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Radical Prostatectomy: A Patient Story

Like many men his age, Helmut Kahlert had no symptoms. His PSA tests (a marker for prostate cancer) had always been low, and his other lab work was normal. So when his primary care physician told him he had found a lump on his prostate-most likely prostate cancer-Mr. Kahlert, 62, was "quite surprised."

Prostate cancer occurs in a small, walnut-shaped gland, located between the bladder and penis, that makes seminal fluid that nourishes and transports sperm. One of the most common cancers in men, prostate cancer usually grows slowly and initially remains confined to the gland, where it may not cause any symptoms or do serious harm. Many of these slow-growing tumors require minimal treatment; more advanced cases can be aggressive and spread quickly. The earlier prostate cancer is detected, however, the better the outcome.

During a routine check of the prostate gland during an annual physical, Mr. Kahlert's family physician detected the lump and referred him to the urology practice at Beth Israel Deaconess Hospital-Needham (BID-Needham) for follow-up. Urologic surgeon Joseph Ciccone, MD, performed a biopsy, which confirmed the diagnosis and the tumor's malignancy. Mr. Kahlert and Dr. Ciccone discussed the various treatments available.

"We talked about radiation and robotic surgery," says Mr. Kahlert, a professor of hospitality at Bunker Hill Community College, "but I opted for open surgery because Dr. Ciccone could also remove any diseased lymph nodes, and I just thought it was a more thorough procedure."

That open surgery, called radical prostatectomy, is a common treatment for early-stage (localized) prostate cancer. During the procedure, the entire prostate gland is removed, along with the associated seminal vesicles and often some of the pelvic lymph nodes to see whether the cancer has spread. The advantage, says Dr. Ciccone, is the "ability to use the sense of touch to guide the dissection."

Depending on the case, an incision is made in either the lower belly or in the perineum, located between the anus and scrotum. (In Mr. Kahlert's case, Dr. Ciccone made a "low transverse [side-to-side] incision" just above the pubic bone, similar to what is done in a cesarean section. Dr. Ciccone says this type of incision is cosmetically better because it lies horizontally beneath the pant line). Once the incision was made, Dr. Ciccone detached the prostate from the urethra (the tube that leads from the bladder and transports urine out of the body) and the bladder and tied off the blood vessels to and from the prostate to prevent internal bleeding. Then, he reconnected the bladder and urethra to restore urinary function. Mr. Kahlert remained in the hospital for a few days following the operation before returning to his home in Westwood.

All patients initially require a urinary catheter to ensure healing of the connection between the bladder and urethra in the proper anatomical position. Common side effects from the procedure include loss of bladder control and erectile dysfunction, but both are usually manageable and short term.

According to the Prostate Cancer Treatment Report, radical prostatectomy has among the highest success rates of all prostate cancer treatments, ranging from 30 percent for high-risk cases to 98 percent for low-risk disease.

Nearly a year after his surgery-his surgeon calls it a "textbook case"-Mr. Kahlert "has done great," says Dr. Ciccone, who sees Mr. Kahlert every three months to his PSA level checked. Mr. Kahlert says he is lucky that his cancer was detected early and that he was able to avail himself of the expertise of both his family doctor and BID-Needham's Dr. Ciccone.

Mr. Kahlert's wife, Heidi, a nurse in the vascular intensive care unit at Beth Israel Deaconess Medical Center in Boston, says her husband's experience at BID-Needham was "wonderful. Everything was smooth and welcoming-a huge comfort zone for us." Her husband, she says, is back to his regular physical activity, riding a bicycle and playing tennis. "Everything," she adds, "was worked out perfectly well."