Prostate Cancer: Radical Prostatectomy

Radical prostatectomy involves surgically removing the prostate gland and some of the surrounding tissue. This is done either through a surgical incision in the lower abdomen or the space between the scrotum and the rectum (called the perineum).

Prostatectomy is the most common treatment for localized cancer of the prostate in men under age 70 who do not have other health complications.

What Are the Two Types of Prostatectomy?

Retropubic prostatectomy and perineal prostatectomy are the two main types of this surgery. The patient is either under general anesthesia (asleep and unconscious) or given a spinal or epidural (to numb the lower part of the body) with sedation during the surgery.

Retropubic prostatectomy. In the retropubic operation, the surgeon makes an incision in the lower abdomen. The surgeon can remove the prostate, surrounding tissue, and lymph nodes (when necessary) through this incision.

Surgeons may also choose a nerve-sparing version of the retropubic operation. During this procedure, the surgeon carefully locates the nerves on either side of the prostate gland. If the cancer has not spread to these nerves, the surgeon will not remove them.

Because these are the nerves that are needed for erections, leaving the nerves lowers (but does not eliminate) the risk of erectile dysfunction and incontinence following surgery.

Perineal prostatectomy. In the perineal operation, the surgeon removes the prostate through an incision in the skin between the scrotum and anus. This procedure is not done as often because nerve-sparing techniques are more difficult to perform by this approach and lymph nodes cannot be removed through this incision. If lymph node examination is needed for men having this operation, the surgeon can remove some lymph nodes through a very small skin incision in the abdomen by using a laparoscope (a narrow lighted tube).

These operations last from two to four hours, with the perineal approach often taking less time than the retropubic approach.

What Happens After the Surgery?

For most patients, a catheter is inserted through the penis and into the bladder during the surgery. The catheter will remain place for 10 to 21 days to allow the patient to urinate easily while healing. Recovery time takes an average hospital stay of three days. Average time away from work is three to five weeks.

What Are the Risks?

The risks of a prostatectomy consist of the typical risks for a major operation. These include infection, bleeding and developing blood clots in the legs which can travel to the lungs.

Side effects of radical prostatectomy include:

• Impotence (unable to achieve an erection)
• Urinary incontinence (leaking of urine)

Surgeons try to avoid removing or cutting the nerves that control a man's ability to achieve an erection or control his urine. Depending on the patient's age and the stage of tumor advancement, nerve-sparing techniques allow about 40% to 65% of men who were sexually potent before surgery to remain potent after surgery.

The incontinence most commonly associated with radical prostatectomy is called stress urinary incontinence. This results in leaking urine while coughing, sneezing or laughing. For many people normal urinary control can be achieved within six months after the surgery. This recovery generally occurs gradually.

What Is the Prognosis?

Survival rates are similar to those of patients who undergo external radiation treatment. Radiation therapy may also be prescribed in surgery patients whose cancers come back.

Reviewed by the doctors at The Cleveland Clinic Urological Institute.