Surgery to remove the prostate is most commonly an option for men with early prostate cancer where the cancer has not spread beyond the prostate gland. It is sometimes also an option for men with Stage III or IV prostate cancer and can involve removing the two appendages attached to the under surface of the prostate called the seminal vesicles, as well as the lymph nodes which drain the prostate. This surgery is called radical prostatectomy.
Sometimes when a surgeon begins this procedure and finds that prostate cancer cells have spread to nearby lymph nodes, which is an indication that the disease may have spread to other parts of the body, the surgeon may decide not to complete the surgery by removing the prostate and will instead suggest other types of treatment.
There are several methods for performing radical prostatectomy. Each type has benefits and risks. Following surgery a patient will experience discomfort for a few days or weeks. The recovery time will depend on the surgery and the overall health and activity level of the patient. Side effects of the surgery can include incontinence, impotence, the inability to produce semen and erectile dysfunction.
Open surgery is traditional surgery in which a large incision is made to remove the prostate. There are two methods of open surgery used for radical prostatectomy. Both methods usually take between 1 1/2 to 4 hours to complete, require a one- to three-day hospital stay, and take approximately three to five weeks before a patient can fully resume normal activities including returning to work. After these surgeries, while still under anesthesia, a catheter will be put in place to help drain the patient’s bladder. The catheter usually remains in use for one to two weeks during healing.
Radical Retropubic Prostatectomy
During retropubic surgery, the prostate gland is removed through an incision in the lower abdomen that extends from the belly button to the pubic bone. This allows for removal of any lymph nodes that may be cancerous as well.
This procedure has a lower risk of damaging nerves in the area which can cause problems with the bladder and with erectile function, and is known as a nerve-sparing approach. The surgeon will try to keep intact the nerves in this area which control the ability to have an erection. Removal of those nerves depends on the location of the cancer. This is the most common method of prostatectomy.
Radical Perineal Prostatectomy
During this procedure, the surgeon will make the incision between the scrotum and the anus (the perineum). The prostate will be removed through this incision but it is more difficult to remove lymph nodes and to avoid nerve damage with this method. However, this procedure is usually quicker and has a shorter recovery time than radical retropubic prostatectomy.
A less invasive prostatectomy uses laparoscopy to remove the entire prostate through several small cuts rather than through a single long incision. This surgery is done with the use of a laparoscope, which is a long, slender tube with a small camera on the end. The camera sends images to a monitor in the operating room and the surgeon watches the monitor as he or she guides the surgical instruments being used.
Advantages to this procedure over open surgery include less blood loss and pain, a shorter hospital stay of usually just one day, and a faster recovery. A catheter needs to be used for the same amount of time as following an open prostatectomy, and the laparoscopic procedure is a longer surgery which requires a patient to be under anesthesia for a greater amount of time.
Robotic Laproscopic Surgery
The da Vinci robotic prostatectomy uses a laparoscope and a robot controlled by a surgeon to remove the prostate. The surgical tools involved in this procedure are attached to a mechanical device called a robot, and the surgeon uses hand controls to guide the robot to move the instruments. This allows the surgeon to make even more precise and nerve sparing movements with surgical tools than is possible with traditional laparoscopic surgery.
This method may result in more rapid and more complete return of urinary control and sexual function and a more rapid return to preoperative activity.
Transurethral Resection of the Prostate (TURP)
During this procedure, an instrument called a resectoscope is passed through the end of the penis into the urethra to the prostate. A cutting tool at the end of the scope removes tissue from the inner part of the prostate gland that surrounds the urethra.
This operation is not used as a way to cure a patient of prostate cancer. It is used more often to relieve symptoms of prostate cancer such as difficulty urinating. It is also often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia (BPH).
This procedure takes approximately one hour. Following the surgery, a catheter is used to help drain urine from the bladder and remains in place for about a day while the prostate heals.
This method of treatment destroys cancer cells by freezing them. During this procedure several hollow needles are placed through the skin between the scrotum and the anus (the perineum) which are guided with the use of transrectal ultrasound. Very cold gases are then sent through the needles which have a freezing effect on the tissue at which they are directed.
Warm saltwater is circulated through a catheter in the urethra to keep it from freezing. The catheter is kept in place for about three weeks after the procedure to allow the bladder to empty while the patient recovers. Spinal, epidural or general anesthesia is used during the procedure.
Cryosurgery is less invasive than radical prostatectomy, so there is usually less blood loss, a shorter hospital stay, shorter recovery period, and less pain than with surgery.
Side effects of cryosurgery can include:
- Blood in the urine
- Soreness in the area where the needles were placed
- Swelling of the penis or scrotum
- Pain and burning sensations in the bladder
- The need to empty the bladder and bowels often
- Erectile dysfunction
- Fistula (an abnormal connection between the rectum and bladder) which can allow urine to leak into the rectum and often requires surgery to repair