Prostate cancer: Radical prostatectomy
Radical prostatectomy is an operation to remove the prostate gland.
This may be recommended as a treatment option for localised prostate cancer and locally- advanced prostate cancer.
What are the types of prostatectomy?
When a traditional open operation is used, retropubic prostatectomy and perineal prostatectomy are the two main types of this surgery. The patient is either under general anaesthesia (asleep and unconscious) or given a spinal or epidural (to numb the lower part of the body) with sedation during the surgery.
Retropubic prostatectomy. In the retropubic operation, the surgeon makes an incision in the lower abdomen. The surgeon can remove the prostate, surrounding tissue, and lymph nodes (when necessary) through this incision.
Surgeons may also choose a nerve-sparing version of the retropubic operation. During this procedure, the surgeon carefully locates the nerves on either side of the prostate gland. If the cancer has not spread to these nerves, the surgeon will not remove them.
Because these are the nerves that are needed for erections, leaving the nerves reduces, but does not eliminate, the risk of erectile dysfunction and incontinence following surgery.
Perineal prostatectomy. In the perineal operation, the surgeon removes the prostate through an incision in the skin between the scrotum and anus. This procedure is not done as often because nerve-sparing techniques are more difficult to perform by this approach and lymph nodes cannot be removed through this incision. If lymph node examination is needed for men having this operation, the surgeon can remove some lymph nodes through a very small skin incision in the abdomen by using a laparoscope (a narrow lighted tube).
These operations last from two to four hours, with the perineal approach often taking less time than the retropubic approach.
Laparoscopic prostatectomy. In many cases, radical prostatectomy can now be carried out through laparoscopic (‘keyhole’) surgery. Instead of one big incision, the surgeon makes several small cuts through which are inserted instruments to visualise the prostate and to perform the operation. Laparoscopic prostatectomy seems to be as good as open operation at treating prostate cancer while giving less blood loss, less pain and a faster recovery time.
What happens after the surgery?
For most patients, a catheter is inserted through the penis and into the bladder during the surgery. The catheter will remain in place for between two days and two weeks or more, until urine is flowing normally without blood clots. Recovery time takes an average hospital stay of three to seven days after an open operation, one to three days after keyhole surgery. Average time away from work is six to eight weeks after open surgery, two to four weeks after laparoscopic surgery.
What are the risks?
The risks of a prostatectomy consist of the typical risks for a major operation. These include infection, bleeding and developing blood clots in the legs that can travel to the lungs.
Side effects of radical prostatectomy include:
Surgeons try to avoid removing or cutting the nerves that control a man's ability to achieve an erection or control his urine. Depending on the patient's age and the stage of tumour advancement, nerve-sparing techniques allow about 40 to 65% of men who were sexually potent before surgery to remain potent after surgery.
The incontinence most commonly associated with radical prostatectomy is called stress urinary incontinence. This results in leaking urine while coughing, sneezing or laughing. For many people normal urinary control can be achieved within six months after the surgery. This recovery generally occurs gradually.