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Surgery for Prostate Cancer

What are the different types of surgery for prostate cancer?

The following are some of the different surgical options used to treat prostate cancer:

  • Radical prostatectomy. An open-surgery procedure in which the entire prostate gland and some tissue around it are removed. This surgery involves an incision in either the abdomen or the area behind the scrotum.

  • Laparoscopic radical prostatectomy. A less-invasive type of radical prostatectomy in which the prostate gland is removed through small incisions using a laparoscope (a long, flexible lighted tube with a video camera attached) and special long, thin surgical tools. This type of procedure is commonly performed by a surgeon sitting at a control panel to precisely maneuver robotic arms holding surgical tools (robotic-assisted laparoscopic radical prostatectomy).

  • Transurethral resection of the prostate (TURP). Surgery to remove part of the prostate gland that surrounds the urethra by using a small tool that is placed inside the prostate through the urethra at the tip of the penis. There is no incision with this method. TURP is used as a palliative procedure (to relieve symptoms), not as a procedure to cure the cancer.

  • Cryosurgery. A procedure that involves killing the cancer by freezing the cells with a small metal tool placed in the tumor.

Surgery for prostate cancer generally requires a stay in the hospital. The length of the hospital stay will depend on the type of procedure performed. A urinary catheter will be inserted into the bladder during surgery, and will be kept in place for a period of time afterward, often for one to two weeks.

Possible complications or side effects of prostatectomy

Long-term, serious side effects are somewhat less common now than in the past, as new surgical methods continue to be introduced. New, nerve-sparing surgical procedures may prevent permanent injury to the nerves that control erection, and damage to the opening of the bladder. However, possible complications and side effects of prostate cancer surgery still exist. Recent research shows that having an experienced surgeon leads to a better outcome for patients. Be sure to discuss the following with your doctor before a surgical procedure:

  • Incontinence. Incontinence is the inability to control urine and may result in leakage or dribbling of urine, especially just after surgery. Normal control returns for many patients within several weeks or months after surgery, although some patients become permanently incontinent.

  • Impotence. Impotence is the inability to have an erection of the penis. For a month, or up to several months, after surgery, most men are not able to get an erection. Eventually, about half of men will be able to get an erection sufficient for sexual intercourse, but without ejaculation of semen, since removal of the prostate gland prevents that process.

    This effect on a man's ability to achieve an erection is related to the stage of the cancer, the patient's ability to have an erection before surgery, and the patient's age. However, most men who have surgery should expect some decrease in their ability to have an erection. For men who are completely impotent after surgery, several solutions are available.

There do not appear to be major differences in terms of these side effects for the different types of radical prostatectomy. Laparoscopic approaches (including robotic surgery) tend to result in shorter hospital stays, less pain, and quicker recovery times because they use smaller incisions. But the rates of incontinence and impotence are about the same as they are with the more traditional approach to prostatectomy. Again, the skill and experience of the surgeon probably matters more than the type of surgery.