Removing the entire prostate gland through surgery, known as a radical prostatectomy, is a common option for men whose cancer has not spread. For men with advanced or recurrent disease, other surgical procedures may be chosen, such as removal of lymph nodes, which are initial landing spots for the spread of prostate cancer.
Open radical prostatectomy is the classical way of surgically removing the prostate. In this procedure, the surgeon makes an incision in the lower abdomen in order to remove the prostate. The prostate may also be removed through the perineum, the area between the scrotum and the anus, although this technique is uncommon.
In the last 10 years, laparoscopic (robotically assisted) radical prostatectomy has become very popular. This method requires small incisions to be made in the abdomen. A surgical robot’s arms are then inserted into the incisions. With a robotic interface, the surgeon controls the robot’s arms, which in turn control cameras and surgical instruments. Some studies suggest a shorter recovery period with robotic compared with open prostatectomy.
Need to know more? Read “Which Procedure is Better – Robotic or Open Prostatectomy?”
Whether open or laparoscopic surgery is chosen, this is a large operation, with a significant healing process. After a 1- to 2-night stay in the hospital, patients typically go home with some form of catheter to help drain urine for 7 to 14 days. In the initial weeks to months after surgery, it is expected and common to have incontinence or leakage of urine, and patients will need to wear adult diapers and/or pads; this generally improves over the first year following surgery. Calisthenics, weight lifting, golf, and many physical activities are prohibited for about the first 2 months after surgery, as the abdominal muscles and urethra heal from the surgery. Physical therapy, including Kegel exercises, can build up pelvic floor muscles and help some patients who are having persistent incontinence. Talk with your urologist about how you can increase your exercise tolerance by walking greater and greater distances over the course of your recovery.
There are 2 other therapies that may be given in conjunction with surgery, based on your pathology report after the surgery:
- Radiation therapy is recommended in some men with high-risk prostate cancer who have cancer that has penetrated through the prostate capsule (layer of connective tissue around the prostate) and/or who have positive margins after surgery. Research has shown that recurrence rates drop by approximately 50% in men with a positive margin or T3 disease if radiation is given after surgery. You should discuss with your doctor the risks and benefits of radiation therapy. Another strategy is to use radiation only if PSA levels rise; this is referred to as salvage radiation. Genomic tests (eg, Decipher, GenomeDx) have been developed that may help you and your doctor decide if you would benefit from adjuvant radiation therapy versus waiting to see if the PSA rises
- Hormone therapy may be recommended for men who have cancer found in their lymph nodes at the time of surgery; for these men, hormone therapy following surgery has been shown to help patients live longer. Multiple clinical trials have not demonstrated a significant benefit to using hormone therapy before surgery, however.
Want more information about treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.