Many men turn to a doctor for an evaluation of their
prostate whether as a precaution or because there are
symptoms in the urinary ducts and/or sexual dysfunction.
Surgery of the prostate or prostatectomy is necessary in the
following situations in the absence of a less aggressive
To recover or improve a lost function or one that has
deteriorated, in other words, to improve the quality of
To increase life expectancy
The first case is when the prostate increases in size to the
extent that it impedes the normal flow of urine. This causes
urinary retention, urinary incontinence, repeated
infections, hydronephrosis, etc. In these cases, a
transurethral prostatectomy, which is the most frequent type
of surgery, could be required. There are also other optional
treatments based on the results of the Prostate C.M.P.
The second case is when prostate cancer is revealed,
directly or indirectly, and after all of the factors that
compromise the results of surgery are evaluated. These
include age, the size of the tumor, metathesis, sexual
activity, patient’s preference, and the chance of getting
the expected results. A radical prostatectomy, which
requires opening the abdomen, will usually cause urinary and
fecal incontinence as well as impotence.
In order to get a more precise idea of the need for a
prostatectomy, the best examination is the Prostate- C.M.P.
preceded by a PSA. A digital rectal examination (DRE) is
limited to evaluating the side of the prostate in contact
with the rectum (see the figure below) for its consistency
and shape plus a limited idea of its size.
Prostate surgery has side effects and complications
depending on the patient, type of surgery, and surgical
complications with the main ones being urinary incontinence
and impotence. There are also complications that are typical
of any surgical procedure such as hemorrhage, infection and
the adverse effects and complications of the anesthesia.
Naturally, a complete medical check-up is indispensable
BEFORE surgery to determine what the risks of surgery will
be vs. its risks. It will also tell the surgeon what kind of
surgery to do and the approach to take. Remember that the
more information the surgeon has about your condition, the
better the results will be.
There are two radical techniques for prostate cancer surgery
– retropubic (behind the pubic bone) and perineal (related
to the perineum). There is also a conservative one for very
elderly or extremely ill sick patients which is intended to
solve urinary problems and is limited to extracting part of
the prostate. Therefore, the side effects are minor in the
The biopsy is not indispensable and is not
an urgent intervention
The prostate biopsy can be
Prostate biopsies are usually
requested when the PSA goes up. But the PSA can go
up for many reasons besides cancer.
One of these reasons is precisely
the prostate biopsy. Each time the biopsy is
performed, the PSA goes up much more.
If instead of a biopsy of the
Prostate- C.M.P. is performed,
which includes a color CAD ultrasound of the
prostate, bladder, ureters, seminal vesicles,
testicles, etc., the cause of the elevated PSA will
be found including cancer.
Once the cause is known, and if
no cancer is suspected, it can be corrected with
adequate treatment and the PSA will go down making
as biopsy unnecessary.
for the Prostate C.M.P.
Be in Bogotá from the night before the exam
Eat a bland diet the night before the exam
The day of the exam, not consume anything except
for a liter of water which should be drunk 10
minutes before the exam, without urinating until
after the examination of the bladder.
Not take any medicine the day of the exam unless
it is indispensable (Ask if it can be taken
Have a travad (or similar) intrarectal enema
(not oral) of 1 liter 3 hours before the
appointment, holding it 15 minutes before
Immediately after releasing the enema a thorough
cleaning of the anus with abundant soap and
water, preferably showering. If evacuation is
repeated, a cleaning of the anus with soap and
water should be repeated. There should be no
remains of fecal material or toilet paper.
If the patient uses contact lenses, they should
bring the case and liquid as they may need to
remove them briefly.
Not use talcum powder or cologne except for
Trim the hair in genital area with scissors
10. Bring any imaging exams carried out in the
last year (older than that are useless)
11. Bring laboratory exams carried out in the
previous month (older than that are no good)
Ries LAG, Eisner MP,
Kosary CL, et al. (eds). SEER Cancer Statistics Review,
1975–2001, National Cancer Institute. Bethesda, MD, 2004
Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of
prostate cancer among men with a prostate-specific antigen
level 4.0 ng per milliliter. The New England Journal of
Medicine 2004; 350(22):2239–2246.
Keetch DW, Catalona WJ, Smith DS. Serial prostatic biopsies
in men with persistently elevated serum prostate specific
antigen values. The Journal of Urology 1994;
University of California, San Diego research published
Sum up this facts:
Biopsy can distinguish
cancer from non-cancer just when they puncture the
cancer. Statistics show that for any reason most
Biopsies do not puncture cancer
Biopsy is not infallible
Biopsy has important
Biopsy can spread cancer
Biopsy is expensive
(about USA $1000=)
There are safer
alternatives with different approaches
Conclusion: The PSA gets
higher because of many conditions besides prostate
cancer. If they want you to have a prostate biopsy taken
because your PSA is high you should first find out what is
heightening your PSA and try solve it. If they can solve it
and the PSA normalizes, there will be no need to perform any
Prostate Ultrasound with Urosonography detects most
conditions heightening the PSA and makes the prostate biopsy