The goal of surgery is to remove the entire prostate gland and all of the cancer. What follows is a description of a number of techniques used by surgeons when operating on the prostate.

Transurethral Resection of the Prostate (TURP):

TURP is a procedure that involves removing tissue from the prostate by inserting an instrument through the urethra.  A resectoscope, which is an electrically heated wire loop, is used to scoop out the unhealthy prostate tissue. This procedure is sometimes necessary to relieve the symptoms of prostate cancer and make urinating easier. It is also performed on men who cannot have a radical prostatectomy due to age or other illnesses. This type of surgery has several advantages. Because no surgical incision is required, hospital stays are brief and recovery is usually uneventful. In most cases, urinary function returns to normal after the procedure and sexual function is not affected by the procedure.

Orchiectomy

Orchiectomy is a surgical procedure that completely removes the testicles. This procedure is also a type of hormonal therapy because, like certain prescription drugs, orchiectomy provides an immediate and permanent reduction in testosterone.  Treatment with LH-RH analog therapy has been shown to be comparable to orchiectomy in decreasing the body's supply of testosterone. Most patients prefer LH-RH analog therapy over orchiectomy to treat their prostate cancer, however, orchiectomy is a routine surgical procedure that usually has no long-term complications. Orchiectomy may require being hospitalized for approximately 2 days or more. While many patients respond favorably to orchiectomy, for those patients for whom this surgical procedure fails, the operation is often viewed as unnecessary, expensive, and possibly psychologically damaging. Common side effects of orchiectomy are hot flashes, impotence, and loss of sexual desire.

Prostatectomy

A prostatectomy is a surgical approach to remove all (radical prostatectomy) or part of the prostate.  Prostatectomy is usually performed to remove early-stage prostate cancer before it has spread to the other parts of the body.  Often, the pelvic lymph nodes are also sampled to see if the cancer has spread.  Patients who undergo a radical prostatectomy should expect at least a 2-4 day stay in the hospital, however a full recovery can take up to 12 weeks.  In most cases, taking out the prostate removes the cancerous tumor as well. Unfortunately, if the cancer has spread beyond the prostate it cannot be cured with surgery.

Hormonal therapy is sometimes used before surgery to shrink the prostate cancer tumor so it can be removed more effectively. Prostatectomy has become safer and less likely to leave men impotent or incontinent, although results vary from surgeon to surgeon. As with all major surgeries, there are risks. The most common risks of a prostatectomy are impotence, the inability to achieve or maintain an erect penis, and incontinence, the involuntary urination. The likelihood for these complications depend on a patient's age, health, and the stage of his cancer.

To reduce the risk of impotence, surgeons aim to spare the erectile nerves that run alongside the prostate.  If the surgeon finds that the nerves cannot be spared because the cancer has spread, it may be possible for the surgeon to create a nerve graft with nerves from other parts of the body. The surgeon will not know if the nerve-sparing procedure is possible until the extent of the cancer can be observed.

Prostatectomy is a very delicate procedure and the success of the procedure is strongly determined by the skill of the surgeon.  When deciding on surgeon to perform your procedure, be sure to assess their success record and experience level and choose someone you trust.

The Complete (Radical) Prostatectomy

Surgical removal of the entire prostate gland is called radical prostatectomy. Radical prostatectomy is usually performed to remove early-stage prostate cancer before it can spread to other parts of the body. Often, the pelvic lymph nodes are also sampled for a biopsy as a precautionary measure. In most cases, taking out the prostate takes out the cancerous tumor as well. If the cancer spreads outside of the prostate, it cannot be cured with surgery. Patients who undergo radical prostatectomy should expect at least a 2- to 4-day stay in the hospital, while full recovery can sometimes take up to 12 weeks. As with all major surgeries, prostatectomy patients may require a blood transfusion. Hormonal therapy is sometimes used before surgery to shrink the prostate cancer tumor so it can be removed more effectively. Radical prostatectomy has become safer and less likely to leave men impotent or incontinent, although results vary from surgeon to surgeon. The risk of impotence, which is the inability to achieve or maintain an erect penis, often depends on a patient’s age, health, and the stage of his cancer. Incontinence, which is involuntary urination, appears to occur less often than impotence in patients after radical prostatectomy.

Surgical Techniques

Nerve-Sparing: The surgeon cuts to the edges of the prostate and aims to spare the erectile nerves that run alongside the prostate.  If the surgeon finds that the nerves cannot be spared because they found that the cancer has spread then it may be possible for the surgeon to create a nerve graft with nerves from other parts of the body to the ends of the erectile nerves that were cut out.  The surgeon will not know if the nerve-sparing procedure is possible until the patient is opened up to see if the cancer has spread.  If this procedure is an option though it will offer the best chance to preserve erectile function.

Laparoscopic: Small incisions are made in the abdomen with the robotic interface and the surgeon inserts narrow instruments with fitted cameras or surgical tools allowing the surgeon to see and operate on the prostate without cutting open the abdomen. 

Prostatectomy is a very delicate procedure and the success of the procedure is strongly determined by the skill of the surgeon.  When deciding which surgeon to have perform your procedure make sure to look at their success record, experience level and that it is someone you greatly trust.

Side Effects

Prostatecomy procedures have become safer and less likely to cause lasting side effects, however results do vary from surgeon to surgeon.  There are potential side effects to having a prostenctomy and those include

  • Erectile function
  • Incontinence 
  • Damage to the urethra
  • Damage to the rectum

What I know now I wish I knew before…getting checked early can save your life.

~John Sharp, prostate cancer survivor

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