Facing Prostate Surgery

Below the Moustache blog series

Dr. Arthur Grabowski, Urologist

Patients with prostate cancer facing surgery are naturally apprehensive. Not only are they usually concerned with how the procedure will go, the extent of pain involved and the time it will take for them to recover, they also worry about long-term side effects. 

In this blog, I hope to alleviate some of these concerns by providing a detailed account of what patients can expect to experience.

Let’s begin with the actual surgery itself.

If a radical prostatectomy is required, it is because a surgeon believes he or she can remove the localized tumour completely. This type of surgery is generally recommended for patients who are younger, in good health and have prostate cancer that requires treatment. The surgeon accesses the area either through a single incision or a few small incisions in the abdomen. Using delicate surgical instruments, the surgeon then removes the prostate gland and some of the surrounding tissue. This is an added measure to ensure the whole area is free of cancer cells.

The procedure takes approximately two to four hours, depending on the extent and type of surgery. When a patient wakes up following the surgery, he will have a catheter to empty his bladder and a small tube in his abdomen to help drain any fluid that may accumulate. He can expect to stay in hospital after surgery for two to three days. He is discharged home with the catheter, which stays in for 10 to 14 days to allow healing of the connection between the bladder and the urinary passage.

Now let’s look at what happens during recovery and any possible side effects.

For the next couple of weeks he may notice some blood in his urine. This is normal and will ease off on its own as the surgical site heals. There will be some pain, as with most surgeries, but it can be managed well with medications both in the hospital and once the patient is home. Each patient and his surgery is different. For example, some may need follow-up radiation if the cancer has spread beyond the confines of the prostate.

Long-term side effects also vary with each patient. Incontinence, the involuntary loss of urine, occurs in about two to seven percent of patients and can vary in degree from mild to bothersome. Erectile dysfunction occurs in about 40 to 50 per cent of patients depending on a patient's age, type of surgery and pre-operative erectile status. Again, these have varying levels of severity and can often improve with time.

Here at Rouge Valley Health System, we understand the anxiousness that patients may be feeling. That’s why we have a patient-centric model that guides how we care for patients before, during and after surgery. We want patients to have the best experience possible throughout their prostate cancer care journey. Our surgeons work with a number of other sub-specialists and healthcare providers to ensure we address all the health needs of patients. Often this means a team approach, which can bring together oncologists, counsellors and even home care professionals.

Rouge Valley urologists are ‘hands on’ in patients’ care well beyond the surgical suite. This is how we provide the best outcomes for patients in Durham and Scarborough.

Partners play vital role for patients with prostate disease

Below the Moustache blog series  

Dr. Zachary Klinghoffer, urologist 
Rouge Valley Centenary

In sickness as in health, significant others play a key role in recognizing and helping their partners cope with illness, especially true when prostate problems arise. Often it’s the sleep-deprived partners who question why trips to the bathroom several times each night have become the new norm and encourage their partner to visit their family physician to discover the reason for the change in pattern.

Sleep isn’t always the only thing interrupted. Because the prostate contributes to a man’s sexual wellbeing, physical changes to the prostate can trigger emotional responses amongst couples. When a man is diagnosed with prostatitis, benign prostatic hyperplasia (BPH) or prostate cancer, the degree to which it affects his partner is proportional to the level of intimacy the couple shares. Partners, like the men themselves, can feel a sense of loss when sexual activity declines so it’s important for couples to remain open and supportive with each other during diagnosis and treatment.

Changes in a couple’s relationship may depend on the severity of disease and the length of treatment required. In many cases, sexual side effects are minimal and short term. Conditions such as BPH can have a wide range of symptoms and can be treated with medication or surgery.  Thanks to the generosity of our donors, the RVHS Foundation was able to contribute $250,000 to enhancing our men's health program, including a new surgical laser at each campus to treat BPH through a minimally invasive procedure. 

The GreenLightTM laser, a type of photoselective vaporization, can eliminate prostate tissue that blocks the urinary tract while sealing blood vessels to minimize blood loss. This new treatment – often performed as a day surgery procedure and available now at each Rouge Valley hospital campus - reduces a patient’s risk and recovery time, so he can get back to the business of living life to the fullest much faster.

Treatment for prostate cancer can be more demanding and require a longer recovery period. In these cases, couples may benefit from relationship counselling if there are long-term sexual side effects. Open communication can help a couple remain emotionally intimate.

Illness or injury never solely affects a man; health issues also affect the people closest to him. It is important for partners, family members and friends to recognize the vital role they play in helping the men in their lives recognize, treat and recover from men’s health issues.

Related links -- 

• View Dr. Klinghoffer’s video 
• 
  
• Dr. Greg Trottier’s ‘Mo’ Food for Thought
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• Dr. Jeffrey Spodek’s Early detection of prostate cancer can save lives

‘Mo’ Food for Thought

Below the Moustache blog series focusing on men’s health

By Dr. Greg Trottier, urologist, 
Rouge Valley Centenary

Maintaining good prostate health may be as close as your refrigerator. There’s evidence to show a link between certain naturally occurring food compounds and health benefits for the prostate, the walnut-sized gland responsible for the male reproductive system.

Called nutraceuticals, these extracts, derived from natural food products, can be consumed as part of your regular diet or as a dietary supplement. Just remember, supplements are no replacement for a good diet.

Vitamin D and fruits and vegetables rich in antioxidants prevent free radicals from forming, keeping cancer cells at bay. For example, it is generally accepted that lycopene, the compound that gives foods such as tomatoes and sweet red peppers their brilliant red pigment, as an antioxidant minimizes the risk of cancer and other diseases.

In some studies, isoflavones, present in soy products such as tofu or edamame, have also offered protection against both prostate and breast cancers, and are considered a healthy alternative to red meat.

While Movember allows us to focus on foods that benefit men below the belt, we recommend you regularly manage your portions so your belt doesn’t need loosening after meals. Following the Canada Food Guide is a good start as it will help you control your weight, which is important since being overweight is a contributing factor for developing prostate cancer. As a rule: more vegetables, less meat.

Our goal is to keep your prostate, urinary tract and love life all functioning well. Small changes to your diet can yield huge benefits. Consider my FARM formula when making prostate-healthy food choices:
• Fresh is always best — organic if possible; fish as a first choice
• Antioxidant fruits and vegetables
• Red pigment in foods, like tomatoes — that’s what to look for
• Moderate portions; keep meat to a minimum

Recipe: Dr. Greg Trottier’s Below the Moustache Prostate-Healthy ‘Mo’rinara Sauce

This sauce is rich in lycopenes, natural compounds that promote prostate health. It’s also really easy to prepare, which makes it good any day of the week.

12 to 14 ripe plum tomatoes chopped, blanched with the skin removed (or two large cans of diced tomatoes)

1 – 5 oz can of tomato paste
1 red pepper, chopped finely
1 medium onion, chopped finely
4 to 5 garlic cloves, minced
3 tablespoons fresh basil
2 tablespoons fresh oregano
1 to 2 bay leaves
½ teaspoon of chili peppers
½ cup red wine (optional; substitute with chicken or vegetable broth if desired)
1 tablespoon honey
3 tablespoons of olive oil

Topping
½ cup bread crumbs
½ cup fresh parmesan cheese
½ teaspoon flax seed
Garlic salt to taste
1 tablespoon olive oil

Heat onions and red peppers with the olive oil in a large pan. Add chopped garlic and stir regularly. Add tomatoes, then paste. Chop the fresh herbs and add to pan. Cook over medium heat for 30 minutes.  Stir in red wine, honey and season with chili peppers. Cook for an additional 30 minutes.

Topping
Blend together the bread crumbs, parmesan cheese, flax seed and garlic salt in a bowl. Heat olive oil in a pan. Add bread crumb combination to lightly toast for five minutes. When brown and slightly crispy, remove from heat.

Serve sauce over your favourite pasta. Sprinkle topping to add flavour and texture. Serve with chicken breast or fish, green salad with pomegranate garnish and cherry tomato pesto bruschetta.

What foods are rich in lycopene? 

• Tomatoes
• Watermelon
• Pomegranate
• Guava
• Papaya
• Mango
• Purple cabbage
• Sweet red peppers 

Read Below the moustache: Early detection of prostate cancer can save lives

Below the moustache: Early detection of prostate cancer can save lives

Rouge Valley Health System’s urologists to men: focus below the moustache

By Dr. Jeffrey Spodek, Chief of Urology,
Rouge Valley Health System 

Men’s health is the focus in November, thanks to the international prostate awareness movement that has affectionately renamed the month Movember.  My fellow Rouge Valley Health System urologists and I would like to remind everyone that while it’s fun to change up their look with a bit of facial hair, it’s more important to focus on what is way, way below the moustache.

Prostate cancer is insidious because there are usually few symptoms in the early stages. That’s because the prostate is situated deep within the pelvis so it can get bigger before any symptoms become evident. In the absence of symptoms, men assume all is well. Of the 23,600 Ontario men diagnosed with prostate cancer in 2014, about one-quarter (6,000) will die from the disease , largely because it was not diagnosed early enough.

Early detection gives patients a better chance of beating the disease that has become one of Canada’s leading health concerns for men. While Rouge Valley urologists are well equipped to perform the required prostate cancer surgery and treatment, our primary goal as health care professionals, is to help stop cancer before it reaches the advanced stages.

There are several ways physicians diagnose prostate cancer. Blood tests can show overall prostate performance and check for any abnormalities. PSA test measures the levels of prostate-specific antigen, which could be a marker for prostate cancer. One of the most effective methods – albeit, perhaps the most dreaded by our patients and the butt of many jokes – is the DRE, digital rectal examination. While a DRE may be unpleasant momentarily, our view is those few minutes could and do save lives.

One in seven Canadian men will be diagnosed with the disease, a staggering number that is expected to climb to one in four within the decade . Translated locally, this means about one-third of the surgeries my colleagues and I now perform are to treat prostate cancer, and this percentage and prevalence are increasing. We encourage men to know the risks and get in tune with their body so they can recognize even the slightest symptom.

Prostate cancer risk factors

Rouge Valley urologists encourage men to understand the risk factors of prostate cancer , which include:
• Age – men 50+ are at greater risk;
• Ethnicity – men of African and Caribbean descent are at higher risk;
• Family history of prostate cancer;
• Diet – high fat diets contribute to risk;
• Weight – men who are overweight are at greater risk.

Some of these risk factors are modifiable so, as a first line of defence, we want men to work with their family doctors to maintain their health in an effort to guard against the disease.

A stiff upper lip, even if covered by a stylish ‘stache, won’t protect men against prostate cancer. Awareness and personal attention will. Rouge Valley urologists want to give all men the greatest fighting chance to live cancer free.

Next week Below the Moustache will cover prostate-friendly foods that should be part of every man’s diet.