Dr Gonzalo E. Díaz Murillo


Prostate Surgery                                                          

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 alternative:

1- To recover or improve a lost function or one that has deteriorated, in other words, to improve the quality of life.

2- 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 latter.

The biopsy is not indispensable and is not an urgent intervention

The prostate biopsy can be avoided

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, a 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.


 Preparation for the Prostate C.M.P.

1.   Be in Bogotá from the night before the exam

2.   Eat a bland diet the night before the exam

3.   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.

4.   Not take any medicine the day of the exam unless it is indispensable (Ask if it can be taken beforehand)

5.   Have a travad (or similar) intrarectal enema (not oral) of 1 liter 3 hours before the appointment, holding it 15 minutes before releasing.

6.   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.

7.   If the patient uses contact lenses, they should bring the case and liquid as they may need to remove them briefly.

8.   Not use talcum powder or cologne except for underarm deodorant.

9.   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 (http://seer.cancer.gov/csr/1975_2001).

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; 151(6):1571–1574.

Inflammation in prostate carcinogenesis. Angelo M. De Marzo1,2, Elizabeth A. Platz3, Siobhan Sutcliffe3, Jianfeng Xu4, Henrik Grönberg5, Charles G. Drake2, Yasutomo Nakai6, William B. Isaacs7 & William G. Nelson2 

University of California, San Diego research published March 19,2007

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 risks

  • Biopsy can spread cancer

  • Biopsy hurts

  • 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 biopsy.

C.A.D. Color Prostate Ultrasound with Urosonography detects most conditions heightening the PSA and makes the prostate biopsy unnecessary.


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