A radical prostatectomy is a surgery to remove the prostate gland partially or completely along with some surrounding tissues to treat prostate gland or benign prostatic hyperplasia.
This surgery can be done in several ways:
• Open surgery – in this open surgery method, surgeon will make an incision either through retropubic approach or perineal approach to reach the prostate gland.
Retropubic approach – surgeon will make an incision in the lower abdomen and may be also remove lymph nodes in the area to be tested for cancer. Patient will be given general anesthesia or spinal epidural anesthesia along with the sedation. Lymph nodes are examined in the lab to check if they have cancer cells in them. If cancer cells are found in any of the nodes, surgeon may not continue the surgery as it is unlikely that cancer can be cured with it and removing the prostate could lead to some complications. Surgeon will then place a catheter (thin tube) in the penis for 1 to 2 weeks to help in draining the bladder while healing from the surgery. Patient may require staying in the hospital for some days post surgery and will be advised to restrict strenuous and exhausting activities for several weeks.
Perineal approach – when the incision is made in the perineum between the anus and the scrotum, it is known as the perineal approach. The recovery time in perineal approach is shorter and may result in less pain as compared to retropubic approach. Surgeon may need to make a separate incision in case of removing the lymph nodes for testing. Perineal approach is used less often as it may lead to erection problems. After the procedure, a catheter (thin tube) is placed in the penis for 1 to 2 weeks to help in draining the bladder while healing from the surgery. Patient may require staying in the hospital for some days post surgery and will be advised to restrict strenuous and exhausting activities for several weeks.
• Laparoscopic approach – surgeon inserts special long surgical tools through several small incisions to remove the prostate. This long instrument (laparoscope) is inserted through one of the incision and it has camera and light which let surgeon to see inside the body. This approach is more beneficial as there is less blood loss and pain, shorter stay in hospital and faster recovery. This also some side effects like erection problems and urine incontinence.
• Robotic – assisted laparoscopic prostatectomy – is done through small incisions in the belly with the help of robotic arms with the guidance of surgeon’s hand motions into more precise action. This procedure requires special instrument and training. Not all hospitals do robotic surgery.
• Nerve – sparing prostatectomy approach –if the cancer is tangled with the nerves on each side of the prostate that control erection, the nerves must be cut to remove the cancer. If both sides’ nerves are cut or removed, person will be unable to have an erection. If only one side nerves are removed then the patient may have less erectile function. And if neither nerve bundle is removed during the surgery, function may return but may take months to know if there is full recovery after the surgery. This is because the nerves will require some time to heel.
Post surgery, it is very important to visit doctor regularly for post surgery follow ups that include physical exam, PSA tests, and digital rectal exams, biopsies which may help in early detection and treatment if the cancer comes back.
There are some common possible risks and side effects with any type of surgical procedure for prostate cancer:
• Reaction to anesthesia
• Unexpected bleeding
• Blood clots in the lungs or legs
• Injury to nearby organs