Are steroids administered post-prostatectomy?

Steroid Administration Post-Prostatectomy

Steroids are not routinely administered post-prostatectomy unless the patient has been on chronic steroid therapy or has adrenal insufficiency. 1

Perioperative Steroid Management Guidelines

For Patients Not on Chronic Steroid Therapy

• There is no evidence supporting routine administration of steroids after prostatectomy for patients who are not on chronic steroid therapy 1
• Routine "push-dose" or "stress-dose" steroids are not recommended in the perioperative period for prostatectomy patients without adrenal insufficiency 1

For Patients on Chronic Steroid Therapy

• Patients who are on corticosteroids at the time of surgery should continue their usual regimen and receive equivalent intravenous hydrocortisone while nil by mouth 1
• Prednisolone 5 mg is equivalent to hydrocortisone 20 mg or methylprednisolone 4 mg 1
• For patients on chronic steroids (≥5 mg prednisolone equivalent for 4+ weeks), intraoperative steroid replacement should be administered: hydrocortisone 100 mg IV at induction, followed by continuous infusion of 200 mg/24h 1
• Postoperatively, these patients should receive hydrocortisone 200 mg/24h by IV infusion while nil by mouth, then resume enteral glucocorticoid at double the pre-surgical dose for 48 hours 1

Special Considerations

Adrenal Crisis Management

• In the event of unexplained, fluid-unresponsive hypotension during or after prostatectomy, adrenal insufficiency should be considered 1
• A push dose of 100 mg IV hydrocortisone should be administered, followed by 50 mg hydrocortisone q6h if adrenal crisis is suspected 1

Risks of Perioperative Steroid Use

• Steroid therapy is associated with increased morbidity in surgical patients, including higher rates of:
  • Infectious complications 1
  • Anastomotic leaks 1
  • Wound dehiscence 1
  • Longer hospital stays 1

Specific Prostate Surgery Applications

• For anastomotic stenosis after radical prostatectomy, TRUS-guided injections of long-acting steroids into the scar area have shown efficacy in treating recurrent/resistant stenosis with lower re-treatment rates and preserved continence 2
• There is no evidence supporting routine steroid administration to improve outcomes after radical prostatectomy 1

Androgen Considerations Post-Prostatectomy

• Surgical stress from prostatectomy naturally suppresses circulating androgens, with levels reaching minimum around 2 days post-surgery 3
• For patients with biochemical recurrence after prostatectomy, androgen deprivation therapy (ADT) may be indicated, not corticosteroids 1, 4
• Recent evidence suggests testosterone replacement therapy in select men with low testosterone after radical prostatectomy may actually reduce biochemical recurrence rates 5, 6

Practical Approach

• Assess if the patient has been on chronic steroid therapy (≥5 mg prednisolone equivalent for ≥4 weeks) 1
• If yes, administer perioperative steroids according to guidelines above 1
• If no, do not administer routine steroids post-prostatectomy 1
• Monitor for signs of adrenal insufficiency (unexplained hypotension) and treat promptly if it occurs 1