Prostate Cancer Surgery
If your cancer is localized to the prostate, and you are in reasonably good health and younger than 75 years old, your doctors may recommend that you have surgery to treat your prostate cancer.
Prostate surgery for Seattle Cancer Care Alliance patients is performed at University of Washington Medical Center by surgeons who are leaders in prostate cancer surgery in the Pacific Northwest and who have performed more laparoscopic prostatectomies than doctors at any other cancer center in the region.
The most common procedure is called a radical prostatectomy, which is surgery to remove the entire prostate gland and the seminal vesicles. When this surgery is performed by a skilled and experienced surgeon, it offers a very good chance for a cure. (Ask your surgeon how many of these surgeries he has done and how many he does each year. We recommend choosing a surgeon who has done at least 250 total and who does at least 40 a year.)
Generally, a radical prostatectomy is an option for men who have localized cancer (meaning their cancer has not spread beyond the prostate gland). Some urologists will offer this procedure to men who have a slight spread of cancer beyond the prostate.
The major advantage of surgery is that, if your cancer is localized, surgery may cure the disease. Another advantage is that your doctors will be able to give you more detailed information about your cancer, including how aggressive it is. The major disadvantages of surgery are the potentials for impotence and incontinence.
A radical prostatectomy can be done in several ways. Ask your surgeon which procedure he prefers and why. Also, ask your surgeon if nerve-sparing surgery is an option for you.
Radical Retropubic Prostatectomy
In radical retropubic prostatectomy, the surgeon removes the entire prostate and surrounding lymph nodes through an incision in the abdomen.
During this procedure, it is sometimes possible for the surgeon to avoid removing the nerves that control erections. This lowers—but does not eliminate—the risk of impotence following surgery.
Laparoscopic Prostatectomy (With or Without Robotics)
In laparascopic prostatectomy, the surgeon removes the prostate by operating through special instruments and cameras so that only very small incisions are necessary. The potential advantage of this type of surgery is that you may heal faster and experience less pain than with other types of prostate surgery, although this has not been proven.
Laparoscopy, with or without robotics, has not been proven to have better urinary continence or sexual function results over open surgery. Additionally, we have not yet shown that the cancer control with well-done robotic surgery is comparable to well-done open surgery.
This surgical method saves the nerves that control a man's ability to have an erection.
If nerve-sparing surgery is not possible for you, you may be able to have a nerve graft instead.
Laparoscopic prostatectomy allows surgeons to operate through several very small incisions using special instruments and cameras, using a robotic system in some cases. Potential advantages include faster recovery, less pain, less blood loss, and lower risk of infection.
If you choose to have a laparoscopic prostatectomy, your surgeon will operate with the help of a robot.
Like after any major surgery, your body will need time to heal from a prostatectomy. You can expect to have a urinary catheter and an abdominal drain for a short period after your surgery.