One surgical approach to treating prostate cancer is to remove the entire 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, and reconnection of the bladder to the urethra. Other surgical procedures may be performed on men with advanced or recurrent disease, such as removal of lymph nodes, which are the initial landing spots for the spread of prostate cancer.
The most common type of prostatectomy is robotic radical prostatectomy, which requires very small incisions to be made in the abdomen by the surgeon. With a robotic interface, the surgeon then 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 (typically 1-2 days). (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 (reconnecting the bladder to the urethra), 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.
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. Sometimes the nerves cannot be spared because the cancer extends beyond the prostate requiring a more extensive resection.
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.
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. As many studies have shown, surgeons who are at the top percentiles of prostatectomies performed have the best outcomes.
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