A radical prostatectomy is a surgical procedure for the partial or complete removal of the prostate. It may be performed to treat prostate cancer or benign prostatic hyperplasia (BPH). A common surgical approach to prostatectomy includes making a surgical incision and removing the prostate gland (or part of it). This can be accomplished using one of two methods, the retropubic (lower abdomen), or a perineum incision (through the skin between the scrotum and the rectum). Prior to having a prostatectomy, it’s often necessary to have a prostate biopsy.
There are four main types or techniques of radical prostatectomy surgery. Many of these procedures can take about 3 to 4 hours to complete.
- Retropubic: This is the most common surgical approach used by urologists. The surgeon will make a cut starting just below your belly button that reaches to your pubic bone. This surgery is generally completed within 2-4 hours.
- Laparoscopic: In laparoscopic prostatectomy, the surgeon makes several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and a radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.
- Robotic surgery: Sometimes, laparoscopic surgery is performed using a robotic system. The surgeon moves the instruments and camera using robotic arms while sitting at a control console near the operating table. This procedure requires special equipment and training. Not every hospital can do robotic surgery. Not every hospital offers robotic surgery.
- Perineal: Radical perineal prostatectomy is used less frequently than the retropubic approach. This is because the nerves can’t be spared as easily, nor can lymph nodes be removed by using this surgical technique. However, this procedure takes less time and may be an option if the nerve-sparing approach isn’t needed. This approach is also appropriate if lymph node removal isn’t required. With the retropubic approach, there is a smaller, hidden incision for an improved cosmetic effect. Also, major muscle groups are avoided. Therefore, there’s generally less pain and discomfort.
Why Is The Procedure Performed?
A Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. The goal of radical prostatectomy is to remove all prostate cancer and is used when the cancer is believed to be confined to the prostate gland. This is called localized prostate cancer. Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.
Factors to consider when choosing a type of surgery include your age and other medical problems. This surgery is often done on healthy men who are expected to live for 10 or more years following the procedure.
As with any surgical procedure, certain complications can occur. Some possible complications of both the retropubic and perineal approaches to radical prostatectomy may include:
- Urinary incontinence: Incontinence involves uncontrollable, involuntary leaking of urine, which may improve over time, even up to a year after surgery. This symptom may be worse if you’re older than age 70 when the surgery is performed.
- Urinary leakage or dribbling: This symptom is at its worst immediately after the surgery, and will usually improve over time.
- Erectile dysfunction: Recovery of sexual function may take up to two years after surgery and may not be complete. Nerve-sparing prostatectomy lessens the chance of impotence, but doesn’t guarantee that it won’t happen. Medicines such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and mechanical aids may help men who are impotent because of treatment. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your concerns.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs gradually, in stages.
The surgery should remove all of the cancer cells. However, you will be monitored carefully to make sure the cancer does not return. You should have regular checkups, including prostate specific antigen (PSA) blood tests. Depending on the pathology results and PSA test results after prostate removal, your provider may discuss radiation therapy or hormone therapy with you.