Why remove lymph nodes
With Gleason 8–10, PSA more than 20 and stage T3, metastases to the pelvic lymph nodes are found in 15–40% of patients, and CT and MRI reveal only enlarged nodes. Extended lymph node dissection removes tissue from the lymph nodes along the iliac vessels and in the obturator fossa - histology determines whether radiation or hormonal therapy is needed after surgery, and removal of the affected nodes improves disease control. The operation takes 40–60 minutes longer; a lymphocele (lymph accumulation) is more often formed, which usually resolves. Nerve sparing at high risk is limited by the tumor.
Who is indicated for radical prostatectomy?
Surgery is the main treatment for localized and locally advanced prostate cancer in men with a life expectancy of more than 10 years. Indications: intermediate and high-risk cancer (Gleason 7 or higher, PSA greater than 10, stage T2-T3) and low-risk cancer if desired by the patient instead of active surveillance. An alternative is radiation therapy; the choice is discussed at the oncology consultation.
Laparoscopy and nerve sparing
Laparoscopic prostatectomy provides an enlarged image, minimal blood loss, precise anastomosis and quick recovery - hospital stay is 5-6 days versus 7-8 with open surgery. In low- and intermediate-risk cancers, the neurovascular bundles are preserved—erection is restored in 50–70% of men within 1–2 years with rehabilitation. Extended lymph node dissection is performed in intermediate and high-risk patients for staging.
Functional results
Urinary continence is restored in 90–95% of patients within 3–12 months with the help of pelvic floor muscle exercises; In the first weeks, pads are used. Erectile function depends on nerve sparing, age and initial potency. PSA after surgery should become undetectable (less than 0.1 ng/ml) - its monitoring every 3-6 months reveals a relapse, in which case radiation or hormonal therapy is prescribed.
