Radical Prostatectomy

Radical prostatectomy is surgery to remove all of the prostate gland, as well as some of the tissue around it, in order to treat prostate cancer.

Radical prostatectomy is most often done when the cancer has not spread outside of the prostate gland. The surgery removes the prostate gland, as well as the glands that produce the fluid part of semen (seminal vesicles). The surgeon also may remove nearby lymph nodes during the procedure to test them for cancer.

Why the Procedure is Performed

Radical prostatectomy is only recommended for men who:
• Are in generally good health and can tolerate anesthesia
• Have prostate cancer that has not spread outside of the prostate gland
• Have a life expectancy of 10 or more years

Types of Radical Prostatectomy

There are four main types of radical prostatectomy surgery:
• Radical retropubic prostatectomy
• Radical perineal prostatectomy
• Laparoscopic radical prostatectomy (LRP)
• Robotic LRP

For these procedures, you will either be asleep (under general anesthesia), or given medicine to numb the lower half of your body (spinal or epidural anesthesia).

RADICAL RETROPUBIC PROSTATECTOMY

During this procedure, the surgeon will make a surgical cut starting just below your belly button and reaching to the pubic bone.

The surgeon will remove your prostate gland, taking care to preserve the nerves on either side of the prostate that control erections (called nerve-sparing surgery). The surgeon also might take out nearby lymph nodes if there is a chance that the cancer has spread. A tube (catheter) is placed in the penis to drain fluids while you heal. The entire surgery should take 90 minutes to 4 hours.

RADICAL PERINEAL PROSTATECTOMY

In this procedure, the surgeon makes a surgical cut in the skin between the anus and base of the scrotum (the perineum). Because the cut is smaller than with the retropubic technique, it is harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. For these reasons, this surgery is not used as often as retropubic prostatectomy.

Perineal surgery usually takes less time to complete than the retropubic approach.

LAPAROSCOPIC SURGERY

In laparoscopic radical prostatectomy, the surgeon makes several small cuts instead of one big cut. Long, thin instruments are placed inside the cuts. A thin, lighted tube with a video camera (laparoscope) is placed inside one of the cuts to help the surgeon see inside the abdomen during the procedure. It is possible to spare the nerves around the prostate and remove lymph nodes with this surgery.

ROBOTIC LRP

Sometimes laparoscopic surgery is done using a robotic system (called the da Vinci system). The surgeon moves the robotic arm while sitting at a control panel near the operating table. The robotic arm can give the surgeon more precise control over the surgery.

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