Prostate Cancer Surgery

Surgery is a common means of treating prostate cancer. The medical term for the surgical removal of the prostate gland is prostatectomy. There are two chief types of prostatectomy: simple and radical. A simple prostatectomy removes part of the prostate, often a benign growth causing urinary discomfort or infection. A radical prostatectomy removes the entire prostate, as well as related structures, the seminal vesicles and vasa deferentia, to combat a malignant cancer.

Prostate cancer is a very real threat to male health. This disease mostly affects men ages 50 and older and is more prevalent among African-American males than other racial or ethnic groups. The good news is that prostate cancer can be treated. If the condition is detected early, before it spreads beyond the prostate, surgery has proven very effective in curbing the disease.

What Types of Prostate Cancer Surgery Are There?

When it comes to prostate cancer surgery, prospects for success depend on a man’s age, overall health, and the degree of his cancer’s development. Because prostate cancers tend to grow slowly, older individuals may not be seen as good candidates for surgery. Those who are good candidates will likely undergo one of the following procedures:

Radical Retropubic Prostatectomy 

Retropubic incision is the most common form of radical prostatectomy. In this procedure, the surgeon makes an incision in the lower abdomen to reach the prostate and other organs for removal. He or she will also check the lymph glands for cancer. A catheter is typically inserted through the penis to assist in urination during recovery. You will be unconscious and sedated for the entire procedure. 

Radical Perineal Prostatectomy

The perineal approach is an alternative to retropubic incision. With this method, the surgeon cuts into the body between scrotum and anus to reach and remove the prostate. It has the advantage of being a simpler procedure, with less pain and quicker recovery times, but it leaves the lymph glands inaccessible to inspection for cancer. As with retropubic surgery, you will be anesthetized for the entire operation.

Laparoscopic Radical Prostatectomy

A recent innovation in prostate surgery involves laparoscopy, or the insertion of long surgical tools through tiny cuts in the skin to remove the prostate and associated organs. One of these tools is a fiber-optic camera that allows the surgeon to operate without directly seeing the prostate. A laparoscopic prostatectomy has several benefits when compared to open surgery; there’s less pain and blood loss combined with shorter recuperation times. Evidence to date suggests that it is just as effective as more traditional forms of surgery, with a similar level of side effects.

Robotic-Assisted Laparoscopic Radical Prostatectomy

The latest advance in laparoscopy has been the use of remote systems to assist in surgery. The surgeon uses a robotic arm to perform the operation, while monitoring progress on a computer screen. Robotic-assisted laparoscopy has the same advantages over open surgery as other laparoscopic procedures.

What Are the Possible Side Effects of Prostate Cancer Surgery?

Serious side effects are relatively rare for prostate cancer surgery; fewer than one man in ten experiences complications. The most significant issues relate to the possibility of nerve damage in the urethra and penis. This can lead to:

  • Urinary incontinence: Incontinence means a loss of control over urination. This tends to be a temporary condition, improving gradually with time. There are steps you can take to manage incontinence, including Kegel exercises, catheter use, compression devices, and incontinence medications and products. Serious cases can be surgically treated. 
  • Erectile dysfunction: Prostate surgery can sometimes interfere with a man’s ability to achieve or maintain an erection during sex. (In fact, a fear of impotence is one reason some men refuse to consider prostate cancer surgery.) As with urinary incontinence, erectile problems sometimes diminish over time. There are also prescription medications, such as Viagra and Cialis, as well as medical devices that offer temporary relief from impotence. 

Other potential complications of prostate surgery include:

  • Post-operational bleeding
  • Blood clots
  • Infection
  • Urinary leakage or resistance
  • Herniated groin
  • Slow healing incisions

What Should I Expect Following Prostate Cancer Surgery?

If you undergo a radical prostatectomy, you can expect to be hospital-bound for one to three days after the procedure. You’ll likely have a catheter to assist you in urinating. This catheter might need to stay in place for some time, even after you’ve returned home. Typically, most men will keep the catheter in for up to two weeks following surgery. Your doctor and healthcare team will help to determine how long you need to continue using the catheter.

It is common to experience some pain following prostate surgery. This pain is typically controlled with prescription medication or over the counter medications, such as ibuprofen or acetaminophen. Depending on whether you’ve had robotic surgery or open surgery, the duration of pain can vary. Generally speaking, recovery time after prostate cancer surgery is 4-6 weeks. Consult with your doctor to determine the best pain management plan for you.

You’ll need to schedule follow-up visits with your physician. Though prostate surgery is often successful, there is always a chance that the cancer might return. 

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