How Prostate Cancer Surgery is Done
Surgery for prostate cancer is the most common treatment of choice for prostate cancer that has not metastasized, meaning it has not spread outside the prostate gland.
The treatment of prostate cancer depends on the individual circumstances of the patient. Its main goal is to cure or control the disease to offer a better quality of life and survival to the man.
Other approaches, which can be done alone or in combination, include:
- Radiotherapy
- Brachytherapy
- Chemotherapy
- Hormone therapy
- Cryotherapy
- High-intensity focused ultrasound
- Immunotherapy, among others
Types of surgery for prostate cancer
Surgeries performed for prostate cancer include different procedures, with the main one being prostatectomy. There are several types of prostatectomy:
- Robotic Prostatectomy: Currently the most performed procedure in the world for prostate cancer treatment, as the quality of approach that the robot offers makes a difference in the cure and quality of life of the patient. Small incisions are made in the skin, through which the instruments are inserted. They are operated by the surgeon through an external control that allows him to precisely move the robotic arms holding the tools and conduct the surgery safely and effectively.
- Laparoscopic Radical Prostatectomy: Small incisions are made in the skin, through which the surgeon inserts special instruments to remove the prostate. One of them has a video camera at the tip that allows internal visualization of the abdomen and the procedure to be performed. This technique has some advantages compared to open radical prostatectomy, such as less blood loss, less pain, reduced hospitalization time, and faster recovery.
- Open Radical Prostatectomy: An incision is made to remove the prostate and the surrounding tissues. With the advancement of techniques, this type of procedure has been performed less frequently.
- Retropubic: An incision is made in the lower abdomen (from the navel to the pubic bone). If the result of the PSA (prostate-specific antigen) test or biopsy indicates that there is a possibility that the disease has spread to the lymph nodes, part of them is removed along with the prostate.
- Transperineal: The incision is made in the skin between the anus and the perineum (scrotum). This type of procedure is not commonly used because it does not allow for sparing of the nerves and the lymph nodes cannot be removed. It is usually chosen when the patient is not concerned about sexual function (specifically erection), which will be affected.
It is also possible to opt for a transurethral resection of the prostate (TURP). Although this procedure is not used to cure prostate cancer, it can be performed in men with advanced disease to help relieve symptoms such as urinary problems. For this purpose, a device called a resectoscope is used to remove the inner part of the prostate that surrounds the urethra.
Risks of prostate surgery
The risks inherent in any type of prostatectomy are very similar to those present in other major surgeries. The main complications that can occur during or shortly after the procedure are:
- Anesthesia reactions;
- Bleeding;
- Clots in the legs or lungs;
- Damage to organs near the prostate;
- Surgical site infections; and
- Injuries to parts of the intestine (although rare, it can lead to abdominal infections. When this occurs, further surgeries may be necessary to correct the problem).
Possible adverse effects of surgery
The main adverse effects of prostate surgeries are urinary incontinence (when a man is unable to control urine) and erectile dysfunction (impotence and difficulty in achieving or maintaining an erection). The older the age, the higher the risk of these events occurring.
The good news is that urinary control usually returns, and if it does not, incontinence can be treated. The same goes for erectile dysfunction, which can be managed with a variety of treatment alternatives.
After radical prostatectomy, a man can no longer ejaculate during sexual intercourse. Therefore, it is recommended that those who wish to conceive children in the future consult a specialist in assisted reproduction before surgery to assess the possibility of freezing semen samples.
