Prostate Cancer Foundation - Prostatectomy (Surgery)
Surgical removal of the prostate, known as radical prostatectomy involves removal of the prostate, seminal vesicles, and a portion of the urethra. The goal is to surgically remove all cancerous tissue and prevent cancer recurrence. This option is intended for men who have cancer that has not yet spread beyond the prostate.
If there is concern that cancer has spread beyond the prostate, lymph nodes surrounding the prostate are removed and examined for cancer. If the cancer has spread to the lymph nodes, other treatment options such as chemotherapy or radiation may be recommended.
During open surgery an incision is made from just below the umbilicus (belly button) to jsut above your pubic bone to allow surgeons to access the pelvic area where the prostate is located. This is the traditional method of performing prostatectomy, and has largely been replaced by laparoscopic techniques.
Laparoscopic prostatectomy is a less invasive surgical technique performed using instruments that are inserted into the abdomen through ports. These ports are made by five tiny incisions in the abdomen. The main advantage with laparoscopic surgery is a shorter and less painful recovery period with less need for narcotics.
Robot-Assisted Laparoscopic Radical Prostatectomy
Recent advances in surgical technology have allowed surgeons to improve on the laparoscopic technique by using the DaVinci robot. The surgery is performed similarly to the typical laparoscopic procedure, but the surgeon sits at a robot to control the instruments. This eliminates even the slightest hand temors, gives surgeons and better view of the surgical field, and allows them greater range of motion with the instruments. This technique is currently being developed at the Prostate Centre.
A common side effect of prostatectomy is erectile dysfunction. This is because there are two bundles of nerves that lie next to the prostate which may be damaged during surgery. Improved surgical techniques allow surgeons to spare one or both of these nerve bundles in order to preserve potency. This is known as "nerve sparing" surgery. Whether or not the nerves are spared depends on how close the cancer is to the nerves.
Many specialists believe that radical prostatectomy offers the greatest chance of long-term survival (past 7 to 10 years) for prostate cancer. Prostatectomy, however, is also the most aggressive treatment option and therefore has the greatest risk of life-altering side effects. The younger and healthier you are, the more successful your recovery is likely to be. When thinking about surgery, you must consider the effect that this will have on your life and weigh the possible benefits against the possible risks.
The most common problems associated with prostate surgery are urinary incontinence and impotence. There is a 30 - 70% chance that your ability to have an erection will be affected. It may take up to a year for the nerves to recover. For some men, potency never returns. A degree of incontinence is expected following surgery, but this should improve with time and exercise. About 5% of men experience a narrowing of the urethra, where it joins the bladder, but this is treatable.