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Prostate Cancer Surgery
Surgery, or radical prostatectomy, involves removing the prostate and some surrounding tissue.
Surgery is the most common option for men under 70 with cancers confined to the prostate.
Surgeons will try to remove the cancer, including local lymph glands if necessary, while trying to spare the surrounding nerves and muscles.
New procedures, like laparoscopic and robotic surgery, are using tools to improve accuracy.
Approximately 75% of men who undergo surgery never experience a recurrence of prostate cancer. However, surgery always has risks, and this type of surgery can cause significant side effects.
Incontinence is common following surgery, but most men recover within a few weeks or months. As many as 35% of men have permanent, mild but treatable stress incontinence, such as passing a little urine while coughing.
Erectile dysfunction (ED) is more common and more difficult to treat. The nerves along the side of the prostate control erections. Sometimes they need to be removed to catch all of the cancer. They can be partially removed or damaged during surgery.
Nerve-sparing surgical techniques can improve the odds of recovering erections, from around 30% for men under 60 with one nerve spared, to about 76% for men under 60 with both nerves spared. Even if one nerve is sacrificed, one may be able to regain potency over time with the remaining nerve. Some patients regain potency over time with the use of ED drugs or medical devices. Sometimes patients are given ED drugs in advance of surgery, to support the system.
There are two approaches to radical prostatectomy:
- Retropubic, where the surgeon operates through an incision in the abdomen.
- Perineal, where the surgeon operates through an incision in the skin between the scrotum and the anus.
Nerve-sparing surgery is done through the abdominal, or retropubic approach.
These procedures usually take 2-4 hours under general anesthesia, and require a 3-5 day hospital stay, followed by 3-5 weeks of recovery time.
Radiosurgery is a medical procedure that has been used to treat patients with brain tumors or other kinds of cancer, including prostate cancer. The procedure allows non-invasive brain surgery, i.e., without actually opening the skull, by means of directed beams of ionizing radiation. It is a relatively recent technique (1951), which is used to destroy, by means of a precise dosage of radiation, intracranial tumors and other lesions that could be otherwise inaccessible or inadequate for open surgery. There are many nervous diseases for which conventional surgical treatment is difficult or has many deleterious consequences for the patient, due to arteries, nerves, and other vital structures being damaged.
Radiosurgery is indicated primarily for the therapy of tumors, vascular lesions and functional disorders. Significant clinical judgment must be used with this technique and considerations must include lesion type, pathology if available, size, location and age and general health of the patient. General contraindications to radiosurgery include excessively large size of the target lesion or lesions too numerous for practical treatment.
The non-interference with the quality of life of the patient in the post-operatory period competes with the inconvenience of the latency of months until the result of the radiosurgery is accomplished. Patients with a bad general state of health and those with tumors which are unreachable by conventional means, are especially helped.
Outcome may not be evident for months after the treatment. Since radiosurgery does not remove the tumor, but results in a biological inactivation of the tumor, lack of growth of the lesion is normally considered to be treatment success.
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Laparoscopic prostatectomy is a relatively new procedure. A tiny lighted camera is inserted through four to five small incisions in the abdomen, often through the bellybutton, providing magnified video images to guide the surgeon. | 
