The normal approach for surgery in the case of localized prostate cancer is to remove the entire prostate gland and surrounding tissue in an operation known as a radical prostatectomy. The operation is usually performed as a retropubic prostatectomy, in which access is achieved through the lower abdomen, or a perineal prostatectomy, in which access is gained through the perineum which lies between the scrotum and the anus.
During a radical prostatectomy the prostate gland is removed, together with the seminal vesicles, the ampullae (the lower sections of the tubes which carry sperm from the testicles to the prostate gland) and some other adjoining tissue. In addition, that part of the urethra which passes through the prostate gland, as well as the neck of the bladder and a part of the sphincter muscle that controls urine flow is also removed.
From this you will see that a radical prostatectomy is not minor surgery, but is a demanding procedure which generally lasts anywhere from about 2 to 4 hours. It is also an operation which generally requires a stay in hospital of about 3 days followed by 10 days to 2 weeks at home during which time you will need to use a catheter to drain urine.
In the past a radical prostatectomy almost always resulted in impotence, but today improvements in surgical techniques and the introduction of what is known as ‘nerve sparing’ surgery means that an increasing number of men are now spared from impotence. When nerve sparing surgery is performed the two sets nerves and other vessels that run along the side of the prostate gland are carefully preserved in order to retain the erectile function. This technique is unfortunately not suitable in all cases of prostate cancer.
One of the commonest results of prostate surgery is a degree of incontinence. Almost all patients will experience some loss of control following their operation and this can vary from occasionally dribbling to a complete loss of urinary control. Fortunately, some men are suitable for further surgery to ease this problem and it is sometimes possible to surgically implant an artificial urinary sphincter or to use collagen injections to narrow the opening of the bladder.
Some men will also suffer muscle damage during surgery leading to fecal incontinence, which is essentially a problem caused by a reduction in the elasticity of the rectum. This too can be corrected surgically in some cases. Radiation therapy can also sometimes be used to stiffen the rectal muscles.
Of course surgery is just one of the treatments available for localized prostate cancer today and, while many men favor it because it involves the immediate and complete removal of cancer cells from the body, you should not automatically assume that this is the best treatment for you. Take some time to look at all of your options and discuss each with your physician before coming to any decision.