Living with Prostate Cancer
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A surgical approach to treating prostate cancer will remove all or part of the prostate. Typically, men with early-stage disease or cancer that’s confined to the prostate will undergo radical prostatectomy—removal of the entire prostate gland, plus some surrounding tissue. Other surgical procedures may be performed on men with advanced or recurrent disease.
In the most common type of prostatectomy—radical retropubic prostatectomy—an incision is made in the abdomen and the prostate is removed from behind the pubic bone. The surgeon then stitches the urethra directly to the bladder so urine is able to flow. (Review the roles of the prostate and the surrounding organs in the About the Prostate section.)
Because it typically takes a few days for the body to get used to this new setup, the surgeon will insert a catheter, or tube, into the bladder. Urine will flow automatically out of the bladder, down the urethra, and into a collection bag without the need for conscious control of the sphincter. The catheter is usually kept in place for about a week to 10 days.
Another type of surgery, known as radical perineal prostatectomy, is performed less frequently these days. In this procedure, the surgeon makes the incision in the perineum (the space between the scrotum and the anus) and the prostate is removed from behind.
In a nerve-sparing prostatectomy, the surgeon cuts to the very edges of the prostate, taking care to spare the erectile nerves that run alongside the prostate. If the nerves cannot be spared because the cancer extends beyond the prostate, it might be possible to surgically attach, or graft, nerves from other parts of the body to the ends of the cut erectile nerves.
Surgeons won’t know until the time of the procedure if nerve-sparing is possible; it depends on whether the cancer is invading the nerves. However, the nerve-sparing procedure offers the best chance to preserve long-term erectile function.
In laparoscopic surgery, very small incisions are made in the abdomen. The surgeon then inserts narrow instruments fitted with cameras and/or surgical tools, allowing him or her to visualize and operate on the internal structures without cutting open the entire abdomen.
With a robotic interface, the surgeon maneuvers a robot’s arms, which in turn control the cameras and instruments. Robotic surgery has become very popular over the past 10 years due to the smaller incision and shorter post-operative recovery period.
To date, open and laparoscopic procedures have never been compared head-to-head in terms of cancer control and side effects. In general, in the hands of a skilled surgeon, these outcomes are optimized with either approach.
The Importance of Surgical Skill
Prostatectomy, like many surgical procedures, is very delicate work, and the difference between a good surgeon and a great surgeon can affect outcomes.
When choosing a surgeon, at a minimum, ensure that he or she is someone in whom you have confidence and trust, and someone who has enough experience to not only perform the operation, but also to make an informed clinical judgment and change course if necessary.