Prostate surgery or prostatectomy
is the removal of the prostate gland. This prostate
cancer treatment is an invasive procedure that can be
performed by a single incision to the lower abdomen
(retropubic) or perineum (perineal), or by a series
of small incisions (laparoscopic and robotic).
Surgery’s Role in
the Treatment of Prostate Cancer
Prostate surgery is one of the oldest prostate cancer
treatments. The premise: “remove the cancerous
organ to treat the patient.” Prostate surgery
(the technical term is prostatectomy) will help only
those patients who have confined, localized disease.
The oldest type of surgery, the radical retropubic prostatectomy,
uses pelvic lymph node dissection (PLND) before surgery
to ensure that the disease has not metastasized out
of the gland.
Radical prostatectomy is the removal
of the entire prostate gland and possibly the seminal
vesicles and surrounding nerves and veins. The part
of the urethra travelling through the gland’s
transition zone is also removed. The two ends of remaining
urethra are reattached in a connection called the anastomosis.
Excising part of the urethra may lead to a penile shrinkage
Types of Prostate Surgery
There are three types of prostate surgeries: retropubic,
perineal, and laparoscopic. They are classified according
to the incision site.
The retropubic incision is made in the center of the
lower abdomen and could be called open prostate surgery.
The incision is from 8 to 10 centimeters long. The
advantages of this technique include PLND and nerve-sparing.
The 4 centimeter perineal incision is made in the
perineum which comprises muscles and exterior skin
between the scrotum and anal sphincter. Surgeons cannot
perform the PLND during this procedure but is considered
acceptable because PSA testing, DRE findings, and
Gleason scoring are excellent indicators of lymph
- Laparoscopic and Robotic
The laparoscope is a slender, tube-like instrument
which allows the surgeon to see inside the abdominal
cavity and excise the prostate through a series of
small incisions rather than a long single one. The
robotic procedure uses the same incisions and tools
but a surgeon uses robotic arms controlled by a console
to perform the surgery remotely. From the patient’s
point of view, the two are virtually identical.
Sex After Prostate Surgery
All prostate cancer treatments affect sexual potency.
Physically, several factors affect the mechanics of
the erection such as diversion of the blood flow or the
nerve stimulations that trigger erections. Surgeons
try to preserve nerve function through the nerve-sparing
Nerve-sparing prostatectomy can be used only for patients
who have small, localized tumors that do not touch the
neurovascular nerve bundles. The technique helps men
regain erectile function more quickly afterwards if
they were potent beforehand. Only the open field of
view available through an abdominal incision allows
a surgeon to spare nerve bundles. Patients considering
the nerve-sparing technique should find an experienced
The History of the Prostatectomy
The radical perineal approach has been in use since
the early 20th century. Not until the 1940’s
did doctors begin to use the radical retropubic approach.
Both of these approaches, however, engaged an unrefined
surgical technique which resulted in significant blood
loss for the patient. Once surgeons began clamping veins
and refining surgical technique, patients immediately
fared better. Until the 1980’s, the retropubic
approach was the most commonly used.
Today, the laparoscopic and robotic
procedures are quickly becoming popular. In this procedure, however, conversion to the abdominal
incision may be used if complications arise during a