What is radical prostatectomy?

Radical Prostatectomy
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Radical prostatectomy: Overview

A radical prostatectomy is surgery to remove the prostate gland. It is done to remove prostate cancer. It may be done as open surgery. Or it may be done as laparoscopic surgery through small incisions.

Laparoscopic surgery may be done by hand. But many doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Open surgery

In open surgery, the surgeon makes an incision to reach the prostate gland. The incision may be in the lower belly. Or it may be in the perineum between the anus and the scrotum.

When the incision is made in the lower belly, it is called the retropubic approach. The surgeon may also remove lymph nodes in the area so that they can be tested for cancer.

Laparoscopic surgery

For laparoscopic surgery, the surgeon makes several small incisions in the belly. A lighted viewing tool called a laparoscope is inserted into one of the incisions. The surgeon uses special tools to reach and remove the prostate through the other incisions.

Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the belly. It's done with robotic arms that translate the surgeon's hand motions into finer and more precise action. This surgery requires specially trained doctors.

The main goal of either type of surgery is to remove all the cancer. Sometimes that means removing the prostate and the tissues around it, including a set of nerves to the penis. These nerves affect the ability to have an erection. Some tumors can be removed using a nerve-sparing technique. This means carefully cutting around those nerves to leave them intact. Nerve-sparing surgery sometimes preserves the ability to have an erection.

How well does radical prostatectomy work?

Radical prostatectomy is a surgery that removes the prostate. It often works well to treat prostate cancer that has not spread outside of the prostate (localized prostate cancer). PSA levels drop almost to zero if the surgery successfully removes the cancer and the cancer has not spread. If cancer has spread, advanced cancer may develop even after the prostate has been removed.

For people who have localized prostate cancer, this surgery works about as well as radiation. With either treatment, the chance of the cancer spreading is low. One study looked at men with localized prostate cancer and found that the risk of early death was very low and about the same, no matter what option men chose.

For people with advanced prostate cancer, other treatments may work better than surgery. Radiation, hormone therapy, and other medicines are often used to help control cancer that has spread beyond the prostate.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the method of surgery, including robotic surgery.

What follow-up testing is done after a radical prostatectomy?

Prostatectomy often removes all cancer cells. But be sure to get follow-up care. It may lead to early detection and treatment if your cancer comes back. Your regular follow-up program may include:

  • Physical exams.
  • Prostate-specific antigen (PSA) tests. These tests let your doctor watch your PSA levels and measure the speed of any changes in those levels.
  • Digital rectal exams.
  • Biopsies as needed. They let your doctor look at suspicious tissue.
  • Imaging tests as needed. These include tests such as X-rays, CT scans, and MRI scans.

What are the risks of a radical prostatectomy?

The main risks of a radical prostatectomy are urinary incontinence and erection problems. Almost everyone will have these issues for a short time after surgery. For some people, they become long-term problems. General surgery risks include bleeding, infection, heart problems, blood clots, and a reaction to anesthesia.

What is a radical prostatectomy?

A radical prostatectomy is surgery to remove the prostate gland. It is usually done to treat prostate cancer that has not spread out of the prostate.

The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen. The prostate surrounds the urethra. That's the tube that carries urine from the bladder out of the body through the penis.

What can you expect as you recover from a radical prostatectomy?

You will likely stay in the hospital for 1 to 3 days after surgery. Most people can go back to work or their usual routine in about 3 to 5 weeks. But it can take longer to fully recover.

A thin, flexible tube called a catheter usually is left in your bladder to drain your urine for 1 to 2 weeks.

After your surgery, you will need to have routine checks with your doctor. This includes having blood tests to measure your PSA level. PSA is a substance that can help show if your cancer has come back.

You may not need any more cancer treatment after surgery. But in some cases, you may need radiation or hormone therapy.

Erection problems and fertility

Whether you can have an erection after surgery will depend on:

  • Your age.
  • Whether you could have erections before the surgery.
  • Whether the nerves near your prostate were damaged or removed.

If the doctor removes the nerves, you will need to use medicine or other treatment to have erections from now on. If your nerves are still in place, you may not need long-term medicines or treatments. As a rule, the younger you are, the better your chances that you will still be able to get an erection. Even if your nerves are not damaged, it will probably take 3 to 12 months after surgery before you can have an erection on your own. During this time, you can use medicine or other treatments to get an erection.

If you have this surgery, you won't be able to ejaculate sperm. That's because the surgery cuts the connection between the testicles and the penis. If you want to be able to have biological children, talk to your doctor about your options. You may be able to save your sperm before the surgery.

Urinary incontinence

After this surgery, you may not be able to control when you pass urine. Or you may leak urine. This is called urinary incontinence. It may go away within weeks or months after surgery. Or it may never go away. Some people will have leakage only once in a while. But others may find it hard to control their urine all the time. Doctors can't say who will have problems and who will not. And they can't tell how long after surgery the problem may last. Medicine and exercises to strengthen the muscles that control the bladder can often help.

Prostatectomy: Returning Home

How is a radical prostatectomy done?

There are three main types of this surgery. You and your doctor can choose which type is right for you.

During surgery, the nerves that run along the sides of the prostate may be damaged or removed. These nerves affect whether a person can have an erection. In some cases, the doctor may be able to avoid damage to these nerves. This is called nerve-sparing surgery. It makes it more likely that a person can still have an erection after surgery.

Radical retropubic prostatectomy

The doctor makes a 3- to 4-inch cut (incision) in the skin between the belly button and the pubic bone. This is done to remove the prostate. Nerve-sparing may be possible with this approach.

Radical perineal prostatectomy

The doctor makes a cut between the scrotum and anus. The prostate and other tissue are then removed. This surgery does not take as long as a retropubic surgery. And it may cause less pain. But nerve-sparing is hard to do with this approach. So this surgery is not done as often as a retropubic prostatectomy.

Laparoscopic radical prostatectomy

The doctor puts a lighted tube, or scope, and other tools through a few small cuts in the lower belly. Nerve-sparing may be possible with this approach. This surgery may also be done with the help of a robot (robotic-assisted). Robotic arms translate the surgeon's hand motions into finer and more precise action.

Why is a radical prostatectomy done?

A radical prostatectomy is done to remove prostate cancer. It is most often used if testing shows that the cancer has not spread outside the prostate.

It is sometimes used to relieve urinary obstruction in people with advanced cancer. But a different surgery, called a transurethral resection of the prostate (TURP), is most often used for that purpose. Surgery usually is not considered a cure for advanced cancer. But it can help relieve symptoms.

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