Prostate removal and other types of prostate surgery are recommended in case of cancer, enlarged prostate, or benign prostatic hyperplasia. The prostate is a gland surrounding the neck of the bladder, which plays an important role in the male reproductive system, by releasing a fluid component of semen. Prostate removal, called radical prostatectomy, means the excision of the whole prostate, the cancer cells inside it, and some tissue around it. The disease is frequent after the age of 50 and is the most common form of cancer in American men, who resort to prostate removal and other treatment options. It often develops slowly and causes very few symptoms, but in the early stages can be treated and has very good chances for survival.
In what cases is prostate removal recommended?
Deciding whether to choose prostate removal surgery or not should be based on pretreatment education and information from trusted sources. Talk to your doctor about your concerns and find out all the answers you need.
Prostate surgery options to consider
Prostate removal is an effective treatment option, depending on how fast cancer has spread. The type of intervention depends on many factors, like the stage of the disease or the patient’s overall health.
Radical (open) prostatectomy
This type of prostate surgery implies the removal of the entire prostate and the seminal vesicles. Lymph nodes in the pelvic area might also be removed. In open surgery, the oncologist makes a short incision that allows them to insert surgical tools and see the site clearly.
The urethra will be reattached to the bladder and the tubes that transport semen will be cut. After the procedure, other interventions can increase the chances that a man can maintain his sexual function or they can be used to fix urinary incontinence.
Robotic or laparoscopic prostatectomy
Robotic prostate surgery removes the entire prostate gland and is done by laparoscopic or robotic techniques. This type of surgery is less invasive than radical prostatectomy, in which a camera and instruments are inserted through key-hole incisions into the pelvic region. This allows a better view of the pelvic area without a large abdominal incision. The surgeon then controls the robotic instrument for the operation of prostate removal.
Robotic prostatectomy causes less bleeding and less pain and may shorten recovery time. The sexual and urinary side effects are similar to those of radical prostatectomy.
Why is da Vinci® prostatectomy a good option for prostate removal?
Robotic prostate surgery is accomplished using the da Vinci® Surgical System, which allows surgeons to operate with improved vision, dexterity, and control.
Bilateral orchiectomy or surgical castration
This is another type of prostate surgery, in which both testicles are removed. It is recommended in order to treat or prevent testicular cancer, prostate cancer, and male breast cancer. Bilateral orchiectomy lowers testosterone, the hormone that causes prostate and breast cancer to spread more quickly. By decreasing the levels of testosterone, cancer may spread at a lower rate, and some symptoms, such as bone pain, may be more tolerable.
This procedure usually lasts between 30 and 60 minutes and most people usually go home the day of the surgery, as it has a short recovery time.
Transurethral resection of the prostate (TURP)
Transurethral resection of the prostate is a urological operation that involves cutting away a section of the prostate. It is most often used to relieve symptoms of urinary blockage, not necessarily to treat prostate cancer.
An instrument called a resectoscope is inserted through the opening of the urethra and the surgeon removes the inner part of the prostate gland (that covers the urethra).
The intervention lasts about an hour and it is most often used for non-cancerous blockage, but may also be used in cases of prostate cancer. The doctor doesn’t need to make any incisions on the body. While most people can go home the same day, it is also likely that patients spend one or two days in the hospital. After the surgery, a urinary catheter will be placed because of the swelling that blocks urine flow.
Should you worry about an elevated PSA after prostate removal?
PSA stands for prostate-specific antigen and is often a very good indicator of how effective treatment has been, in case of prostate removal or other prostate surgeries.
After prostate surgery, the PSA level gets very low, but this result isn’t always reliable. That’s why the patient should discuss the expected PSA levels after prostatectomy with their doctor.
A lower PSA level following the removal of the prostate gland is only a part of the overall picture. There are many factors to monitor closely after prostate surgery.
Prostate removal side effects
It is a common but temporary effect of prostate surgery. Usually, the symptoms improve within a year after the prostate removal.
Erectile dysfunction is one of the most common prostate removal side effects. About 40% of men lose some erectile function after radical prostatectomy, but they see gradual improvements within 2-3 years.
One of the side effects that occur after prostate removal is related to fertility. Following the surgery, a man will no longer be able to produce or ejaculate semen. But there are options the patient can discuss with the doctor, like freezing and storing sperm.
Other side effects of prostate removal
In rare cases, bowel function is affected and dry orgasms appear.
What is the life expectancy after the removal of the prostate gland?
Prostate removal prolongs life with about three years in men with prostate cancer. However, prognosis depends on many factors. A doctor should know the patient’s medical history in detail and put this information together with survival statistics in order to offer an informed answer.
Option treatments have evolved over the years and life after prostate removal is now associated with less complications and a higher success rate.