Surgical removal of the entire prostate is called a radical prostatectomy. If the cancer is confined to the prostate, surgery can be considered a cure. It is also a reliable method of controlling more extensive cancer, and the long-term success rate is very high at 10 years or more. The procedure is performed one of several ways, depending on the patient and his cancer:
Minimally Invasive Surgery (laparoscopy)
Minimally invasive surgery is performed with either a laparoscope or a robotic laparoscope. With this technique, about six incisions, each the size of a fingertip, are made in the abdomen. Cameras are placed in some of the incisions so the surgeon can see the prostate. When a surgery is done laparoscopically, the surgeon manipulates tools that reach into the abdomen.
Robotic-assisted laparoscopic surgery is done with robotic arms, tools and cameras that the surgeon controls on a computer station in the operating room. Called the da Vinci® Surgical System, the computer gives surgeons three-dimensional vision and improved magnification to see smaller nerves. It also enhances the surgeon's dexterity and precision. The da Vinci system enhances surgeons' vision by 10 times. Better visualization can translate into less blood loss, improved continence and potency for patients, and better reconstruction of the bladder as well as sparing the nerves.
Laparoscopic and robotic-assisted laparoscopic surgeries typically involve a one- to two-day hospital stay. Patients generally recover in about three weeks, report less pain and less scarring than those who have open surgery. After surgery, patients are sent home with a catheter, which is usually removed in about eight days.
In an open retropubic prostatectomy (prah-steh-tek-tom-ee), the surgeon reaches the prostate by creating a six-inch incision from the belly button to the pubic bone. The surgical procedure generally involves a two-day hospital stay.
Recovery from an open surgery takes from four to six weeks. Recovery time is affected by several factors, including your pre-surgical physical condition, skill of the surgeon, quality of your preoperative exercises and location and severity of your cancer. After surgery, you will be sent home with a catheter, which is usually removed in about eight days.
One of the advantages to an open prostatectomy is the ability to perform a full lymph node dissection, which is necessary for higher-grade cancers. This type of surgery is recommended over a robotic (minimally invasive) method for this stage of cancer.
Long-Term Risks of Prostatectomies
Incontinence, impotence and bowel problems, including irritation to the bowel, are all long-term risks of prostatectomies that vary from patient to patient. The risk of impotence has lowered dramatically over the years, and medication to help erectile dysfunction has significantly increased the chances of potency after surgery. When one of the nerves is spared, the chances of staying potent increase 25 to 45 percent; when both nerves are spared, the rate is about 80 percent chance of potency.
The risk of moderate to severe incontinence with a need for a corrective procedure is about 1 to 4 percent; the risk of minor incontinence during vigorous activity, also called "stress incontinence" is 20 percent. Incontinence after surgery typically lasts a few weeks to a few months. Continence improves through exercise and time. Continence has also greatly improved with new surgical techniques. Total incontinence that lasts more than a year is very rare and often occurs as a result of other medical problems. There is a risk that you may need re-operation. One to 2 percent of men have bowel problems after surgery. It is very rare.
You should discuss these risks with your urologist because the chance of occurrence varies from patient to patient.