by Mr Ogden on a quarterly basis (with a PSA test) for the first year, every six months for the second year and annually after this. Of course, your status is reviewed at each consultation and your follow up plan arranged then depending on your progress and PSA results.