Surgery

In men whose cancer is confined to the prostate, surgical resection (radical prostatectomy) offers the potential for cure. Cure rates from initial surgery in men with localized cancer are about 90%, depending on tumor stage, tumor grade, PSA levels, and overall health of the patient. Research suggests that surgery provides long-term cancer control. Most patients can consider themselves disease-free if their PSA levels remain undetectable 10 years after surgery.

Radical Prostatectomy

Radical prostatectomy is the surgical removal of the entire prostate gland along with the seminal vesicles (the vessels that carry semen) and surrounding tissue. The surgeon may also remove the pelvic lymph nodes (a procedure called pelvic lymphadenectomy). The incision can be made in one of the following regions:

• Retropubically (through the abdomen and under the pubic bone, exposing the entire surface of the prostate). This is the approach used most often.
• Through the perineum (the skin between the scrotum and the anus). The perineal approach causes less bleeding and has a shorter recovery time, but it makes it more difficult to preserve nerves and remove lymph nodes. This approach is now rare.

The gland and other structures are then removed. The operation lasts 2 - 4 hours.

Minimally Invasive Prostatectomy. Less invasive surgical techniques using laparoscopy have been developed for radical prostatectomy. These techniques use smaller incisions and allow faster recovery, but they require special surgical training. Laparoscopic surgery may also be done using a robotic system, which involves the surgeon directing a robotic arm through a computer monitor. Not every hospital can do robotic-assisted laparoscopic prostatectomy and these procedures are difficult to perform.

Click the icon to see an illustrated series detailing prostatectomy surgery.

Nerve-Sparing Techniques. In the retropubic approach, the surgeon will attempt to spare the nerves that control erection:

• A bilateral nerve-sparing procedure saves the nerves on both sides of the sex organs.
• A unilateral procedure saves nerves on only one side.

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Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)