Treatment Options

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.  The most common procedure is called a radical prostatectomy.

Radical prostatectomy
A radical prostatectomy 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. The answers, according to SCCA's Dr. Paul Lange, should be at least 150 in total, and at least 15 a year.)

Generally, a radical prostatectomy is an option for younger 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 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
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.

Radical perineal prostatectomy
The surgeon removes the entire prostate through an incision between the scrotum and the anus. Nearby lymph nodes are sometimes removed through a separate incision in the abdomen. Dr. Paul Lange says that a nerve-sparing approach does not work as well with this procedure.

Laparoscopic prostatectomy
The surgeon removes the prostate using laparoscopic techniques (operating through special instruments and cameras so that only very small incisions are necessary). The advantage of this type of surgery is that you will probably heal faster and experience less pain than with other types of prostate surgery.

While a newer procedure, Dr. Lange says he believes that within several years laparoscopic prostatectomy will be the preferred surgical technique at major prostate centers across the country. You may want to read more about this new type of surgery.

Prostate surgery for SCCA patients is performed at the 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 any other cancer center in the region.

More information on Surgical Options:

• Nerve-sparing surgery 
• Nerve graft surgery 
• Laparoscopic prostatectomy 
• Laparoscopic robots 
• What to expect after surgery 
• Side effects of surgery 

More information on Treatment Options:

• Surgery
• Radiation therapy 
• Hormone therapy 
• Chemotherapy 
• Watchful waiting 
• Treating advanced prostate cancer 

October 2004