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Surgery is a common treatment for prostate cancer. The type of surgery depends on the stage of cancer, patient age, and life expectancy. The goal is to remove all or as much of the cancer as possible. Surgery for early stage prostate cancer offers the best chance for a cure.

Surgery for Early Stage Prostate Cancer
Radical Prostatectomy

A radical prostatectomy is the removal of the prostate gland, seminal vesicles, and part of the vas deferens. The goal is to remove the cancer while it is still contained within the prostate gland.

There are two different methods:

  • Radical retropubic prostatectomy—An incision is made in the lower abdomen to access the pelvic area and the affected organs. In some cases, nerves that control erections can be spared. This depends on the location and extent of the cancer in the prostate. The surgery may be stopped if cancer is found in the lymph nodes. This would indicate it has spread beyond the primary site.
  • Radical perineal prostatectomy—An incision is made through the perineum, the area between the scrotum and anus. The prostate is removed, but the nearby lymph nodes are spared. This method is not used as often because of damage to nerves that control erections. If lymph nodes need to be removed, another incision is made through the abdominal wall.

Prostatectomies can be done as:

  • Open—An incision is made through the abdominal wall. It starts at the belly button and ends near the top of the bladder at the pubic bone. Doing so exposes the organs so they can be removed through the incision.
  • Laparoscopic—Tubes are inserted into small incisions in the abdomen. A lighted camera and surgical instruments can be used through the tube. Images from the laparoscope are viewed on a special monitor. Healing and recovery time for laparoscopic surgery is generally faster than open surgery
  • Robot-assisted—Robotic arms are inserted through small incisions. This allows for greater range of movement than a doctor's hand.
  • Nerve-sparing—The surgeon will leave the two nerve bundles that control spontaneous erections. The ability to do this depends on how close the cancer is to the nerves. It is possible to have one nerve bundle removed and still have the ability to get an erection.

Side effects to this type of surgery include:

  • Urinary incontinence, which may include:
    • Stress incontinence—Urine leaks during times there is a sudden increase in pressure. Examples include sneezing or laughing.
    • Urge incontinence—Bladder spasms cause a sudden urgent need to urinate. This can cause urine to leak from the bladder.
    • Overflow incontinence—This causes difficulty with empyting the bladder. Urine stream may be weak or there may be dribbling. Urine builds up in the bladder and leaks out.
  • Erectile dysfunction (ED)—The inability to attain or maintain an erection that is firm enough for sexual intercourse. This may be more of an issue if nerve-sparing surgery was not an option. There are several treatments available to treat ED.
Cryosurgery

Cryosurgery is the freezing of abnormal tissue in the prostate gland. Several needles are passed into the prostate to deliver a gas straight to the prostate tissue. The freezing gas destroys prostate tissue. An ultrasound will help guide the needle and avoid damage to nearby healthy tissue.

Although it is used to treat early stage prostate cancer, it is not usually the first option. It may be done if cancer returns after other nonsurgical treatments are done.

Surgery for Advanced and Metastatic Prostate Cancer
Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is done through a tube called a rectoscope. The scope is inserted through the penis and into the urethra, the tube that carries urine out of the body. Surgical instruments can be passed through the tube to remove prostate tissue. Tissue can also be removed with an electric wire or laser, or by vaporization. It is done to manage urinary symptoms caused by growing tumors.

Orchiectomy

Orchiectomy is the surgical removal of one or both testicles. The testicles are removed through an incision in the skin of the scrotum. This procedure is done to remove the major source of androgens in the body. It does not offer a cure, but it helps slow the growth of cancer cells. It is considered a type of hormonal therapy. It is generally used only to manage metastatic prostate cancer that is stimulated by hormones. Orchiectomy can also be done with hormone-reducing medications.

References

Cryotherapy for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/treating/cryosurgery.html. Updated March 11, 2016. Accessed Accessed April 19, 2017.

Prostate cancer. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/prostate-cancer. Updated November 2013. Accessed April 19, 2017.

Surgery for prostate cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html. Updated March 11, 2016. Accessed Accessed April 19, 2017.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq. Updated July 7, 2016. Accessed April 19, 2017.

What is cryotherapy? Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/prostate-cancer/treatment/cryotherapy. Accessed April 19, 2017.

What is radical prostatectomy (surgery) for prostate cancer? Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/prostate-cancer/treatment/surgery. Accessed April 19, 2017.



Last reviewed September 2016 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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