Prostatectomy - Prostatectomy : Prostate cancer

Prostatectomy
Prostatectomy is the surgical removal of the prostate and is performed by an urologist. A radical prostatectomy can be performed to remove the prostate and the cancer from nearby areas where the cancer has spread. This type of surgery may help prevent further spread of the cancer.
If the tumor is small and has not spread outside of the prostate, then surgery may optimally treat the disease. However, complete surgical removal of the prostate is not common when the cancer has spread to the lymph nodes or other sites.
Radical Prostatectomy
Radical retropubic prostatectomy and radical perineal prostatectomy are the two most common types of radical prostatectomy procedures. The entire prostate gland, attached seminal vesicles, and some nearby tissues are removed during these surgeries.
A radical retropubic prostatectomy involves a surgical incision in the lower abdomen. The surgeon can then remove the cancer through this incision. The entire prostate and attached seminal vesicles are removed, along with a small part of the bladder next to the prostate.
When possible, depending on the size of the tumor, a version of this technique called nerve-sparing radical retropubic prostatectomy is performed. This allows the surgeon to identify the nerves on either side of the prostate so that they can be left alone, if possible. In general, there is a lower risk of certain adverse effects if the nerve-sparing technique can be used. These side effects will be discussed in the section titled "Disadvantages." If necessary, a pelvic lymphadenectomy is also performed to remove nearby pelvic lymph nodes.
This surgery can include a nerve transplant, where the nerve is generally taken from the patient's leg, in an attempt to preserve the ability to have erections in those patients where nerve-sparing surgery is not possible.
Radical perineal prostatectomy is similar to radical retropubic prostatectomy except that the cancer is removed through an incision in the perineum. A surgical incision is made in the area between the scrotum and the anus. The entire prostate is removed along with any nearby cancer. Pelvic lymphadenectomy cannot be performed during this procedure.
What to expect: Radical prostatectomy procedures often last anywhere from 1.5 to about 4 hours. The perineal type is generally a shorter operation than the retropubic type.
A catheter is usually inserted into the urethra after these procedures while the patient is still asleep. This catheter will help to enable urination during the healing process and should only be needed for a few weeks or less.
After the catheter is removed, the patient should be able to urinate on his own. Both types of radical prostatectomies require approximately 3 days of recovery in the hospital, followed by about 3 to 5 weeks of rest at home. Your physician and/or surgeon will provide specific guidelines.
After the prostate is removed, it is sent for evaluation where the margins or edges of the prostate are inspected. If the margins of the prostate do not have cancer cells (negative margins), it is assumed that the cancer was confined within the prostate and has not spread outside of the prostate. This is called localized prostate cancer. However, if the margins are found to contain cancer cells (positive margins), cancer may have spread outside the prostate and further treatment, such as radiation or hormonal therapy, may be necessary. This is called locally advanced prostate cancer.
Advantages: Prostatectomy is a one-time procedure that may optimally treat prostate cancer in its early stages.
Disadvantages: Prostatectomy is a major operation that requires general anesthesia and hospitalization, and can produce some side effects. Possible side effects include impotence, urinary incontinence, bowel complications and sometimes narrowing of the urethra that can make urination difficult.
Impotence can occur in a large number of patients immediately after surgery, but may go away with time. However, the chance of impotence is lower with the newer nerve-sparing technique. Urinary incontinence occurs in only a small percentage of patients.
The most recent advancements in prostate cancer surgery are laparoscopic and robotic prostatectomy. Talk to your doctor if you'd like to learn more about these surgical treatment options.
Transurethral Resection of the Prostate (TURP)
A transurethral resection of the prostate (TURP) is another type of prostate surgery. It is sometimes used in men who have prostate cancer but cannot have a radical prostatectomy, either because of advanced age or a serious illness (other than cancer). TURP is also used to treat the symptoms of benign prostatic hyperplasia (BPH)..