Understanding Prostate Cancer: Surgery
Prostate cancer surgery means removing either the whole prostate or only part of it. Surgery is most often recommended for men with early prostate cancer. This typically means Stage 1 or 2. Sometimes it’s also considered for men with Stage 3 or 4.
Before removing your prostate, the surgeon will usually examine the lymph nodes in your pelvis. This is done by removing those lymph nodes. It is important to do this to check for cancer spread. If there are cancer cells in your lymph nodes, this means the cancer might have spread to other parts of your body. If cancer has spread to the lymph nodes, the surgeon may not remove your prostate. Instead, you may need another type of treatment.
There are 5 main kinds of prostate cancer surgery. Each one has different risks and benefits. Following is a description of each:
Open surgery: The surgeon makes a large cut (called an incision) into your body. This can be done through your abdomen. The surgeon can remove your entire prostate this way. This procedure is called a radical retropubic prostatectomy.
Another option is to go in between your scrotum and anus. The entire prostate can be removed this way. This procedure is called a radical perineal prostatectomy.
Laparoscopic prostatectomy: Rather than making one long cut in your abdomen, the surgeon removes the entire prostate through several smaller cuts. A thin lighted tube called a laparoscope helps the surgeon remove the prostate.
Robotic laparoscopic surgery: A laparoscope is used in this surgery. Unlike a regular laparoscopic procedure, though, the surgeon uses a robot’s arms to perform the surgery. The surgeon controls the robotic arms through handles below a computer display.
Cryosurgery: In this procedure, the surgeon makes a small cut between your scrotum and anus. Then the surgeon inserts a device. This tool freezes and destroys prostate tissue.
Transurethral Resection of the Prostate (TURP): This procedure is more commonly recommended for men with advanced prostate cancer. TURP can help relieve symptoms. In this procedure, the surgeon will insert a long thin scope through your urethra. There is a cutting tool at the end of the scope. This removes tissue from the inside of your prostate. A TURP procedure does not always remove all of the cancer. However, it can remove some of the tissue that blocks the flow of urine.
What to Expect With Surgery
All types of surgery usually require general anesthesia. Most men are in the hospital for up to 4 days.
The urethra will need to heal. To give it time to heal, there will be a thin, flexible tube called a catheter inserted in the bladder. Urine drains through this. The catheter may remain for 1 to 3 weeks after surgery. Your doctor or nurse will show you how to care for the catheter.
You will probably be uncomfortable for the first few days after surgery. Sometimes this continues for a few weeks. However, any pain can be controlled through medication. Make sure you get any pain prescription filled on your way home from the hospital. This is an errand that a friend or relative can do for you.
It is not uncommon to have poor bladder control for a few months after the catheter is gone.
Some men have a large tumor or one that is very close to the nerves around the prostate. In this case, prostate cancer surgery can damage the nerves around the prostate. This can cause impotence. This means you cannot have an erection. Often, though, your surgeon is able to protect the nerves that control erection.
You may want to talk to your doctor about medications to manage the sexual side effects of prostate surgery.
You will no longer produce semen if your prostate is taken out. You will still be able to have orgasms, but they will be dry. If you have not fathered children and still want to do so, you may want to bank some of your sperm before prostate surgery.
Here are some good questions to ask before surgery:
- Which surgery do you recommend for me?
- Why is it the best for me?
- How long will I be in the hospital after surgery?
- How will I feel after the operation?
- If I have pain, how can I manage it?
- Will I have any lasting side effects?
- What is the chance that the surgery will cause incontinence or impotence?
- Is there someone that I can talk with who has had the same surgery that I'll be having?
- How often will I need checkups?