Road to Rehab

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<li>In most circumstances a patient will be under review by their GP, either because they’ve been symptomatic (poor or reduced urine stream, getting up at night to urinate more than usual) or because they have a family history of prostate cancer. Your GP will typically review your blood pathology results (PSA test) and may perform a rectal prostate exam. In cases where PSA levels have increased more than your GP would consider normal, they will refer you to a Urologist for further examination. The relationship between changes in PSA level and prostate cancer is not linear. For example, a patient’s PSA level may increase from 2 to 5 and they may have prostate cancer whereas another patient’s PSA may increase from 15-18 and they may not have prostate cancer. This is why it is important to have a review with a Urologist</li>
<li>Typically, when you see a Urologist, they will review your pathology, rectal exam and, if necessary, they may perform an ultrasound guided biopsy of the prostate. Your Urologist takes multiple cores to determine a Gleason Score (a system used to rank the aggressiveness of prostate cancer). Pending the result of the biopsy, your Urologist will opt for a either a “watch and wait” approach or advocate for a radical prostatectomy if the risks of leaving the prostate intact are outweighed by the possible progression of cancer beyond the prostate</li>
<li>In the case of simple <a href="https://staging.menshealthdownunder.com.au/pros-ta-tec-tomy/#BPH">BPH (swelling of the prostate)</a> your Urologist may prescribe medications such as tamsulosin, dutasteride or a combination to manage symptoms. Alternatively they may perform a <a href="https://staging.menshealthdownunder.com.au/pros-ta-tec-tomy/#TURP">Transurethral Resection of the Prostate (TURP)</a>. This surgery utilises a combined visual and surgical instrument called a resectoscope which is inserted through the tip of the penis and into the urethra. It acts like a re-bore or the prostate, relieving some of the pressure the prostate places on the urethra, allowing normal urine flow. It is worth noting that once you reach 50 years of age there is a 50% chance you will develop BPH, and for every year after your 50th birthday the percentage risk of developing BPH is the same as your age - i.e. at age 90 there is a 90% chance of developing BPH</li>
<li>Once a diagnosis of prostate cancer is made and a radical prostatectomy is decided upon, patients are generally operated on within a small number of weeks. <em>Da Vinci Robotic </em>surgery is the gold standard for prostatectomy and involves having <a href="https://staging.menshealthdownunder.com.au/pros-ta-tec-tomy/#RADPROS">5 small incisions made across your abdomen</a> through which surgical instruments can be inserted. This technology is preferred because it is less traumatic, minimally invasive and enables the surgeon to overcome many of the shortcomings of both open prostatectomy (larger incision) and laparoscopic prostatectomy (smaller incision). The shortcomings of open prostatectomy and laparoscopic prostatectomy include reduced patient activity and mobility, increased time spent in hospital and more often results in loss of bladder control and sexual function because of damage to the delicate network of nerves around the prostate</li>
<li>All forms of prostate surgery are quite expensive (approx $14,000-$20,000) and despite having private health insurance you will still encounter significant out of pocket expenses if the surgery is performed in the private setting (as opposed to having the surgery in the public system). Given the often urgent need for surgical intervention, many patients rely on the private health system to avoid the potential waiting lists of the public system</li>
<li>Once the surgery is complete, your hospital stay is brief; with robotic prostatectomy your hospital stay is generally less than a week (it may even be one to two days). It is interesting to note that robotic surgery takes only 2-3 hours which is very quick compared to the other traditional removal options, hence some of the improved recovery times. It is also worth noting that all patients will have a catheter inserted for their surgery. The catheter usually remains in place for 7-10 days post-operatively, after which it is removed (assuming there hasn’t been any complications) by your Urologist or their registrar</li>
<li>After this you will return home and begin your rehabilitation. This has historically involved a physiotherapist advising on pelvic floor exercises to correct incontinence but today we aim to treat more than continence</li>
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