The symptoms that bring the patient to a physician are similar to the enlargement of the prostate (benign prostatic hyperplasia-BPH). Nowadays, most cases of prostate cancer are diagnosed at an early stage. Incidental findings after transurethral prostatectomy for BPH may also result in a diagnosis of prostate cancer.
The diagnosis and differentiation from other conditions of the prostateare done by the following means:
– Digital rectal examination of prostate.
– Prostate specific antigen (PSA).
– Prostate Ultrasound.
– Prostate Biopsy.

The urologist performs a digital rectal examination, estimating the prostate by its palpation with the fingertip. It is an old method, but still reliable to initiate an investigation of a prostate gland with possible cancer. A prostate that contains cancer is harder to the touch and loses its normal shape.
PSA test is the next diagnostic step. PSA is a substance produced by the prostate and found in the blood. Its normal range is between 0-4ng/ml but several conditions like (but not only) a prostate tumor may increase the value.This means that a man with an elevated PSA could havethe tumor but not all the men with increased PSA will have it. For this reason,the patient should consult an urologist to proceed with further testing. It is important to note that men who have undergone surgery for benign prostatic hyperplasia often have the impression that he has had the entire prostate removed and therefore they think that a regular screening for prostate cancer is not required anymore. This is not truebecause the peripheral portion of the prostate remains after surgery for BPH and may develps the cancer;therefore, a continued screening even in this case is recommended.
It is very useful, when there is suspicion of prostate cancer, to perform a rectal ultrasound. This examination provides useful information. It can detect if there is any suspicious area and the doctor could obtain a sample by the use of needle (biopsy) and send it for histological analysis. A biopsy is the ultimate and only reliable method to answer the question of the presence of cancer. Moreover, the biopsy provides information regarding the so-called “stage of cancer” and its aggressiveness. With this information, the treating urologist can propose an appropriate solution to the problem.

Prostate cancer can be addressed in different ways which include active surveillance, radiotherapy, brachytherapy, hormonal therapy and surgery (radical prostatectomy).
Surgery is proposed in the initial stages of the disease. Radical prostatectomy consists in the surgical removal of the whole prostate gland and seminal vesicles. Then, the bladder is sutured again to the urethra in order to re-establish the urinary continuity. Radical prostatectomy has beenperformed for decades with an open surgical approach, including a large incision below the umbilicus.
The laparoscopic radical prostatectomy, proposed in our department is a modern less invasive technique in which five small incisions (5-12mm) are used to insert into the abdomen sophisticated laparoscopic tools to reach the prostate and perform an accurate procedure. In this way, the laparoscopic approach achieves lower blood loss, less postoperative pain, faster recovery and mobilization of the patient. It is important to underline that, rarely, if during the procedure intraoperative conditions doesn’t allow the surgeon to continue in safety, the conversion into the open approach is possible.
The bladder catheter placed at the end of the surgery is removed the fifth post-operative day. However, since the second day after surgery, the patient may leave the hospital to return after 3 days to remove the catheter.

Radical prostatectomy, in line with any other surgical procedure, may have some postoperative complications but its contribution in the improvement of oncological outcomes for prostate cancer is invaluable.
The main complication is the sexual impotence. This is due to injury to the nerves responsible for sexual function. Impotence is often present immediately after a radical prostatectomy but erectile function is recovered naturally in a percentage of the patients within few weeks or months. The development of new surgical techniques and equipment has significantly reduced the percentage ofpostoperative impotence. During the procedure,the surgeon tries to save as much as possible of the neural pathways that surround the prostate, butthis must always be balanced with the prospect of an optimal cancer survival outcome and the possibility to remove all the tumoral tissue.
Urinary incontinence after radical prostatectomy is the second main complication, due to a damage into the mechanism that holds the urine in the bladder. This mechanism is provided by a valve or sphincter that ensures the so-called continence. The surgeon aims also to preserve this tissue, but as for the impotence, is not always possible for oncological or anatomical limits.This complication is also frequent in the immediate post-operative period and continence can beoften restored over a period of weeks/months.
Anyway, the patient is followed up regularly after the surgery, so that the urologist can adopt solutions suitable for each case.