Surgical removal of the prostate is called a Radical Prostatectomy. In this operation the prostate, the internal sphincter, and the seminal vesicle are removed. Generally, if the cancer is located centrally, away from the surface of the prostate, both nerve bundles are spared. If the cancer is located on only one side of the prostate, only one nerve bundle is removed. If both sides of the prostate are cancerous, both nerve bundles are removed.
There are four types of surgery:
No matter which type of surgery you choose, the outcome and your chances of success depend not only on the stage of your cancer, but also on the surgeon. Therefore, if is very important to select a surgeon who does the selected surgery on a regular basis and who has a proven track record of success.
Surgery is not for everyone. Generally, the best candidates are men who might otherwise expect to live at least 10 more years and whose cancer is confined to the prostate.
Advantages of surgery:
- Surgery can potentially cure the cancer.
- The cancer can be accurately staged with pathological examination of the prostate.
- Follow up PSA tests can be used to determine if the cancer has been completely removed.
- If surgery fails to remove all of the cancer, radiation therapy can still be used.
Disadvantages of surgery:
- As with any major operation, recovery time could take up to eight weeks.
- Depending on the nerve bundles removed, you may not be able to have an erection.
- You may become temporarily or permanently incontinent.
Retropubic Surgery
This is probably the most common type of surgery. In this procedure, a vertical incision is made from the pubic bone up to the navel. At the beginning of the surgery, the pelvic lymph nodes can be examined to determine if the cancer has spread beyond the prostate. If the lymph nodes are clear, the surgery continues; if not, the operation is discontinued and other treatment methods must be used.
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Perineal Surgery
In this procedure, a semicircular incision is made between the scrotum and the anus. If the pelvic lymph nodes need to be examined, a separate incision must be made in the lower abdomen. This operation might involve less bleeding and generally heavier men do better with this method. Obviously, there is no visible scarring, but it might be more difficult to save the nerve bundles.
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Laparoscopic Surgery
This surgery is performed through several small incisions in the abdomen. A device consisting of a tube and an optical system (laparoscope) is inserted into one incision and is used to guide the procedure. Surgical instruments are inserted through the other incisions. This procedure is not available in all areas, and not all surgical patients are good candidates for the laparoscopic approach.
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Robotic-Laparoscopic Surgery
This surgery is performed through several small incisions in the abdomen. A device consisting of a tube and an optical system (laparoscope) is inserted into one incision and is used to guide the procedure. Robotic arms then guide instruments which have been inserted in the other incisions. The robot mimics the movement of the human hands, wrists and fingers to remove the cancerous prostate and affected tissue and also to finish the operation. Currently, this procedure is even more limited than regular Laparoscopic Surgery.
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