Surgical Procedures for Prostate Cancer

Radical Prostatectomy

A radical prostatectomy will remove the prostate. It will also remove attached tubes called seminal vesicles and part of the vas deferens.

There are 2 methods:

• Radical retropubic prostatectomy—The doctor will make a cut through the lower belly. The doctor will look around the pelvis. Lymph nodes may be tested. The surgery may be stopped if the cancer has spread outside the prostate. Nerves that control erections are in this area too. Steps will be taken to spare these nerves if the doctor can.
• Radical perineal prostatectomy—A cut is made through the area between the scrotum and anus. The prostate is removed. This method works closer to nerves that control erections. There can be a higher risk of damage to these nerves. It can lead to problems getting or keeping an erection. A cut may need to be made in the belly if lymph nodes need to be removed.

Prostatectomies can be done as:

• Open—A cut is made through the belly. It starts at the belly button and ends at the pubic bone. The prostate is found and removed through the cut.
• Laparoscopic—Small cuts are made in the belly. Tools are passed through these cuts. A tube with a lighted camera lets the doctor see inside the pelvis. Other tools remove the tissue. Healing time is often shorter with this type of surgery compared to open.
• Robot-assisted—Small cuts are made in the belly. Robotic arms control tools through these cuts. The arms let the doctor do very fine movements in small spaces. It may help to save nerves and other healthy tissue in the area.
• Nerve-sparing—There are 2 nerve bundles that control erection. The doctor may be able to leave them if cancer has not grown into or near them. Erection may still be possible if only 1 bundle is removed.

This surgery has a risk of causing problems with urine control or erection. Some problems may not last long. Others may be permanent and need other treatment or care.

Cryosurgery

Cryosurgery uses freezing to destroy cancer cells. A needle is passed into the prostate. A freezing gas is released into prostate tissue.

It is most often used to treat cancer in early stages. It is not always the first treatment used. It may also be done if cancer comes back after it has been treated.

Transurethral Resection of the Prostate

Transurethral resection of the prostate is a procedure to remove prostate tissue. A scope is placed through the tube that carries urine out of the body. Tools can be passed through the tube to remove the prostate. The tissue may be destroyed with electric wire or laser. Removing some of the prostate can improve the flow of urine.

Orchiectomy

Testicles make hormones called androgens. One type of prostate cancer grows faster with this hormone. An orchiectomy is the removal of one or both testicles. That removes the major source of androgens.