What to Know About Surgery for Prostate Cancer

Phillip Koo, MD [00:00:00] So, you’ve seen both. You do a consult. Now your decision is made to go down the surgical route. Dr. Hu, walk us down that route of what surgery entails, what patients need to be thinking, what questions they should be asking, and how we’ll get to this, but also how to find the best surgeon for themselves. 
 
Jim Hu, MD, MPH [00:00:20] Absolutely. So, you know, I know prostate cancer foundation, for example, has outstanding resources in this regard. There’s also books, one of them surviving prostate cancer by Dr. Walsh. And so, so those, I think, give the patient beyond the let’s say the radiation oncology and the surgeon consultation, it gives you a firm foundation from a layperson’s perspective, but also these resources will tell you right like commonly patients will come in and say, well, how many surgeries have you done? And another common question that you still get is are you doing it through robotic assisted surgery? There’s still pockets around the country where, for example, open surgery may be performed, right? And that then gets into your question was, what are the expectations for surgery? And so, one of the things that patients can try to get a sense of the confidence level of the surgeon is when they ask, well, how long will the surgery take, right. And there’s a little bit of a fine balance. If, for example, I have three cases on a day and I need to be home at six o’clock, then every surgery is gonna be a set amount of time and speed is not the be-all and the end-all here. And so, I always tell patients, look, I’m there to take as long as it takes to do a good job, but it’s variable. Like for me, I’d say that the length of the operation has increased as I’ve learned some things in the operating room. So, I’d stay on average, it’s a two-and-a-half-hour operation You’re showing up a few hours before surgery. You stay overnight; you go home the same day. We also did these outpatients during COVID when the New York hospital beds were full. So, catheter is put in when you’re asleep, catheter stays in for a week. Because of those small keyhole incisions don’t lift anything more than 10 pounds, no strenuous exercise for one month. Most patients when the catheter comes out will have some degree of stress urinary incontinence, also some degree or erectile dysfunction. If you have ED going in, that’s gonna be a significant predictor of post-operative ED. And it’s important to realize that both of those functional outcomes improve over the course of two years. So, in other words, they slowly gradually improve. And then at two years, what you have left is what you’re gonna have permanently. 
 
Phillip Koo, MD [00:02:30] So what can patients do to maximize their chance of success before the surgery? 
 
Jim Hu, MD, MPH [00:02:38] Absolutely. So, one of the factors also that goes back into this question of surgery versus radiation, for example, right? Someone with a high body mass index, let’s say over 40. Because we’re doing the robotic surgery in what we call the Trendelenburg position where your head is lower than your feet in order for the robotic arms to get down into the pelvis of the prostate. Someone with the higher body mass-index, there’s a lot of weight of the, what we called the omentum or the fat inside the abdomen that’s going to push down against the diaphragm, and that’s going to lead to problems with ventilating or the anesthesiologist. And so, so you just don’t want to get into a situation with someone with a high body mass index that, that you want to try to say, look, now there’s great GL1P or the, the injections and now the oral forms of weight loss, and, or you just want to tell people, look you’re, you’re just not a great candidate because you have a high body, mass index. And so, always stress also for those people who aren’t fit, who don’t exercise and they’re prioritizing, for example, erectile function. Typically, ED, it’s been said erectile dysfunction will precede a heart attack by 10 years, right? And so, being healthy, getting to the gym, keeping track of your cholesterol, your high blood pressure is gonna set you up for success long-term in terms of just overall fitness, survival, as well as fighting off erectile disfunction. As it does in all men, regardless of a prostate cancer diagnosis. And so going back to your question, it’s being fit. And beyond that, the other, I think, could like choice of surgeon, for example, you know, I see patients from other centers where if they’ve had prior abdominal surgeries, they’re told that they can’t get robotic surgery. And in some cases, they’re referred to see the radiation oncologist. And so, one thing to keep in mind is for surgeons, most of us do what we were taught in residency. And that’s a powerful statement because if you didn’t see certain things during your training, I’d say the majority of us don’t have the ability to learn something new or the sense of adventure, if you will, to pick it up. So that’s also where it behooves someone to have second opinions, particularly if you’ve had abdominal surgery with a big incision and you may be told, you know, we can’t do your surgery.