Prostate Cancer

Surgical Treatments for Prostate Cancer

Surgical removal of the prostate and affected tissue is an excellent course of action when the cancer is localized to the prostate.

The Types of Surgery

Retropubic prostatectomy - The surgeon makes an incision in the lower abdomen through which the prostate and surrounding tissues are removed.
Perineal prostatectomy - The surgeon removes the prostate through an incision in the skin between the scrotum and the anus.
Laparoscopic prostatectomy - A telescopic device with a tiny camera is inserted in the abdomen and the prostate is cut out and removed with microscopic instruments. The patient experiences less pain and scarring than through the other methods, and recovers faster. But patients who’ve already undergone pelvic surgery in the past don’t qualify for laparoscopic surgery.
Robotic prostatectomy - Similar to a laparoscopic procedure, but the surgeon has the assistance of a devise that allows a better view of the prostate and surrounding structures.

Complications

Surgical treatment of prostate cancer carries some possible complications:

Urinary incontinence - This is relatively rare. Incontinence only occurs in about five percent of all surgeries, and it can be treated.
Impotence - If impotence occurs as a result of prostate surgery, it can be treated with a variety of medications and/or devices. Surgical techniques commonly preserve the nerves associated with the ability to obtain and maintain an erection.

What to Expect Post-Surgery

Patients can go home after a few days in the hospital, but must use a catheter to expel urine until the follow-up hospital visit. Some patients regain urinary control as soon as the catheter is removed, while others remain incontinent for six months or longer. Kegel exercises are taught as a way of re-strengthening the urinary control valve. In five percent of cases, or less, the patient remains incontinent following surgery,

While most patients won't lose the ability to function sexually, there will be little or no ejaculate during orgasm. This is known as a "dry orgasm." Therefore, the ability to procreate is lost.

Commonly asked questions about surgical treatments for prostate cancer:

I've just had a radical prostatectomy. How often should I get my PSA tested, and what value should be considered cancer free?
I've just had a radical prostatectomy, and I’ve been told there has been a rise in my PSA. Should I repeat the test?
I've had a radical prostatectomy, and I still have loss of urinary control after 6 months. Is this normal?

I've just had a radical prostatectomy. How often should I get my PSA tested, and what should the value be to be considered cancer free?

Following a radical prostatectomy, it is generally accepted that PSA tests should be obtained at 3-6 month intervals. The value should be in the undetectable range, which is usually less than 0.05, but varies slightly from lab to lab.

I've just had a radical prostatectomy, and I've been told there has been a rise in my PSA. Should I repeat the test?

If following the radical prostatectomy a rise in PSA is noted sometime later, a repeat test is standard procedure. It is entirely appropriate to wait several months before repeating the test. There are variations in the test, so repeat determinations are necessary. Prostate cancer grows very slowly so a several month wait does not present an increased risk. If the repeat PSA determination confirms the rise in PSA, then this would indicate that there has been recurrent disease, and further follow-up and possibly other therapy such as radiation or endocrine therapy may be warranted. The likelihood of failure for PSA to fall, or the development of an elevated PSA at a later time following radical prostatectomy is 30%.

I've had a radical prostatectomy, and I still have loss of urinary control after 6 months. Is this normal?

Urinary control in some patients is delayed following radical prostatectomy and at times can require 9-12 months for full healing and return of continence. The process is gradual. There are medications that can help to either relax the bladder or tighten the sphincter muscle.