PERINEAL PROSTATE CANCER SURGERY
SHORTENS HOSPITAL STAY
A message from Dr. Bollinger
Prostate cancer remains the most common cancer in men, other than skin
cancer It is estimated that there are
189,000 new cases a year with 30,200 deaths expected in the U.S. this year,
according to the American Cancer Society.
Surgical removal of the prostate is a common treatment when the cancer
is confined to the walnut-sized gland.
Traditionally, surgeons remove the prostate through an incision in the
lower abdomen. Known as radical
retropubic prostatectomy (RRP), the surgery routinely includes removal of the
nearby pelvic lymph nodes to detect whether the cancer has spread beyond the
prostate.
For men with early stage prostate cancer, there is an alternative to
standard prostate surgery that results in less pain and blood loss, a shorter
hospital stay, and a quicker return to daily activities.
This technique is known as radical perineal prostatectomy (RPP). As its name suggests, the incision is made
in the perineum, the area between the scrotum and the rectum. The procedure is not new, but has not been
widely used because the surgeon cannot remove the pelvic lymph nodes at the
same time.
Beginning in the 1980’s, however, the widespread use of the
prostate-specific antigen (PSA) blood test to detect early stage prostate
cancer paved the way for radical perineal prostatectomy to experience
resurgence as a viable treatment. Not
only has this tumor marker resulted in an increase in the number of prostate cancers
detected, it has given surgeons a tool to determine the stage of the cancer
without necessitating a lymph node dissection.
When the PSA indicates the cancer is confined to the prostate, the
patient is a candidate for the perineal approach because there is no need to
remove the pelvic lymph nodes.
I favor radical perineal prostatectomy because it allows easy access to the
prostate, which is located close to the skin surface of the perineum. By contrast, in retropubic surgery, the
surgeon must cut deep into the abdominal cavity to reach the prostate. This difference in location is important in
terms of patient recovery time, blood loss and pain control. The patient usually only has an overnight
hospital stay, does not need a blood transfusion, and can return to normal
activities more quickly. For hospitals,
a quicker turn-around time translates into cost savings.
I have been performing RPP for 10 years and am one of only a few urologists
in the Philadelphia area to offer the procedure. Its outcomes in terms of cancer recurrence, incontinence, and
sexual potency are comparable to the abdominal technique, according to various
studies presented at a recent world conference on radical prostatectomy.
In the last year I have modified RPP to include the injection of long-and
short-acting pain medications, so that the patient wakes up with no pain, and
the use of magnification equipment, which allows me to better view and preserve
the nerves that control bladder function and erections. For the last 50 cases, there have been no
transfusions, and 48 of them went home the following day. The patient has minimal pain and can go back
to work in two weeks. One patient had
surgery on Friday, went home Saturday, and returned to his desk job on Monday.
Radical perineal prostatectomy isn’t more widely used because surgeons are
no longer trained in it. I expect a
trend toward RPP to develop as the data continue to support its effectiveness,
both from a cost and medical perspective-and more medical schools offer training
in the procedure.
LAST UPDATED: January 22, 2005