Radical Prostatectomy

Open retropubic prostatectomy uses an 8-10 cm abdominal incision with 500-1000 mL blood loss and 2-4 day hospital stay. Laparoscopic surgery uses 5-6 small incisions with reduced blood loss (200-400 mL) and 1-2 day stay. Robot-assisted laparoscopic prostatectomy (RALP) using the da Vinci Xi system offers the same minimally invasive benefits plus 10x magnification and enhanced precision for nerve-sparing dissection. Thailand hospitals offer all three approaches, with robotic being preferred for optimal functional outcomes.

Radical prostatectomy achieves 85-95% biochemical (PSA) control at 5 years for localized disease. Cancer-specific survival is 94-99% at 5 years and 95-98% at 10 years for low-intermediate risk cancer. High-risk patients have 45-70% 5-year biochemical recurrence-free survival but still achieve 85-95% cancer-specific survival at 10 years per NCCN/EAU guidelines. Surgery provides definitive staging through pathology examination.

Temporary urinary incontinence is common initially. With nerve-sparing technique, 80-95% of men regain continence within 1 year. Most experience significant improvement by 3 months. Pelvic floor physical therapy accelerates recovery by 30-50%. Starting Kegel exercises 2-4 weeks before surgery improves outcomes. For persistent incontinence, options include male slings or artificial urinary sphincter.

Erectile function recovery depends on age, baseline function, tumor location, and whether nerve-sparing surgery is possible. With bilateral nerve-sparing, 30-70% of men recover erections adequate for intercourse. Younger men with good baseline function have better outcomes. Erectile rehabilitation starting 2-4 weeks post-surgery with PDE5 inhibitors and/or vacuum devices improves recovery rates. Penile prosthesis is available for men who don't respond to conservative measures.

PSA (prostate-specific antigen) blood testing is the primary surveillance tool. After successful surgery, PSA should be undetectable (<0.1 ng/mL). Testing schedule: every 3 months during year 1, every 3-6 months years 2-3, every 6 months years 3-5, then annually. Biochemical recurrence is defined as PSA ≥0.2 ng/mL confirmed on repeat testing. Rising PSA triggers evaluation for salvage radiation therapy.

Biochemical recurrence (rising PSA) occurs in 10-40% of patients depending on risk category. Salvage radiation therapy to the prostate bed is the most common treatment, often combined with androgen deprivation therapy (ADT). Timing is critical—earlier salvage radiation when PSA is low (<0.5 ng/mL) improves outcomes. For distant metastases, systemic therapy including ADT, chemotherapy, or novel hormonal agents is used.

Plan for minimum 14-21 days in Thailand. Pre-operative workup requires 2-3 days, surgery and hospital stay 1-4 days, and local recovery 10-14 days until catheter removal and initial healing. Surgeon clearance for long-haul flights typically occurs at 2-3 weeks post-surgery. Bringing a travel companion is strongly recommended for the first 2 weeks and mandatory for the return flight.

Thailand hospital packages typically include surgeon fees, anesthesiologist fees, operating room and hospital facility fees, standard pre-operative tests (labs, ECG), post-operative medications, and nursing care. The da Vinci robotic system fee is included in robotic surgery packages. Additional costs may include extended hospital stay, ICU if required, and adjuvant therapy. International airfare, hotel accommodations, and travel insurance are not included.

Key factors include surgeon case volume (>50 prostatectomies annually, ideally >100), positive surgical margin rate (<15% for experienced surgeons), continence and potency outcomes, and JCI accreditation. Bumrungrad, Bangkok Hospital, and Vejthani all offer robotic prostatectomy with the da Vinci Xi system. Request surgeon credentials, fellowship training details, and outcome statistics during your consultation.

Pre-habilitation significantly improves recovery. Start pelvic floor (Kegel) exercises 2-4 weeks before surgery—10 repetitions holding 10 seconds, 4-8 sets daily. Maintain aerobic conditioning with 30 minutes of moderate exercise daily. Optimize nutrition with high-protein diet. Most importantly, stop smoking at least 2-4 weeks before surgery (8 weeks ideal) as smoking impairs wound healing and increases complication rates.