Prostate cancer surgery

Oncological surgery for prostate cancer is the indicated treatment for tumor removal, the removal of the prostate itself and also the area around it. It is the most used procedure against this type of cancer. Learn more.
Prostate cancer surgery

The treatment of prostate cancer depends on the individual circumstances of the patient. Its main goal is to control the disease or cure it, prolonging the patient’s life, as well as ensuring a good quality of life.

Surgery is the most common treatment of choice for prostate cancer that has not metastasized, meaning that it has not spread outside the prostate gland.

Other approaches, which can be done alone or in combination, include radiation therapy, brachytherapy, chemotherapy, hormone therapy, cryotherapy, high-intensity focused ultrasound, and immunotherapy, among others.

Types of surgery for prostate cancer

Surgeries performed for prostate cancer include different procedures, the main one being prostatectomy. There are several types of prostatectomy:

  • Robotic prostatectomy: it is currently the most used procedure in the world for the treatment of prostate cancer, due to the quality of approach offered by the robot, which makes a difference in healing and in the patient’s quality of life. Small incisions are made in the skin, through which the instruments are inserted. This procedure is done by the doctor by an external control that allows him/her to precisely move the robotic arms that hold the tools and safely and effectively perform the surgery;
  • Open radical prostatectomy: an incision is made to remove the prostate and surrounding tissue. With the advancement of techniques, this type of procedure has been performed less frequently;
  • 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 small a video camera on the tip that allows the internal visualization of the abdomen and the performance of the procedure. This technique has some advantages when compared to the open radical, such as less blood loss, less pain, reduced hospitalization and better recovery time;
  • Retropubic radical prostatectomy: an incision is made in the lower abdomen (from the navel to the pubic bone). If the results of the PSA (prostate specific antigen) test or biopsy indicate that there is a possibility that the disease has spread to the lymph nodes, part of the lymph nodes is removed along with the prostate; and
  • Radical perineal prostatectomy: an incision is made in the area between the anus and the perineum (scrotum). This type of procedure is not as commonly used, as it does not allow nerves to be spared and the lymph nodes cannot be removed. It is usually chosen when the patient is not concerned about sexual function (more specifically erection) being affected.

It is also possible to opt for a transurethral resection of the prostate. While this procedure is not used to cure prostate cancer, it can be performed on men with advanced disease to help relieve symptoms, such as problems with urination. For this, 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 may occur during or shortly after the procedure are the following:

  • Reactions to anesthesia;
  • Hemorrhage (bleeding);
  • Blood clots in the legs or lungs;
  • Damage to organs near the prostate;
  • Surgical site infections; and
  • Injury to parts of the intestine (although rare, it can lead to infections in the abdomen. When this occurs, further operations may be necessary to correct the problem).

Possible adverse effects of surgery

The main adverse effects of prostate surgery are urinary incontinence (when the man is not able to control his urine) and erectile dysfunction (impotence and difficulty in obtaining or maintaining an erection). The older the age, the greater the risk of these events occurring.

The good news is that urinary control often returns, and if it doesn’t, incontinence can be treated. The same goes for erectile dysfunction, which can be managed with a number of treatment alternatives.

After radical prostatectomy, the man is no longer able to ejaculate during sexual intercourse. Therefore, it is recommended that those wishing to conceive children in the future visit an assisted reproduction specialist before surgery to assess the possibility of freezing semen samples.

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