Surgery

• Erections may not be as rigid as before the operation
• Orgasm and sexual sensation may be altered
• Patients who retain potency may suffer from retrograde ejaculation, also known as dry ejaculation. During ejaculation, semen travels backward into the bladder, causing infertility.

Fecal Incontinence. Radical prostatectomy can also cause fecal incontinence. The risk may actually be higher in men undergoing nerve-sparing procedures.

Contracture of the Bladder Neck. Another common postsurgical complication is contracture of the bladder neck at the point where it has been stitched to the remainder of the urethra. Contracture usually occurs within the first 3 months after the operation, causing a sharp decrease in urinary stream. The condition can be treated by dilation or surgery on the bladder neck, and rarely recurs.

Pelvic Lymphadenectomy

Pelvic lymphadenectomy is the surgical removal of the pelvic lymph nodes. It is usually performed at the same time as prostatectomy. If the surgeon suspects that cancer has spread beyond the prostate, he will perform the lymphadenectomy as part of the operation. Some surgeons do this procedure as a matter of course when performing prostatectomy, since it has few complications and adds information on the state of the disease. The lymph nodes are removed through an incision in the lower part of the abdomen, using conventional surgery or laparoscopy, a less invasive variation. The nodes are immediately examined. If they show signs of cancer, then metastasis has occurred. In such cases, the operation is usually stopped and the patient is offered radiation or hormone treatments. Experts argue about whether a prostatectomy may still be beneficial. One study found a survival advantage in those who had their prostate removed even when cancer had spread. More research is needed.

Click the icon to see an image of the pelvic lymph nodes.

Cryosurgery (Cryoablation)

Cryosurgery is an alternative to standard prostatectomy. A 2001 study reported that it was as effective as radiation therapy (and perhaps better than brachytherapy in patients at medium to high risk). Survival in the study exceeded 70%, comparable to radiation therapy and brachytherapy. Among patients with localized prostate cancer, the 5-year disease-free rate approached 80%. The cryosurgical technologies used in the study were not as good as newer ones now available, so these figures even may understate the technique's performance.

The Procedure. The goal of cryosurgery is destruction of the entire prostate gland and possibly surrounding tissue. Steel probes are inserted through the skin between the anus and the rectum and into the prostate. Liquid nitrogen is pumped through the probes to freeze all prostate cells, both healthy and cancerous. For success, cryosurgery requires a uniformly frozen area. The dead cells are absorbed and eliminated by the body. Patients can leave the hospital in 2 to 3 days.