Prostate Cancer: Surgery
Prostate cancer may be treated with surgery. Different kinds of surgery may be done. Which type you have depends on the type of cancer, where it is, how much it has spread, and other factors. Surgery removes all or most of the prostate gland. After surgery, you won’t be able to ejaculate semen.
Goals of surgery for prostate cancer
Prostate cancer surgery can be done for different reasons. Most often, surgery is a treatment for early-stage prostate cancer. In this case, the goal of the surgery is to remove all of the cancer.
Surgery to try to cure the cancer is less likely to be an option if the cancer has spread outside of the prostate. In this case, surgery may be done to help relieve symptoms from the cancer, such as trouble urinating. But this surgery won't remove all of the cancer.
If you are considering surgery to treat your prostate cancer, be sure you understand what the goal of the surgery is.
Types of surgery for prostate cancer
Prostate cancer can be treated with:
Radical prostatectomy. This surgery removes the whole prostate gland and some nearby tissue. The surgery may be done with a long cut (incision) in the belly (abdomen). Or it may be done with an incision in the area between the scrotum and the rectum (perineum).
Laparoscopic radical prostatectomy. This is also a surgery to remove the whole prostate gland and some nearby tissue. It's done with a few small incisions instead of one larger incision. A laparoscope is used to do the surgery. This is a thin, flexible lighted tube with a tiny camera at the end. Special small tools are used with the scope. The surgery may also be robotic-assisted. This means it's done by a healthcare provider using a control panel to move robotic arms that hold the tools. Laparoscopic surgery can lead to a shorter stay in the hospital, less pain, and quicker recovery time. This is because it uses small incisions.
Transurethral resection of the prostate (TURP). This surgery removes part of the prostate gland. It’s done with a small tool that is put inside the prostate through the urethra. There is no incision with this method. TURP is used to relieve symptoms. It's not used to cure the cancer.
Cryosurgery. This procedure is also known as cryotherapy. This surgery kills cancer cells by freezing them. This is done with a small metal tool placed in the tumor. The healthcare provider makes a tiny incision in the skin and inserts a thin metal probe into the prostate. Liquid nitrogen is then put into the probe to freeze the cancer cells. This treatment may be used in early stage prostate cancer or if the cancer returns after radiation therapy.
Risks and possible side effects of surgery
All surgery has risks. The short-term risks of surgery for prostate cancer include:
The possible long-term side effects include:
Incontinence. Incontinence is trouble controlling urine. This can range from slight leakage or dribbling of urine to complete loss of bladder control. Problems urinating are usually worse just after surgery. Normal bladder control returns for many men within several weeks or months after surgery. Some men may have long-lasting problems.
Erection problems (erectile dysfunction or impotence). For a few months after surgery, most men will not be able to get an erection. But over time, many men will again be able to get an erection that allows them to have sexual intercourse. They will not ejaculate semen, since removal of the prostate gland prevents that process. The effect of surgery on a man's ability to achieve an erection is related to the extent of the surgery, the man's ability to have an erection before surgery, and the man's age. But most men who have surgery should expect some decrease in their ability to have an erection. For men who have erection problems after surgery, different types of medicines or devices might be helpful.
Talk with your healthcare provider about the chances of side effects affecting you after surgery. Keep in mind, though, that healthcare providers can only give you their best estimates. No one can guarantee that you won't have side effects.
Getting ready for your surgery
Before you have surgery, you will talk with your surgeon. After you have talked about all the details of the surgery, you will sign a consent form. This gives the surgeon permission to do the surgery.
You will also talk with an anesthesiologist. This is the healthcare provider who will give you the medicine (general anesthesia) that prevents pain and makes you sleep during surgery. He or she also watches you during surgery to keep you safe. He or she will ask about your health history and your medicines.
What to expect during surgery
On the day of surgery, you will be taken into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and nurses.
During a typical surgery:
You will be moved onto the operating table.
You may need to wear special compression stockings on your legs. These are to help prevent blood clots.
You will have electrocardiogram (ECG) electrodes put on your chest. These are to keep track of your heart rate. You will also have a blood pressure cuff on your arm.
You will be given anesthesia through an IV tube in your hand or arm.
When you are asleep, the surgeon will do the surgery.
A urinary catheter will be put into the bladder during surgery. It will be kept in place for at least a few days.
What to expect after surgery
You will wake up in a recovery room. You will be watched closely by healthcare providers. You will be given medicine to treat pain. Depending on the type of surgery, you might need to stay in the hospital for one or more nights.
After surgery you will have follow-up appointments with your surgeon and other healthcare providers. Make sure to keep your appointments. If you have any problems or concerns, contact your healthcare team.