by Maria Adams, MS, MPH
Anatomy and Physiology
The prostate is a walnut-sized gland that makes and stores seminal fluid, which nourishes sperm and forms part of the semen.
The prostate gland is located at the base of the bladder, in front of the rectum. It wraps around the urethra, a tube that carries urine from the bladder. Bordering the prostate are the seminal vesicles, a pair of pouch-like glands that contribute secretions to the semen.
Reasons for Procedure
Prostate cancer is one of the most common types of cancer in men. It can be diagnosed only by doing a biopsy, which involves taking a sample of tissue from the prostate and examining it under the microscope. Prostate cancer is the main indication for a radical prostatectomy.
Although many men have no symptoms, prostate cancer, and other conditions involving enlargement of the prostate, can cause: frequent urination, especially at night, inability to urinate, painful urination, and/or blood in the urine or semen.
Prostate cancer that has spread may also cause persistent pain in the lower back, hips, or upper thighs.
There are many treatment options available for prostate cancer. If your doctor determines that the cancer is localized and has not spread beyond the prostate, the four main ways to manage the cancer are: watchful waiting, prostate surgery, radiation therapy, and cryoablation.
A radical prostatectomy is the surgical removal of the entire prostate along with attached seminal vesicles and some surrounding tissue.
There are four main types of radical prostatectomy: open perineal, open retropubic, and Laparoscopic Robotic. You and your doctor will choose the most appropriate option for you based on your age, your general health, and the severity of your cancer.
In the days leading up to your procedure: Arrange for a ride to and from the hospital, and for help at home as you recover. Eat a light dinner and do not eat or drink anything after midnight. You may be given laxatives and/or an enema to clean out your intestines. You may be given antibiotics to take before coming to the hospital. If you regularly take medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. A prostatectomy usually takes between two and four hours. Before the procedure, an IV line will be started. You may receive antibiotics through the IV to decrease your chance of an infection.
You will receive general, spinal, or epidural anesthesia. With general anesthesia, your doctor will insert a breathing tube through your mouth and into your throat to help you breath during the operation. With spinal or epidural anesthesia, the lower half of your body will be numb and you will be given a sedative to help you relax.
In an open prostatectomy, your surgeon will choose between a retropubic and a perineal approach. The retropubic approach, involves an incision in the lower abdomen. In the perineal approach, the incision is made between the scrotum and the rectum.
Your surgeon will then carefully separate the prostate, seminal vesicles, and a small amount of surrounding tissue from nearby structures and remove them. Your surgeon will take special care to locate the nerves on either side of the prostate gland and leave them intact. Nerve sparing techniques decrease, but do not eliminate, the possibility of impotence.
One of the advantages of the retropubic approach is that it allows your surgeon to also remove the lymph nodes, if necessary, which the perineal approach does not.
In a laparoscopic prostatectomy, your surgeon will make several tiny incisions in the abdomen, rather than resorting to a single large incision. Through these small "ports," your surgeon may insert a laparoscope, which is a thin tube equipped with a light and camera, and several other specialized tools.
In some cases, the surgeon may need to revert to an open prostatectomy if he or she is unable to complete the laparoscopic procedure.
In a robotic prostatectomy, tiny robot arms and a robotic laparoscope are passed through the ports. The surgeon then controls these arms and the camera from a remote console.
At the end of the operation, the surgeon will put a catheter into your bladder to keep it draining. The catheter will usually be left in place for 10 days to 2 weeks after surgery. Your surgeon will close your incisions with stitches or clips that will remain in place for 7-10 days.
Risks and Benefits
Possible complications of a radical prostatectomy include: excessive bleeding, wound infection, blood clots, inability to control your bladder, or incontinence, impotence, narrowing of the urethra, adverse effects of the anesthesia, and/or heart and lung problems.
Benefits of a radical prostatectomy include: removal of the cancerous mass, which helps your doctor more accurately determine the severity of your cancer and the need for additional therapy, low rates of cancer recurrence compared to other treatment options.
In a radical prostatectomy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
After the procedure: If you received general anesthesia, your breathing tube will be removed. You will be taken to the recovery area for monitoring. You will be given pain medication as needed. You may continue to receive antibiotics through your intravenous line. Your bladder may be flushed intermittently through the catheter with a sterile solution. The usual hospital stay following a prostatectomy is 2-3 days.
Depending on what is found during your preoperative evaluation and surgery, your doctor may recommend additional treatment, such as radiation therapy, to reduce your risk of recurrence. This decision will be aided by closely monitoring the levels of prostate specific antigen, or PSA, in your blood.
After you leave the hospital, be sure to contact your doctor if you experience: signs of infection, including fever and chills, redness, swelling, increasing pain, excessive bleeding, or discharge from the incisions, cough, shortness of breath, chest pain, or severe nausea or vomiting, pain, burning, urgency or frequency of urination, or persistent bleeding in the urine, abdominal swelling or pain, constipation, and/or new, unexplained symptoms.
- Detailed Guide: Prostate Cancer. Risks and Side Effects of Treatments. American Cancer Institute. Available at: http://www.cancer.org/docroot/cri/content/cri_2_4_4x_risks_and_side_effects_36.asp?sitearea=cri. Accessed June 30, 2004.
- Know Your Options: Understanding Treatment Choices for Prostate Cancer. National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/understanding-prostate-cancer-treatment. Accessed March 12, 2004.
- Prostatectomy - TURP. Queensland Government website. Available at: http://www.health.qld.gov.au/informedconsent/ConsentForms/urology/prostatectomy_turp.pdf. Accessed June 21, 2004.
- The UCI Robotic Prostatectomy. Department of Urology. University of California at Irvine. Available at: http://www.ucihs.uci.edu/urology/prostate/surgery.html. Accessed August 3, 2004.
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