Prostate Cancer Surgery

Prostate Cancer Surgery can be performed to remove the cancer from the prostate and from nearby areas where the cancer has spread. It is most often used during early stages, when prostate cancer is located only within the prostate. If the tumor is small and has not spread outside of the prostate, then surgery may cure the disease. Surgery may help prevent further spread of the cancer.

Surgical options include:
Robotic Prostatectomy


The latest advancement in surgical technology for prostate cancer is robot assisted laparoscopic prostatectomy. Robot assisted prostatectomy provides the benefits of laparoscopic surgery but with important technological improvements, including advanced optics that provide 10-times magnified, three-dimensional images of the prostate and surrounding nerves and tissues; robotic arms that eliminate even the slightest human hand tremors; and instruments with “wrists” that pivot 540 degrees for greater maneuverability than is possible with the human hands or laparoscopic instruments.

What to expect:

The surgeon sits at a console a few feet from the patient and operates the computerized controls. A camera and specialized instruments are mounted on the robotic arms, which are inserted through four small incisions in the patient’s abdomen and connected to the robot. As the surgeon moves his or her hands, wrists and fingers, the robotic technology translates the motions into precise micro-movements that allow greater precision – especially critical to spare nearby nerves that control urinary continence and sexual function.

Following the surgery, patients are monitored overnight and usually go home the next day. A urinary catheter remains in place for about a week. Most patients return to normal activities in two to three weeks. For more information, see Robotic Prostatectomy.

Advantages:

Benefits of robot assisted prostatectomy include:

  • smaller incisions and less scarring
  • shorter hospital stay
  • less pain
  • better visualization for the surgeon
  • less blood loss and transfusions
  • faster recovery and return to normal activities

Open Prostatectomy Procedures

Radical retropubic prostatectomy and radical perineal prostatectomy are two types of radical prostatectomy procedures. The entire prostate gland, attached seminal vesicles, and some nearby tissue are removed during these surgeries.

A radical retropubic prostatectomy involves a surgical cut in the lower abdomen. The surgeon can then remove the cancer through this skin incision. The entire prostate and attached seminal vesicles are removed, along with a small part of the bladder next to the prostate.

If necessary, nearby pelvic lymph nodes are removed as well. Recent developments in surgery have led to a newer version of this technique, called nerve-sparing radical retropubic prostatectomy. This allows the surgeon to identify the nerves on either side so that they can be left alone, if possible.

The benefit to leaving these nerves alone is that some men will have a better chance of achieving erections after surgery. In general, there is a lower risk of certain adverse side effects if the nerve-sparing technique can be used.

Radical perineal prostatectomy is similar to radical retropubic prostatectomy except that the cancer is removed through an incision in the perineum, the area between the scrotum and the anus. The entire prostate is removed along with any nearby cancer.

What to expect:

Radical prostatectomy procedures often last anywhere from an hour and a half to about four hours. The perineal type is generally a shorter operation than the retropubic type. A catheter is usually inserted after these procedures while the patient is still asleep. This catheter will help make urination easier during the healing process and will only be needed for a few weeks or less. After the catheter is removed, you may be able to urinate on your own. Both types of radical prostatectomies require about three days of rest in the hospital, followed by three to five weeks of rest at home.

Advantages:

Prostatectomy is a one-time procedure that may cure prostate cancer in its early stages and may help extend life in the later stages. Surgery avoids some of the problems seen with radiation and other therapies.

Disadvantages:

Prostatectomy is a major operation that requires hospitalization and can produce side effects. The possible side effects include impotence, incontinence, and narrowing of the urethra, which can make urination difficult. Most men who have this surgery should expect some decrease in their ability to have an erection. However, the chance of impotence is lower with the new nerve-sparing technique. In general, impotence is more likely to occur in older patients, especially those older than 60 years of age. The risk of impotence is even greater for men older than 70 years of age. Incontinence occurs in only a small percentage of patients.

Transurethral Resection of the Prostate (TURP)

A transurethral resection of the prostate (TURP) is the removal of tissue from the prostate by inserting an instrument through the urethra in the penis.

An instrument is placed into the urethra and guided up into the prostate to cut some of the tissue that surrounds the urethra. TURP is most often recommended for men with noncancerous enlargement of the prostate.

In this case, the procedure is performed to relieve the symptoms associated with this condition. TURP also may be an option for men who have prostate cancer but cannot have a radical prostatectomy either because of advanced age or a serious illness (besides cancer). TURP was designed to relieve symptoms that a tumor can cause; it will not cure cancer and usually removes only part of a tumor.

What to expect:

A TURP operation takes about an hour. A catheter is inserted after the surgery and may remain in place for about two to three days to make urination easier. The patient probably will stay in the hospital for one or two days and may be able to return to work after one or two weeks.

Advantages:

A TURP requires less recovery time than a radical prostatectomy, and the side effects often are less severe.

Disadvantages:

Because TURP is not a curative procedure for prostate cancer, other forms of treatment may be required.