1. Initial Appointment
Typically, your primary care physician will check your PSA levels in your blood workup during your routine check-up. If your laboratory results show an “elevated PSA”, you will be referred to a urologist for further testing.
2. Laboratory Results
The exam likely consists of a standard digital rectal exam (DRE), in which Dr. Allen manually palpates the prostate by way of the rectum. Even if he detects nothing abnormal, he will schedule a biopsy to be certain there is no evidence of prostate cancer. The biopsy is performed by inserting a tubular structure in the rectum, from which projectile needles collect 5-6 “cores” of tissue from each side of the prostate. Although many patients tolerate the biopsy without medication, Dr. Allen may offer something to alleviate your discomfort and anxiety associated with the procedure.
3. Treatment Options
If you have an early diagnosis of prostate cancer, there is usually a range of treatment options. These may include conservative management, radiation therapy with external bream or brachytherapy, cryosurgery and prostatectomy – surgical removal of the prostate. The treatment options will depend on a number of factors, including the stage of the disease, and you age, health and personal preference.
If you choose to have a da Vinci® Prostatectomy – robotic prostate surgery – here is what you can expect:
You will have a physical examination and discuss the various types of anesthesia with your anesthesiologist. This visit is arranged by Dr. Allen and will likely occur the week before surgery. The evening before surgery, you will need to follow instructions for bowel preparation that Dr. Allen will provide.
5. Day of Surgery
Shortly before the operation, anesthesia is administered and you will sleep for the duration of the operation, which typically lasts 2-4 hours. The procedure begins when your abdomen is inflated with carbon dioxide gas, creating an operating space for the surgeon. Next, six small incisions, 1/4 to 1/2 inch in length, are made in your abdomen and ports are inserted to keep the incisions open.
During the procedure, Dr. Allen uses the da Vinci System’s laparoscopic surgical instruments and video camera, via the temporary ports, to direct the dissection of the prostate gland and adjacent tissue. If deemed appropriate, he tries to preserve the nerves attached to your prostate gland (nerve sparing). At the end of the surgery, the ports are removed from your abdomen and the remaining incisions are closed with sutures.
(For detailed information about this procedure, please set up a consultation with Dr. Allen.)
After robotic prostatectomy surgery, you wake up very groggy and with a urinary catheter in place. You will likely spend one night in the hospital resting and recovering from the effects of the anesthesia. As the anesthesia wears off, there may be some discomfort, for which pain medication may be prescribed. During this time, the medical team gets you patient sitting, standing and eventually walking around, which is recommended throughout the recovery period. Because a catheter typically remains in place for approximately 7 days, Dr. Allen will review guidelines for use that will ease discomfort and ensure proper function of the catheter during this time.
7. Recovery Period
The first week post-operatively will likely be spent resting; however, frequent walks are encouraged. Depending on the your individual recovery needs, regular activities may resume as soon as soon as a few days after surgery; straining and heavy lifting is discouraged for the first four weeks post-operatively. Approximately one week after surgery, a post-operative follow-up is scheduled, at which time your bladder function may be assessed. This is done by filling the bladder with saline via the catheter, removing the catheter and then allowing you to void naturally. Some incontinence after surgery is normal and is typically managed with medication until bladder control resumes. Erectile dysfunction may also be a side effect of surgery. Like incontinence, this side effect may be discussed with the Dr. Allen and managed with medication until it lessens or completely resolves over time.
8. Follow-Up Care
After this treatment for prostate cancer, Dr. Allen will want to watch you carefully, checking to see if your cancer recurs or spreads further. Typically, Dr. Allen will outline a follow-up plan with you that includes regular visits, PSA blood tests and digital rectal exams, which will likely begin within a few months of finishing treatment. PSA tests are usually recommended about every 6 months for the first 5 years after treatment, and at least yearly after that.