Surgical Treatment of Prostate Cancer

If you have been diagnosed with early-stage prostate cancer, surgery or radiation will be one of your treatment options. In cancer that is confined to the prostate, surgical resection (radical prostatectomy) offers the potential for cure. Cure rates from initial surgery in men with localized cancer are about 90 percent, depending on tumor stage, tumor grade, PSA levels and overall health of the patient. Research suggests that surgery provides long-term cancer control. Most patients can consider themselves disease-free if their PSA levels remain undetectable tenj years after surgery.

There are several surgical approaches to prostate cancer, the stage of your cancer along with your age and health will impact the type of surgery you choose. It is important that you choose a surgeon with expertise in this surgery and that you are comfortable with. Make sure and ask any questions regarding the surgery, risks and benefits and what the potential side effects are so that you have a clear understanding before you make a decision.


Surgery Choices
Radical prostatectomy is the main type of surgery for prostate cancer, it is an operation to remove the entire prostate and any nearby tissue that may contain cancer. This approach can be done in several ways. This surgery can also be done laparoscopically through several very small incisions in the abdomen. Sometimes lymph nodes in the area also are removed so that they can be checked for signs of cancer. This is called a lymph node biopsy.

 

Open Approaches to Prostatectomy
In the more traditional approach to doing a prostatectomy, the surgeon operates through a single long incision to remove the prostate and nearby tissues. This is sometimes referred to as an open approach.

Radical Retropubic Prostatectomy
For this operation, the surgeon makes a skin incision in your lower abdomen, from the belly button down to the pubic bone. You will be either under general anesthesia (asleep) or be given spinal or epidural anesthesia (numbing the lower half of the body) along with sedation during the surgery.


Radical Perineal Prostatectomy
In this operation, the surgeon makes the incision in the skin between the anus and scrotum (the perineum). This approach is used less often because the nerves cannot easily be spared and lymph nodes can't be removed. This is often a shorter operation and could be an option if you don't want the nerve-sparing procedure and you don't require lymph node removal. It is often easier to recover from.

It also might be used if you have other medical conditions that make retropubic surgery difficult for you. It can be just as curative as the retropubic approach if done correctly. The perineal operation usually takes less time than the retropubic operation, and may result in less pain afterward.

Laparoscopic Approaches to Prostatectomy
Laparoscopic approaches use several smaller incisions and special surgical tools to remove the prostate. This can be done with the surgeon either holding the tools directly, or using a control panel to precisely move robotic arms that hold the tools.


Laparoscopic Radical Prostatectomy
For a laparoscopic radical prostatectomy (LRP), the surgeon makes several small incisions, through which special long instruments are inserted to remove the prostate. One of the instruments has a small video camera on the end, which allows the surgeon see inside the abdomen.

Laparoscopic prostatectomy has some advantages over open radical prostatectomy, including less blood loss and pain, shorter hospital stays (usually no more than a day), and faster recovery times (although the catheter will be needed for about the same amount of time).

In the hands of an experienced surgeon, this approach appears to be as good as open radical prostatectomy, although we do not yet have long-term results from procedures done in the United States.

Studies report that the rates of side effects from laparoscopic surgery are about the same as for open prostatectomy. Recovery of bladder control may be slightly delayed with this approach. A nerve-sparing approach is possible, increasing the chance of normal erections after the operation.


Robotic-Assisted Laparoscopic Radical Prostatectomy
Advances in technology have led to another laparoscopic technique using the da Vinci® system, this approach is called robotic-assisted laparoscopic prostatectomy. The surgeon sits at a panel near the operating table and controls robotic arms to perform the operation through several small incisions in the patient's abdomen.

Robotic-assisted surgery has advantages over the open approach in terms of less pain, blood loss, and quicker recovery time. So far though, there seems to be little difference between robotic and direct laparoscopic surgery for the patient.

In terms of the side effects men are most concerned about, such as urinary problems or erectile dysfunction, there does not seem to be a difference between robotic-assisted and other approaches to prostatectomy.
Robotic-assisted surgery provides more maneuverability and precision when moving the instruments than standard laparoscopic surgery. Still, the most important factor in the success of your surgery is the surgeon's experience, commitment, and skill.

Nerve-sparing surgery helps preserve the nerves that are along either side of the prostate and are needed for an erection. This is only done when there is little chance of leaving cancer cells behind. If the cancer is growing very close to the nerves the surgeon will have to remove them. If you already have sexual function issues, nerve-sparing surgery may not be the best choice for you. Your surgeon will discuss nerve-sparing surgery with you and whether or not you are a candidate for this.

 

Side Effects
As with any procedure there are potential side effects. The two major possible side effects from removing the prostate are:

  • Urinary Incontinence
  • Impotence

It should be noted that these side effects can also occur with other forms of treatment for prostate cancer.

  • Urinary Incontinence
    You may develop urinary incontinence, which means you are not able to control your urine or have leakage or dribbling. There are different degrees of incontinence. Being incontinent can affect you not only physically but emotionally and socially as well.
  • Impotence (erectile dysfunction)
    This means you cannot get an erection sufficient for sexual penetration. The nerves that allow men to get erections may be damaged or removed by radical prostatectomy. Other treatments (besides surgery) may also damage these nerves or the blood vessels that supply blood to the penis to cause an erection.