Radical prostatectomy is the removal of the entire prostate gland, surrounding tissue, and the seminal vesicles. Lymph nodes may also be removed during a radical retropubic prostatectomy. There are two methods for this surgery:
Radical retropubic prostatectomy – the prostate is removed through an incision in the lower part of the abdomen
Radical perineal prostatectomy – the prostate is removed through an incision in the perineum, the skin between the rectum and scrotum
If you have a radical perineal prostatectomy and also require lymph node removal, you may also undergo a laparoscopic lymphadenectomy. For this is procedure, a tiny incision is made in your abdomen to allow the insertion of a thin scope for viewing and removing lymph nodes.
New techniques are being developed to allow a radical prostatectomy to be carried out through tiny “keyhole” incisions, using scopes and miniaturized surgical instruments. Laparoscopic radical prostatectomy can be done at certain specialized centers.
Both types of prostatectomy have similar post-surgical complications. You are likely to have some difficulty controlling your urine after surgery, and may find that you are leaking urine involuntarily (incontinence). Difficulty urinating after prostate surgery may mean that scar tissue is making the neck of the bladder more narrow than normal.
All men have trouble obtaining erections or difficulty reaching orgasm after this surgery, but many will regain these functions with time. Specialized techniques during the course of surgery, called nerve-sparing techniques, can be used to identify and avoid important bundles of nerves and therefore decrease the chance of incontinence and/or impotence after surgery.
Orchiectomy is the removal of the testicles, which are the major producers of male hormones in the body. The surgeon removes the testicles through an incision in the skin of the scrotum.
Orchiectomy is considered a type of hormonal therapy. Prescription hormonal therapies are available as alternatives to orchiectomy. The only reason a surgeon will recommend an orchiectomy or injectable (or oral) hormones is when the prostate cancer is particularly large, involves the lymph nodes, or has spread beyond the pelvis. This treatment should not be offered for early stage cancer; in fact, this surgery is usually reserved for patients with metastatic prostate cancer. In patients with metastases, orchiectomy can be quite effective in reducing symptoms and suppressing the cancer, although it is not curative.
Orchiectomy causes impotence and reduced sexual desire, as well as decreased muscle mass, hot flashes, breast tenderness, and osteoporosis. Furthermore, orchiectomy can be very difficult psychologically.
Transurethral Resection of the Prostate (TURP)
This procedure removes only part of the prostate gland. It is usually done to relieve symptoms of an enlarged prostate, and is more commonly performed to treat benign prostatic hyperplasia than prostate cancer. It may be used to relieve certain symptoms in men with prostate cancer who are not necessarily candidates for a radical prostatectomy, due to age or other health-related factors.
The surgeon inserts a tool through the urethra in the penis until it reaches the prostate. The tool is used to cut out the prostate tissue surrounding the urethra. A catheter is placed through the urethra into the bladder to drain urine for a few days after the surgery.
Cryosurgery is the freezing of abnormal areas of the prostate gland. The surgeon inserts a tool called a cryoprobe through the skin between the anus and the scrotum until it reaches the prostate. Ultrasound is used to guide the cryoprobe into place, where it is placed against the prostate tissue that is to be destroyed. Liquid nitrogen flows through the cryoprobe, dropping its temperature to extreme lows (about -320 degrees Fahrenheit or –196 degrees Celsius), and destroying the prostate tissue.
After this procedure, a catheter is placed into the bladder to drain urine for one to two weeks. Cryosurgery may cause some of the same complications as radical prostatectomy, including impotence and incontinence, as well as bleeding, bruising, and temporary swelling of the penis and scrotum.
Although cryosurgery is performed at many centers in this country, it is not an accepted standard for the management of prostate cancer. Cryosurgery is generally thought to be useful in men with very small areas of cancer that are completely within the prostate. It’s not a good treatment for patients with more widely spread areas of prostate cancer.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a