Surgery - Prostatectomy

Surgery – Prostatectomy

The only other treatment besides seed implants and radiation therapy proven to cure prostate cancer is a prostatectomy. This is considered a major operation that typically takes several hours. It involves making at least a 4” incision in the lower abdomen to surgically remove the prostate gland. Hospitalization is required for a few days, and a catheter in the bladder needs to be used in all patients for a few weeks following the procedure.

Robotic prostatectomy can be done at select institutions. Here, the surgeon guides robotic arms to perform the operation. Smaller incisions are used resulting in somewhat shorter recovery times. Some studies have questioned whether there is a higher risk of positive margins (leaving cancer behind) following robotic surgery. Long-term side effects are similar to open prostatectomy in most studies. Loss of urinary control (incontinence) and loss of sexual function (impotence) can occur with this procedure. The likelihood of these complications varies greatly with the skill and experience of the surgeon.

A prostatectomy can only cure men when the cancer is completely removed. If surgery leaves behind even a few microscopic cancer cells, these can later grow and ultimately spread.

Robotic prostatectomy can be done at select institutions. The surgeon guides robotic arms to help perform the operation. Smaller incisions are used, which may result in slightly shorter recovery times. Some studies have shown a higher risk of positive margins (leaving cancer behind) following robotic surgery requiring supplemental treatment afterwards. (JCO 2008) A recent major study from Harvard showed that men who underwent robotic surgery actually had higher rates of incontinence (loss of urinary control) and loss of sexual function (impotence) than men treated with an open prostatectomy (JAMA 2009) (Eur Urol 2010). The likelihood of these complications, as well as success rates, varies greatly with the skill and experience of the surgeon. Several recent studies have shown that outcomes following surgery are significantly worse if the surgeon has performed less than 250 of these procedures. (JNCI 2007) (NEJM 2002)