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Prostate Cancer

Aid & Information

Site provided by a patient with Stage IV Prostate Cancer

 

Prostate Surgery

While other treatment options are available, prostate surgery is often the treatment of choice for prostate cancer.

Prostate Gland

Radical Prostatectomy vs. RALRP


 

Radical Prostatectomy

Radical prostatectomy is an operation to remove the entire prostate and any nearby tissue that may contain cancer. It can be done as open surgery through an incision in the belly, or as laparoscopic surgery through several very small incisions in the belly. Laparoscopic surgery to remove the prostate is done with a tiny camera and special tools.

When removing the prostate, the surgeon will pay close attention to the 2 tiny bundles of nerves that run on either side of the prostate. These nerves control erections. If you are able to have erections before surgery, the surgeon will try not to injure these nerves (known as a nerve-sparing approach). If the cancer is growing into or very close to the nerves the surgeon will need to remove them. If they are both removed, you will be unable to have spontaneous erections. This means that you will need help (such as medicines or pumps) to have erections. If the nerves on one side are removed, you still have a chance of keeping your ability to have erections, but the chance is lower than if neither were removed. If neither nerve bundle is removed you may be able to function normally. Usually it takes at least a few months to a year after surgery to have an erection because the nerves have been handled during the operation and won't work properly for a while.

Surgery Image

Radical Retropubic Prostatectomy

Your surgeon will make a cut starting just below your belly button and reaching to your pubic bone. The entire surgery should take 90 minutes to 4 hours. This approach is used less often because the nerves cannot easily be spared and lymph nodes can't be removed. But it is often a shorter operation and might be an option if you don't want the nerve-sparing procedure and you don't require lymph node removal.

Laparoscopic Radical Prostatectomy (LRP)

The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This helps the surgeon see inside your belly during the procedure.

Laparoscopic prostatectomy has some advantages over the usual open radical prostatectomy, including less blood loss and pain, shorter hospital stays (usually no more than a day), and faster recovery times (although the catheter will be needed for about the same amount of time).

Robotic-Assisted Laparoscopic Prostatectomy (RALRP)

Sometimes laparoscopic surgery is done using a robotic system. The surgeon sits at a panel near the operating table and controls robotic arms to perform the operation through several small incisions in the patient's abdomen. Like direct LRP, RALRP has advantages over the open approach in terms of pain, blood loss, and recovery time. So far though, there seems to be little difference between robotic and direct LRP for the patient.

For the surgeon, the robotic system may provide more maneuverability and more precision when moving the instruments than standard LRP. Still, the most important factor in the success of either type of LRP is the surgeon's experience, commitment, and skill.

Radical Perineal Prostatectomy

Your surgeon makes a cut in the skin between your anus and base of the scrotum (the perineum). The cut is smaller than with the retropubic technique. This makes it harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. Perineal surgery usually takes less time than the retropubic way. There is also less blood loss.

Incontinence

Incontinence after prostate surgery is a concern shared by many patients facing prostate cancer surgery. After undergoing surgery to treat prostate cancer one should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.

Many men regain normal bladder control within several weeks or months after radical prostatectomy. There is no way to predict if leakage will occur and for how long. Most men experience leakage for weeks to a few months, some experience no leakage and a small percentage will have continued long-term or permanent leaking. There is a 10 percent risk of stress incontinence (urine leakage with activity) lasting up to three years following surgery.

Urge incontinence (causes urine to leak without any warning) is seen in some men soon after surgery. It may be due to bladder nerve damage that affects the bladder's ability to store urine at low volume. Mixed incontinence, a combination of stress and urge incontinence, can also occur when bladder instability and urethral sphincter weakness both occur.

Impotence

Impotence is the inability to obtain and maintain an erection satisfactory for intercourse. The nerves and blood vessels that are involved in erection run alongside the prostate. Depending on the location of the cancer, it can be impossible to perform a prostatectomy without damaging these nerves and blood vessels. This can result in loss of sensation, which can impact one's ability to get an erection. After surgery, all men will experience loss of ejaculate, because the organ responsible for ejaculate has been removed. Orgasm quality is adversely affected in many men. Erectile dysfunction is immediate and recovery from it is slow. As of now there is no way to determine who could be affected or for how long prior to treatment.

After 1 year from a prostatectomy about 40-50% of men will have returned to their pre-treatment function. After two years, about 30-60% will have returned to pre-treatment function. These rates vary widely depending on the surgeon and level of experience.