Prostate cancer is second only to skin cancer for incidence rates among men in the United States, and only lung cancer is responsible for more cancer-related deaths. While prostate cancer can be extremely aggressive, it often grows slowly, remains in the prostate gland, and if caught early, can be dealt with before causing complications or fatalities. While there are many treatment options available, if the cancer has not yet spread beyond the prostate gland, surgery is most commonly used.
Any surgical treatment is going to involve removing the entire prostate, called a “radical prostatectomy.” This can be alarming for many men, especially once they know what the prostate gland actually does. It is wrapped around part of the urethra (which transports urine away from the bladder), and so sits underneath the bladder itself, right in front of the bottom of the rectum. It’s a round, walnut sized gland attached to the seminal vesicles responsible for sending sperm to the testicles. Because of its location, a radical prostatectomy was traditionally an open surgery performed through a large incision in the abdomen. Open surgeries increase the risk of infection and time required to heal, thus it has become a less common method, as alternative, less invasive methods for removal have arisen.
Radical Retropubic Prostatectomy
Similar to the traditional method, a retropubic procedure is performed through an abdominal incision. However, instead of one long cut, the surgeon usually makes an upside down T, across the bottom of the abdomen and up to the belly button. The prostate and surrounding tissue is removed; the nearby lymph nodes can also be assessed and removed if necessary. A catheter is generally placed in the urethra to assist with urination during the surgery and may remain for a couple of weeks. This method requires a few days of hospitalization and around a month of healing time with decreased activity. Retropubic surgery is often favored because nerve damage occurs less frequently than in other methods.
Radical Perineal Prostatectomy
With this procedure, instead of removing the prostate abdominally, an incision is made beneath the scrotum and above the anus. Sometimes a retropubic prostatectomy is not an option, and so the perineal method must be used. However, although recovery is often easier and surgery is quicker, there are also several drawbacks. Nerve damage is more likely from this angle, which can not only cause problems with bladder control but may inhibit erections. Even if this is not a concern for the patient, the physician must be certain the cancer has not spread, because the lymph nodes cannot be removed in this manner. Additionally, a catheter will still be placed, and activity must be decreased for the same amount of time.
Laparoscopic procedures involve the use of multiple small incisions to insert a long tube with a camera on the tip and specially designed surgical instruments. These procedures may be performed by only a surgeon or with robotic assistance. Although the healing time is often faster and there is less chance of infection, the surgeon performing the laparoscopic prostatectomy must be extremely skilled to avoid nerve damage. When done well, this is probably the least physically traumatic option. If done poorly, it can be extremely problematic. Whatever choice is made should be based off the best approach for the patient combined with the surgeon’s abilities to ensure the best outcome for any man.