Читать книгу Saving Your Sex Life: A Guide for Men With Prostate Cancer - John P. Mulhall - Страница 23

While watchful waiting is not associated with any specific complications, it does require that a man be comfortable not treating his prostate cancer and keeping a close eye on his PSA with perhaps repeated prostate biopsies conducted periodically. Men often opt for a treatment because of the anxiety of knowing that a cancer is present within the body and is not being treated. Both surgery and radiation share erectile problems and urinary problems, but otherwise, they each have their own individual potential complications. Understanding these complications is critical to making a decision as to which treatment you will choose.

Table 1 • Overview of Long-Term Complications of Prostate Cancer Treatments

For example, surgery is an operation, and therefore, men are exposed to anesthesia and its potential risks. The older and more unhealthy a man is, the greater the risks are from anesthesia, whether it is a general or spinal anesthetic. Likewise, surgical procedures of this nature are associated with the development of clots in the veins of the legs (deep venous thrombosis, or DVT) and potentially dislodging one of these clots into the lung (pulmonary embolus). These concerns are serious and sometimes life threatening. They are, however, very uncommon today with the use of compression boots that are worn on the operating table during the operation and for sometime after the procedure. An incision is made in the abdomen whether the surgery is done in an open fashion, laparoscopically (using a telescope passed into a small incision in the abdomen) or robotically (using a telescope as above but with the surgeon sitting away from the patient and using a robot to perform the operation), and whenever an incision is made, there is a risk that a wound infection may occur. Wound infection, again, is currently very uncommon.

At the time of radical prostatectomy, the lymph glands (nodes) are generally removed, and sometimes this can lead to the collection of lymph fluid in the pelvis area, known as a lymphocele. It is not well known what percentage of patients actually have a lymphocele present. To answer this question, every patient undergoing radical prostatectomy would need to have a CT scan or an MRI in the first weeks after surgery, and this is not done. However, lymphoceles, for the most part, do not cause any symptoms, but some do cause problems (some lymphoceles may get infected and others may cause leg swelling) and need to be drained for complete resolution. This involves the placement of a narrow tube through the abdominal wall into the fluid collection; sometimes, this tube will need to stay for a few days to ensure complete drainage.

Because the prostate is removed, the bladder at its neck needs to be joined to the urethra (the urine channel). Where these structures are joined is called an anastomosis. This is achieved by using sutures. Sometimes one of these sutures breaks, and a leak of urine occurs behind the bladder. This is known as an urinoma. Again, this is very uncommon in the hands of an experienced and technically proficient surgeon, but all the same it is a recognized complication. More common in the old era and rare now is injury to the rectum. Remember, the prostate sits on top of the rectum as you lie on your back and upon its removal, particularly if there is a lot of scarring around the back side of the prostate, an injury to the rectum can occur. In the vast majority of cases, this can be repaired at the same time in the operating room without any problems.

These complications are generally experienced in the early stages after surgery and, after several weeks, most of these are fully resolved, with the exception of erectile dysfunction and, sometimes, urinary incontinence. However, some people are innately adverse to the concept of surgery because of the fear of needles, incisions or bleeding.

Radiation therapy, whether external beam or seed implantation, is also associated with erection and urinary problems.There are others that are specific to radiation as well. Because of the close proximity of the rectum to the prostate, radiation to the prostate and the surrounding 1 cm will include the front wall of the rectum. This can result in a condition known as proctitis. Proctitis is typically associated with mucous passage in the stool, some bleeding and urgency for passing stool.

One of the differences in complications between surgery and radiation therapy is that proctitis and urinary problems with radiation therapy may occur early on (the latter particularly with seed implantation) and may take several months to resolve as opposed to the several weeks that most men after surgery take to resolve any potential complications. In contrast to surgery, when most men in the earliest stages after surgery have erection problems, most men in the first year after radiation do not have erection problems but may develop these erection problems between years one and five after treatment. In fact, the low point in erectile function after radiation probably is between three and five years after completion of the radiation therapy.The reason for such a delayed effect on erectile function is due to the slow and progressive damage that radiation can cause in the endothelium (lining of the blood vessels). This may lead to a steady reduction in blood flow into the penis over the first five years after treatment.