Surgery for Prostate Cancer

The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, which is removal of:

  • The entire prostate gland
  • Both seminal vesicles, which play a part in making semen
  • A short segment of the urine tube that passes through the prostate

The urinary system is reconstructed by suturing (sewing) the bladder opening to the urethra. In some patients, one or more lymph node groups in the pelvic area may be removed to find out if the prostate cancer has spread. This is called lymphadenectomy or lymph node dissection. In more advanced prostate cancer, one or both of the neurovascular bundles, which play a part in erectile function, may be partially or completely removed.

Prostate Cancer Surgery Techniques

The two main surgical techniques for removal of the prostate are:

  • Open: A large incision is made in the lower abdomen, and the prostate is removed.
  • Robot-assisted (laparoscopic) minimally invasive: Multiple small incisions are made in the abdomen, and then an endoscope connected to robotic arms is inserted. A miniature video camera and surgical tools are attached to the end of the endoscope. The surgeon, seated at a console, can view the surgery site on a video screen and control the robotic arms. MD Anderson surgeons are experts at nerve-sparing techniques and sural nerve grafts that may help men keep urinary and sexual function.

The robotic surgery technique is commonly used in the United States. Studies show robotic-assisted surgery may result in:

  • Less blood loss
  • Shorter hospital stays
  • Less urinary tract scarring
  • Fewer complications

However, the techniques are fairly equal in retaining urinary and sexual function and controlling cancer. The experience of the surgeon probably will affect your result more than which set of tools is used.

Prostate Cancer Surgery vs. Radiation Treatments – How to Decide:

There is no “best” way to treat prostate cancer. The method of treatment recommended will be based on your symptoms and other life factors. Be sure to discuss all available treatment options with your doctor.

Side Effects and Recovery of Function After Prostate Cancer Surgery

Urinary Control

Most men have stress urinary incontinence (leakage of a small amount of urine when laughing, sneezing, coughing, etc.) after a radical prostatectomy.

  • Within a few days to three months, most men have 90% or more of the urinary function they had before surgery.
  • At one year, approximately 95% of men have pre-surgery levels of urinary control or are very close.
  • Approximately 10% have rare urinary accidents and wear protective pads.
  • Fewer than 5% have permanent significant leakage problems.

Sexual Function

Since the prostate and seminal vesicles produce the majority of semen, sexual climax after a prostatectomy does not produce fluid. However, the climax response is preserved.

The success of preserving the functional ability for sex after prostate cancer surgery (the ability to maintain erections for sex) depends on:

  • Age, sexual function before surgery and medical history
  • Number of nerve bundles spared
  • Experience and expertise of the surgeon