Prostate Cancer Surgery: Questions on Initial and Follow-Up Procedures - Urology

More Info

---

Understanding prostate cancer surgery and the associated follow-up procedures can be quite complex, especially when considering the various treatment options available. In your uncle's case, it seems he has been diagnosed with early-stage prostate cancer, possibly stage 0 or stage I, which often allows for a more conservative approach, such as active surveillance. This means that the medical team will monitor the cancer closely rather than immediately proceeding with aggressive treatment.

When it comes to surgical options, there are several methods available for treating prostate cancer, including traditional surgery (radical prostatectomy), minimally invasive techniques like robotic-assisted surgery, and other non-surgical options such as high-intensity focused ultrasound (HIFU), which your uncle referred to as "波多刀" (HIFU). Each of these methods has its own advantages and disadvantages, and the choice often depends on the specifics of the cancer, the patient's overall health, and personal preferences.

1. Initial Surgery and Follow-Up: The concern about needing a second surgery often arises from the possibility that the initial procedure did not remove all cancerous tissue. This can happen for several reasons, including the tumor's location, size, or the complexity of the surgical procedure. In some cases, cancer cells may be present at the surgical margins, which means that the cancer was not completely excised. If this is the case, follow-up treatments may be necessary, which could include additional surgery, radiation therapy, or hormone therapy.

2. Second Surgery Considerations: If a second surgery is required, it is typically evaluated based on the results of the initial surgery and any subsequent imaging or biopsy results. The medical team will assess whether there are remaining cancer cells and the extent of their spread. This evaluation is crucial in determining the best course of action. The decision to proceed with a second surgery is not taken lightly and usually involves discussions about the potential benefits and risks, as well as the patient's overall health and preferences.

3. Insurance and Cost Considerations: The choice between self-paying for a procedure like HIFU versus opting for a covered procedure like transurethral resection of the prostate (TURP) can also influence decision-making. HIFU is often considered a less invasive option with potentially fewer side effects, but it may not be covered by insurance, leading to higher out-of-pocket costs. On the other hand, TURP is a more traditional approach that may be covered by insurance but can have its own risks and complications.

4. Importance of Comprehensive Evaluation: Before any surgical procedure, a thorough evaluation is essential. This includes imaging studies, biopsies, and discussions with a multidisciplinary team that may involve urologists, oncologists, and radiologists. This team approach helps ensure that all aspects of the patient's health and cancer status are considered before proceeding with treatment.

5. Monitoring After Surgery: After any surgical intervention, regular follow-up appointments are crucial. These visits typically involve PSA (prostate-specific antigen) testing to monitor for any signs of cancer recurrence. If PSA levels rise after surgery, further evaluation and treatment may be necessary.

In conclusion, while it is not uncommon for patients to require additional procedures after initial surgery for prostate cancer, each case is unique. The decision-making process should involve careful consideration of the patient's specific circumstances, the characteristics of the cancer, and the potential risks and benefits of each treatment option. Open communication with the healthcare team is essential to navigate these decisions effectively.