Surgery is a common treatment choice for men with prostate cancer whose disease has not spread outside the prostate. The main type of surgical procedure for prostate cancer is a radical prostatectomy.
Prostate cancer is a common disease among older men and the second-most common cancer in American males. It occurs when there is an uncontrollable growth of the cells in the prostate, a walnut-sized gland that is part of the male reproductive system. The prostate is located between the penis and the rectum below the bladder and around the urethra. Due to the location of the prostate, prostate cancer affects both the reproductive and urinary systems.
A radical prostatectomy is a surgical procedure in which a surgeon removes the entire prostate gland as well as some of the tissue around it, including the seminal vesicles. Surgeons can perform it as open surgery or as laparoscopic surgery.
Open radical prostatectomy
An open radical prostatectomy is a more traditional approach to this surgery. The surgeon makes a single long skin incision to remove the prostate and nearby tissues. There are two main ways to do this operation: radical retropubic prostatectomy and radical perineal prostatectomy.
In either procedure, patients are asleep under general anesthesia or numbed with spinal or epidural anesthesia, so that they do not feel any pain. During a retropubic prostatectomy, the surgeon makes the incision in the abdomen, from the belly button down to the pubic bone. During a perineal prostatectomy, the incision is made between the anus and scrotum (the perineum). The perineal approach is less common since it is more likely to cause erectile dysfunction. However, it is a shorter and faster procedure. During a retropubic prostatectomy, the surgeon also may remove some of the lymph nodes if cancer also affects them.
Laparoscopic radical prostatectomy
Laparoscopic radical prostatectomy is a more modern and less invasive approach than an open prostatectomy. During this operation, the surgeon makes several small incisions and uses special long surgical tools to remove the prostate. In addition to the surgical instruments, the surgeon also inserts a small camera called a laparoscope through the incision. This allows the surgeon to see what it being done inside the patient’s body.
There also is a second laparoscopic approach that uses a robotic interface called the da Vinci system. During the operation, the surgeon sits at a control panel in the operating room. Working through several small incisions in the patient’s abdomen, the surgeon operates by moving the system’s robotic arms.
Benefits and risks
The removal of the prostate through a prostatectomy is an effective method to treat prostate cancer, particularly in cases in which the cancer has not metastasized, or spread to other tissues.
As in any surgery, there are possible risks and side effects. These include reactions to anesthesia, bleeding from the surgery, blood clots in the legs or lungs, damage to nearby organs, and infections at the surgery site. Men who have the surgery also are at risk of erectile dysfunction, changes in penis length, and urinary incontinence.
Last updated: July 17, 2020
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