Prostate cancer treatment: Surgery (radical prostatectomy)

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Surgery to remove the entire prostate is called a radical prostatectomy. This is a common way to treat prostate cancer.

Your surgeon will remove your prostate gland and some surrounding tissue, including the seminal vesicles. If cancer has spread to nearby nerves, your surgeon will also remove some or all of those nerves to make sure the cancer is gone.

How prostate cancer surgery works

There are 2 ways a prostatectomy can be performed:

Laparoscopic radical prostatectomy (a type of keyhole surgery):

Your surgeon will make 6 small cuts across your upper stomach. This can be done by hand or using a robot—usually the Da Vinci robot. The prostate will then be removed through one of the small cuts. This approach is considered minimally invasive and helps your doctor reduce damage and scarring to your abdominal wall.

Open radical prostatectomy

Your surgeon will make a cut below your belly button (about 4 fingers below). Then, they’ll go in and remove the prostate from between the bladder and urethra.

The approach your surgeon takes (laparoscopic, robotic or open) can depend on many things but no matter which, the goal is always to safely and effectively remove the prostate gland and seminal vesicles. It’s OK to ask your surgeon which approach is best for you, and it’s also OK to then ask how many surgeries your doctor has performed.

With either approach, your surgeon will try to avoid harming the nerves that run down the left and right side of the prostate (these are the nerves responsible for erections). It can be hard to see these nerves during surgery, so your surgeon relies on their knowledge of the body to avoid harming them.

However, if your surgeon thinks cancer has reached the nerves, they will cut them on purpose to make sure the cancer is gone. It all really depends on where the cancer is and how far it’s spread. Your surgeon will discuss their plans with you before surgery and you can ask any questions you need to.

Side effects of a radical prostatectomy

Common side effects to prostate cancer surgery can include short- and long-term changes to your sex life, infertility, and urinary problems. There are strategies you can use to manage these side effects, so it’s important to talk to your doctor about them before and after surgery.

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