Surgical Procedures for Prostate Cancer

Surgery is a common way to treat prostate cancer. The type depends on the stage of cancer, your age, and life expectancy. The goal is to remove as much of or all of the cancer as can be done. Surgery for early stage prostate cancer offers the best chance for a cure.

Surgery for Early Stage Prostate Cancer

Radical Prostatectomy

A radical prostatectomy is done to take out the prostate, seminal vesicles, and part of the vas deferens. The goal is to remove the cancer while it's still contained within the prostate gland.

There are 2 methods:

  • Radical retropubic prostatectomy —A cut is made in the lower belly to get to the pelvis. In some cases, nerves that control erections can be spared. This depends where the cancer is and what the extent is. The surgery may be stopped if cancer is found in the lymph nodes. This would mean it has spread beyond the prostate.
  • Radical perineal prostatectomy —A cut is made through the area between the scrotum and anus. The prostate is removed, but the nearby lymph nodes are spared. This method isn't used as much because it can harm the nerves that control erections. If lymph nodes need to be removed, the belly wall will be opened.

Prostatectomies can be done as:

  • Open —A cut is made through the belly wall. It starts at the belly button and ends near the top of the bladder at the pubic bone. The organs are found and removed through the cut.
  • Laparoscopic—Tubes are placed into small cuts in the belly. A lighted camera and tools can be used through the tube. In most cases, healing time is shorter with this type.
  • Robot-assisted—Robotic arms are placed through small cuts. This allows for greater range of movement than a doctor's hand.
  • Nerve-sparing —The surgeon will leave the two nerve bundles that control spontaneous erections. The ability to do this depends on how close the cancer is to the nerves. If you have one nerve bundle taken out, you may still be able to get an erection.

These can cause:

  • Urinary incontinence, which may involve:
    • Stress incontinence—Urine leaks during times there is a sudden rise in pressure such as with sneezing or laughing.
    • Urge incontinence—Bladder spasms cause a sudden urgent need to pass urine. This can cause leaking from the bladder.
    • Overflow incontinence—This causes problems with draining the bladder. Urine stream may be weak or there may be dribbling. It then builds up in the bladder and leaks out.
  • Erectile dysfunction (ED)—Unable to get or keep an erection that's firm enough to have sex. This may be more of an issue if nerves were cut. There are many ways to treat ED.

Cryosurgery

Cryosurgery is the freezing of abnormal tissue in the prostate gland. Needles are passed into the prostate. The freezing gas kills prostate tissue. The needles are guided with an ultrasound.

It’s mainly used to treat cancer in early stages. But, it’s not always the first treatment used. For some, it may be done if cancer comes back after it’s been treated with methods.

Surgery for Advanced and Metastatic Prostate Cancer

Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is done through a tube called a rectoscope. The scope is placed through the penis and into the tube that carries urine out of the body. Tools can be passed through the tube to remove prostate tissue. It can also be removed with an electric wire or laser, or by vaporization. It helps control urinary system problems caused by the growing cancer.

Orchiectomy

Taking out one or more testicles is called orchiectomy. They're taken out through a cut in the skin of the scrotum. This is done to remove the major source of androgens in the body. It doesn't offer a cure, but it helps slow the growth of the cancer. It may be used to control cancer that's spread. This can also be done with medications.

References

Androgen deprivation therapy for prostate cancer. EBSCO DynaMed Plus website. Available at: https://www.dyname.... Updated May 15, 2018. Accessed October 29, 2018.
Cryotherapy for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/treating/cryosurgery.html. Updated March 11, 2016. Accessed Accessed October 29, 2018.
Metastatic prostate cancer. EBSCO DynaMed Plus website. Available at: https://www.dyname.... Updated May 1, 2018. Accessed October 29, 2018.
Management of localized or locally advanced prostate cancer. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114483/Prostate-cancer. Updated October 16, 2018. Accessed October 29, 2018.
Prostate cancer. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/prostate-cancer. Updated October 2017. Accessed October 29, 2018.
Surgery for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html. Updated March 11, 2016. Accessed Accessed October 29, 2018.
Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#section/_142. Updated October 12, 2018. Accessed October 29, 2018.
What is cryotherapy? Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/prostate-cancer/treatment/cryotherapy. Accessed October 29, 2018.
What is radical prostatectomy (surgery) for prostate cancer? Urology Care Foundation website. Available at: https://www.urologyhealth.org/urologic-conditions/prostate-cancer/treatment/surgery. Accessed October 29, 2018.
Last reviewed September 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP
Last Updated: 10/29/2018

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