Prostate Cancer: Surgery
Most often, surgery is a treatment for early-stage prostate cancer that has not spread to distant sites such as bones and lymph nodes. In this case, the goal of surgery is to remove all the cancer. The most common surgery for prostate cancer removes the entire prostate gland using a procedure called radical prostatectomy. Surgery may also be used as part of a multimodal approach to treating aggressive or metastatic prostate cancer.
Surgeries performed in high-volume medical centers by skilled doctors who routinely perform them result in the best outcomes. Some patients may be candidates for more than one surgical technique. Your doctor will help you choose the best form of prostate cancer surgery for your condition.
Radical (Open) Prostatectomy
As an open approach to prostate cancer surgery, the surgeon creates an incision in one of two possible areas to remove the prostate and nearby tissues. During a radical retropubic prostatectomy, the surgeon makes an incision in the lower abdomen, extending from the belly button to the pubic bone. A radical perineal prostatectomy is performed through an incision made between the anus and the scrotum.
Laparoscopic Radical Prostatectomy
Laparoscopic approaches to radical prostatectomy involve using smaller incisions and long surgical tools to take out the prostate. The surgeon uses an instrument with a video camera on the end to look inside the patient’s body. Compared with open approaches to prostate surgery, this method usually results in less pain and blood loss, faster recovery times and shorter hospital stays.
A robot-assisted laparoscopic radical prostatectomy is performed with the aid of a robot controlled by a surgeon. Multiple small incisions are made in the abdomen to allow for the movement of the robotic arms and camera. Compared with standard laparoscopic radical prostatectomy, this robotic approach may improve the surgeon’s precision and maneuverability.
Recovery from Radical Prostatectomy
Typical hospital stays following radical prostatectomy are one to two days. You will need to use a catheter to help drain your bladder for one to two weeks after surgery. Regardless of the surgical approach, you should expect to be walking soon after your procedure. Walking helps speed up your recovery and reduces your risk of developing complications. Recovery from prostate cancer usually involves a process of regaining continence (urinary control) and potency (erectile function).
Incontinence:Prostate surgery may affect your ability to control urine, resulting in leakage or dribbling of urine. Normal bladder control returns for many patients within several months. In rare cases, patients may remain permanently incontinent.
Impotence: The nerves that control erection, which run on either side of the prostate, are very delicate and can take time to recover. Full erectile recovery can take up to two years. While recovering, men may benefit from using oral medications (e.g., sildenafil), injection therapy, vacuum devices and penile implants. The nerves controlling the sensation of orgasm are not affected by prostate surgery. However, for some men, orgasm may decrease in intensity or become nonexistent. The degree of erectile dysfunction relates to the cancer burden, how many nerves were removed, the patient’s ability to have an erection before surgery and the patient’s age.
Robotic Prostate Surgery | Q&A
Thanks to advances made by surgeons like Dr. Patrick Walsh, The Brady Urological Institute at Johns Hopkins offers unparalleled prostatectomy expertise. Learn more about prostate cancer surgery and the difference between open and robotic procedures from Dr. Mohamad Allaf.