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The Prostate Gland Click here to see animated anatomy of Prostate and entire Genito-Urinary System. Click on the below links to get to the desired section of the page. 
Tests involved with prostate cancer treatment: Prostate
Cancer Discussion on:Factors Determining Treatment
Radical Retropubic Prostatectomy Trans
Rectal Ultrasound (TRUS) Guided biopsies Trans
Urethral Resection of the Prostate (TURP) Brachytherapy
RADICAL RETROPUBIC PROSTATECTOMY INFORMATION Introduction The bladder is the organ that stores urine and the urethra is the tube that drains urine out through the penis. The prostate lies immediately beneath the bladder and completely surrounds the urethra. Attached to the prostate are accessory organs that assist in fertility known as the ejaculatory ducts and the seminal vesicles. Prostate Cancer is the second commonest cause of cancer related deaths in men in Australia and each year this amounts to approximately 2500 men – an almost identical number to women dying of breast cancer each year.If treated sufficiently early, the survival at 15 years has been shown to match those of men without prostate cancer. Preparation For Surgery Follow the instructions on your hospital admission papers.If you have been instructed to donate your own blood, you will need to contact the Red Cross on the forms that you will be provided with. If no such instructions have been made, it can be assumed that blood will be collected at the immediate commencement of surgery by the anaesthetist. Most men are admitted to hospital the day prior to surgery to allow for preparation of the bowel.Emptying out the bowel allows for optimal operating conditions.In selected situations you could be admitted to hospital on the morning of your surgery but this would require you to self-administer your bowel prep the day prior to surgery. The main problem with taking the bowel prep at home is dehydration if you cannot keep up with an adequate fluid intake. During this process you will have marked diarrhoea, which will ultimately become water-like, which is how bowel prep empties your bowels. Soon after your arrival into hospital, staff are under instructions to put up an intravenous line for the administration of additional fluids into your veins. Usually a number of routine tests are arranged through a Pathology Laboratory prior to your admission to hospital. If this is to be the case, you should have these carried out approximately a week prior to your admission to hospital – you will be given a referral to have blood tests and an electrocardiograph (ECG). The results will automatically be sent to both the hospital and to your doctor. 
Nature of the Surgery A cut is made in the lower abdomen in the midline. Through this opening, the entire prostate and the immediate surrounding tissues are surgically removed. The bladder is then rejoined to the urethra with stitches. A catheter, which is a plastic tube that drains urine from the bladder, is left in place and exits from the body through the penis. A tube known as a drain is also left in place and attached to a special bottle to allow excess fluids to drain out after the surgery – this tube exits from the lower abdomen. The anaesthetist will discuss with you the type of anaesthetic to be administered and as a general rule you would have a general anaesthetic. Your pain relief requirements will also be discussed with your anaesthetist this may take the form of an epidural (needle in the back through which pain relieving medications can be administered) or a PCA (patient controlled analgesia) pump where you press a button to automatically administer pain relief to yourself. In Hospital Post Operative Course Following this type of surgery, the bowels usually fail to function normally for a day or so. An early sign of resumption of normal bowel activity is the sounds of bowel activity by listening to your abdomen with a stethoscope.Another early sign is the passage of flatus from your back passage. Once this occurs, fluids will be introduced and as they are tolerated, you will generally be back onto a fairly normal diet by about the fourth or fifth day after the operation. The drain coming from the abdomen is usually removed on the second or third day. The plastic cannula or drip in your veins is usually in place until the third or fourth day. The catheter is generally in place throughout the entire in-hospital recovery period. In selected cases, it may be possible to remove the catheter prior to going home. Many men will go home with the catheter in place. Usually by the fourth day, the catheter is switched over to drainage into a bag that attaches to the leg rather than a large drainage bag that hangs from the side the bed. After its removal, a pathologist assesses the prostate gland under the microscope – the results will then be able to give an indication as to whether the cancer was fully contained within the prostate. This result is usually but not always available prior to your discharge from hospital. After Going Home Obviously you will need to take things easy after going home. You are free to walk around but avoid going up and down stairs unnecessarily in the first few weeks. Have plenty of fibre in your diet to minimise any difficulty with opening your bowels. If you go home with a catheter in place, arrangements may be made for you to have a special X-ray called a cystogram to check on the healing internally. This is usually performed about a week or two following discharge from hospital. These arrangements as well as your follow up appointments are arranged and detailed to you prior to your discharge from hospital.
Risks of Surgery The risks of surgery are mentioned to allow you to be fully informed. It is worth bearing in mind that the great majority of men will have a fairly uneventful recovery. Like any form of surgery anywhere on the body, there are general risks such as bleeding and infection. It is relatively uncommon to require a blood transfusion in addition to any blood that is collected from you either prior to your admission to hospital or immediately prior to your surgery. Administering antibiotics at the time of the procedure reduces the risk of infection. Urinary incontinence or in other words the loss of your control of the urine, is a significant complication that occurs in only a small minority of patients. You can expect your urinary control to be ‘shaky’ immediately after the removal of the catheter, but this rapidly improves over the following few weeks. By about 3 months the majority of men will not find it necessary to wear any pads. Further improvement in urinary control can occur over a period as long as 12 months. The loss of penile erections (Erectile Dysfunction) is commonly encountered following radical prostatectomy. The nerves that are important in generating an erection run closely behind the prostate. Whilst it is possible to carry out the surgery with preservation of these nerves, this needs to be balanced against obtaining clearance of the cancer. Furthermore, nerve sparing radical prostatectomy does not guarantee continued erections although the success rates are quite good. Whether or not you are a candidate for nerve sparing radical prostatectomy will be discussed on an individual basis. In the event of erection problems following surgery, there are a number of treatment options available. Scar tissue can sometimes form following surgery. Internal scarring can lead to an obstruction where the urethra is joined to the bladder and is known as a bladder neck contracture or a bladder neck stricture.This is usually rectified by a simple telescopic procedure through the eye of the penis.This complication is uncommon. Injury to adjacent organs to the prostate such as the bladder, ureters and rectum (back passage) is theoretically possible. Fortunately, these risks are particularly rare but are mentioned for completeness. There are also general risks associated with any major operation but as is the case with all surgery, the risks are carefully balanced against the risks of continuing with the cancer untreated. If there are any issues that you are unsure about, you should discuss them with your Doctor prior to your surgery.
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