Surgical Treatments for Prostate Cancer

Advanced Expertise in Radical Prostatectomy Techniques

The most important factor in the success of any type of prostate surgery is the surgeon’s skill. The surgical oncologists at University Hospitals have extensive experience in prostatectomy surgery and the expertise to provide each patient with the best possible outcome while minimizing the impact on sexual and urinary function.

A radical prostatectomy can be done in one of two ways:

Robot-Assisted Radical Prostatectomy
This minimally invasive, laparoscopic approach to prostatectomy is by far the most common technique used in the United States today. To perform the procedure, the surgeon makes several small incisions in the abdomen, through which a surgical robot’s arms are inserted. The surgeon then controls the robot’s arms through a robotic interface and, in turn, the robot arms control the surgical instruments used to remove the prostate.

Robot-assisted surgery may provide more maneuverability and more precision when moving the instruments than open surgery. In addition, the precise nature of robotic technology often results in a more complete seal around the urethra and can spare the key nerves surrounding the prostate involved in bladder control and sexual potency.

When compared to open prostatectomy, patients who undergo robotic-assisted surgery typically experience:

• Less bleeding
• Less pain
• Fewer short-term complications
• Faster recovery times
• Equivalent cancer cure rates

Open Prostatectomy
Before the development of sophisticated robot technology, open surgery was the traditional way to surgically remove the prostate. It is rarely used any more, but still may be the surgical approach of choice for patients with a very large prostate and/or certain bladder conditions.

In this procedure, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. There are 2 main ways to do this operation, named for the location of the incision.

Retropubic. The incision is made in the lower abdomen, from the belly button down to the pubic bone.
Perineal. The incision is made between the anus and scrotum.

The perineal approach is used less often because it is more likely to lead to erection problems. However, it is a shorter operation and may result in less pain and a faster recovery. It might be an option for men who aren’t concerned about sexual function or those who have other medical conditions that might make retropubic surgery more difficult. The perineal approach cannot be used to remove lymph nodes so if there is any suspicion that the cancer has spread beyond the prostate, this technique would not be optimal.

Recovery after Radical Prostatectomy Surgery

With both open and laparoscopic robot-assisted surgery, patients typically go home after an overnight stay in the hospital with a bladder catheter to help drain urine for 5-10 days. Men with symptoms such as urinary frequency, urgency or a weak urine stream may notice significant improvement in these symptoms after surgery.

Your doctor will talk to you about what to expect during the recovery period, including any restrictions following surgery, including lifting, exercise and sexual activity. Most men will be back to their normal routine in about four to six weeks. Follow-up appointments will be scheduled with your surgeon based on your individual needs, with most men seeing their doctor at six weeks post-surgery and then again every three months for the first year, and twice in the second year after surgery.

Risks and Side Effects of Prostate Surgery

Even with the advanced techniques now used to perform radical prostatectomy, the surgery can pose certain risks, particularly if the tumor is large or close to the nerves that control erections. Potential side effects may include:

• Dry ejaculation
• Erectile dysfunction
• Loss of fertility
• Lymphedema
• Urinary incontinence

Our team of medical, radiation and surgical oncologists will work with other UH specialists to ensure you receive the best possible follow-up care to manage any side effects that may occur after surgery.