Procedures for prostate cancer

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 When prostate cancer is suspected, or if you are on Active Surveillance for prostate cancer, Mr Aw may recommend a prostate biopsy.  

Prostate biopsies are performed as a day procedure, under general anaesthetic. This involves passing a very fine needle through the skin into the prostate gland, and biopsies are performed systematically. Additional target cores may be taken if there is an area of suspicion. 

Preparing for your surgery

If you are advised that you are undergoing a prostate biopsy, please inform the clinic if you are on blood thinning medications.

Risks of surgery 

• Bleeding: it is very common to have some blood in your urine for 2 weeks and semen for 6 weeks after the procedure.  
• Difficulty passing urine: this can occasionally occur, when the prostate is swollen after the biopsy and blocks the urine flow. We will ensure you can empty your bladder before discharge. You may need a catheter in the bladder overnight if you are unable to pass urine 
• Erectile dysfunction: can rarely occur, and usually temporary. 
• Infection: risk is 0.5%, and is limited with the transperineal approach 

Recovery after your surgery 

• We encourage you to take laxatives and not strain when going to the toilet, as well as keeping well-hydrated  
• You will receive an appointment to discuss the results within 4 weeks following the procedure.   If you do not receive an appointment, please call the clinic on (08) 6317 3464.

When should you be concerned?

There are some things to look out for as you recover after your surgery. These include symptoms like: 

• Unable to pass urine 
• Passing large blood clots in urine 
• Fever with temperature >38 degrees 

If any of the above symptoms occur, please contact the clinic on (08) 6317 3464 during the hours of 9am – 5pm, Monday to Friday.  For medical emergencies after hours, go to your local emergency department. 

A radical prostatectomy involves the removal of the entire prostate. Depending on stage and grade of the cancer, Mr Aw will discuss about removal of pelvic lymph nodes and nerve-sparing options. 

Preparing for your surgery

• If you are advised that you are undergoing a radical prostatectomy, please inform the clinic if you are on blood thinning medication 
• We will put you in touch with a prostate cancer nurse, who will provide you with ongoing information and support throughout your journey 
• You will need to see a specialist pelvic floor physiotherapist before the surgery, as this helps you recover your continence earlier after surgery. 

Risks of surgery 

• General risks: these are risk for anyone under general anesthesia and can include heart and lung issues, blood clots or infection 
• Incontinence: most men would have some leaks after the catheter is removed. Pelvic floor exercise encourages earlier recovery of continence 
• Bleeding 
• Conversion to open surgery: this is uncommon, however the dissection can be more difficult than anticipated, and an open conversion may be needed to allow safer completion of the surgery 
• Positive margins: this is where a tumour is seen to extend to the edge of the specimen that has been removed. Most times this can be managed with surveillance. 
• Injury to surrounding organs (e.g.rectum, bladder, ureter): this is a rare complication, and may require repair during surgery 
• Cancer recurrence: the risk of recurrence increases with more advanced cancers 

Recovery after your surgery 

• You will have a catheter after the surgery. This will stay for 2 weeks to allow the surgery site to heal. Some urine bypass and bleeding around the catheter is expected. Do not allow anyone to remove or replace the catheter unless this is discussed with Mr Aw 
• It is anticipated that you will stay in the hospital for 2-3 days 
• Drink plenty of water to keep you urine clear.  
• No heavy lifting  >6kg for 3 weeks and driving until you have been seen by Mr Aw 
• We encourage you to take laxatives and not strain when going to the toilet 
• Wear your compression stockings for 3 weeks
• If lymph nodes are removed, we will teach you to self-administer blood thinning medications to reduce the risk of blood clots in your lower limbs 
• We will organise for the catheter removal by our continence nurse in St John of God Midland, usually 10-14 days after the surgery
• You will be put you on a surveillance program after surgery, with interval PSA testing
• You will receive an appointment  at 3 weeks to review your wounds and recovery, and another appointment at 6 weeks to check you PSA .  If you do not receive an appointment, please call the clinic on (08) 6317 3464.

Depending on your medical circumstances and stage of prostate cancer, a radiation oncologist may recommend treating your prostate cancer with radiotherapy.  

To minimise scatter radiation to the surrounding organs, fiducial markers (Gold seeds) can be inserted in a few strategic locations in the prostate. This allows for mapping of the prostate accurately. SpaceOAR is a hydrogel which is placed in space between your prostate and bowel. This creates an additional buffer to minimise radiation effects on the bowel.  

Preparing for your surgery

If you are advised that you are undergoing a ureteroscopy, please inform the clinic if you are: 

• On blood thinning medications 
• When you have received an appointment for the procedure, please collect the fiducial markers (Gold seeds) at ICON, and bring this with you to the hospital 

Risks of surgery 

• Bleeding: it is very common to have some blood in your urine for 2 weeks and semen for 6 weeks after the procedure.  
• Difficulty passing urine: this can occasionally occur, when the prostate is swollen after the biopsy and blocks the urine flow. We will ensure you can empty your bladder before discharge. You may need a catheter in the bladder overnight if you are unable to pass urine 
• Fiducial marker migration 
• Infection: risk is 0.5%, and is limited with the transperineal approach 
• Rectal discomfort: You may feel fullness in your rectum and pelvic pain. This is usually temporary until the hydrogel sets in. Use of laxatives help to avoid constipation 
• Rectal injury is a very rare complication 

Recovery after your surgery 

You will most likely be able to return home on the same day. You will be advised to drink plenty of water to help with drainage of the urinary system.  Mr Aw will notify your radiation oncology team when your procedure is completed. Please contact ICON if you have not received an appointment to commence your treatment on (08) 6317 3464. 

When should you be concerned? 

There are some things to look out for as you recover after your surgery. These include symptoms like: 

• Unable to pass urine 
• Passing large blood clots in urine 
• Fever with temperature >38 degrees 

If any of the above symptoms occur, please contact the clinic on (08) 6317 3464 during the hours of 9am – 5pm, Monday to Friday.  For medical emergencies after hours, go to your local emergency department.