Prostate Cancer

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Prostate Cancer Surgery

If your cancer is in the early stages or localized to your prostate, your doctors may recommend surgery to try to cure the disease.

The experience of the surgeon can affect prostate surgery outcomes. Surgery for Seattle Cancer Care Alliance patients is performed at University of Washington Medical Center by experienced surgeons who are leaders in prostate cancer surgery.

When choosing a surgeon, be sure to select someone whom you trust and have confidence in. He or she should have enough experience to not only perform the operation you need but also to make an informed clinical judgment and change course, if necessary. We recommend choosing a surgeon who has done at least 250 prostatectomies (prostate removals) total and who does at least 40 a year. A list of questions you might want to ask your surgeon is included below.

Radical Prostatectomy

Choosing Prostate Surgery

Rob WilkinsonRob Wilkinson, diagnosed with prostate cancer at age 63, considered his treatment options and had a radical prostatectomy. See Rob’s story and video.

The most common surgical treatment for prostate cancer is a radical prostatectomy. In this surgery the entire prostate gland, some lymph nodes, and nearby tissue, such as the seminal vesicles, are removed.

The major advantage of a radical prostatectomy is that it offers a very good chance for a cure. Another advantage is that your doctors will be able to give you more detailed information about your cancer, including how aggressive it is, which can help guide other treatment decisions. The major disadvantage is the potential for side effects.

Nerve-Sparing or Nerve-Graft Prostate Surgery

Tiny bundles of nerves, one on each side of the prostate, control a man’s ability to have an erection. If your cancer is growing into or very close to the nerve bundles, they may need to be removed.

Nerve-sparing surgery saves the nerve bundles. If your surgeon is able to save the nerves on both sides, your chances of regaining sexual potency are between 40 and 85 percent. If the nerves on only one side can be saved, then the likelihood is 25 to 45 percent. In either case, because the nerves have been handled during surgery, it may take them a few months or longer after surgery to recover. If the nerve bundles on both sides are removed, you will be unable to have spontaneous erections.

If you are not a good candidate for nerve-sparing surgery, talk to your doctor about the possibility of doing a nerve-graft procedure. In this procedure, the surgeon takes a nerve from the ankle area and splices it to the cut ends of the nerves in the prostate nerve bundles at the same time as the prostatectomy. If the procedure works, men usually see an improvement in potency within a year or two. This specialized procedure is not done at many medical centers, but our surgeons are leaders in it in the Northwest.

Surgical Approaches

A radical prostatectomy can be done in several ways, including using an open (conventional) approach or a minimally invasive approach (laparoscopic surgery). In addition, cryosurgery may be an option for treating prostate cancer or relieving symptoms.

Open Surgery for Prostate Cancer

There are two types of open surgeries for prostate cancer: retropubic and perineal.

A retropubic prostatectomy is the most common open surgery for prostate cancer. In this procedure, your doctor operates through an incision in your lower abdomen.

In a perineal prostatectomy, the surgeon makes an incision between the anus and scrotum (perineum). This type of surgery is rarely used because the nerves cannot easily be spared and lymph nodes cannot be removed. However, it may be an option for men who have medical conditions that make retropubic surgery difficult.

Laparoscopic Surgery, With or Without Robotics, for Prostate Cancer

In laparoscopic prostatectomy, the surgeon operates through very small incisions using special instruments and cameras, and in some cases using a robotic system. The potential advantages of this type of surgery include faster recovery, less pain, less blood loss, and lower risk of infection than with an open procedure. Learn more about laparoscopic prostate surgery.

Cryosurgery for Prostate Cancer

Cryosurgery may be used to treat early-stage prostate cancer; however, it is generally not a good option if you have a very large prostate. In this procedure, your surgeon makes a small incision to insert a tool that freezes and kills prostate tissue. Your surgeon may use ultrasound imaging, along with a catheter and precise temperature monitoring of nearby tissues, to help ensure the prostate is targeted and damage to healthy tissue is minimized.

Questions to Ask Your Surgeon

  1. Which procedure does your surgeon prefer and why?
  2. What type of surgery does he or she recommend for you, and is nerve-sparing surgery an option? If it’s not an option, what is the possibility for a nerve-graft procedure?
  3. How many of these surgeries has he or she performed?
  4. How many of these surgeries does he or she do each year?
  5. What are the statistics on incontinence and impotence for your surgeon’s patients?

Side Effects of Prostate Cancer Surgery

Surgery for prostate cancer is a major operation that has risks and requires recovery time. Talk with your treatment team about the side effects that are most common with your surgery. Like with any major surgery, risks include the potential for pain, infection, muscle weakness, blood loss that requires a transfusion, and blood clots in the legs. Most of these problems are very rare or can be controlled with medication. Your risks depend on many factors, including your overall health, your age, and the skill of your surgical team. For general advice, see the symptom management section.

Read more about what to expect after prostate cancer surgery and about potential urinary and sexual side effects of prostate cancer treatment