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Prostate Cancer (cont.)

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The removal of the entire prostate gland and the urethra that runs through the prostate and the attached seminal vesicles is referred to as a radical prostatectomy. A variety of approaches are available for performing this procedure. The type of approach may vary with your surgeon's preference, your physique, and medical conditions. Traditionally, radical prostatectomy was performed through an incision that extended from below the belly button (umbilicus) down to the pubic bone or through an incision underneath the scrotum (perineal approach). In an effort to decrease the morbidity of the procedure, laparoscopic approaches to performing a radical prostatectomy were developed. The use of the robot to perform the laparoscopic radical prostatectomy is currently the most common method to perform a radical prostatectomy. Compared to open radical prostatectomy, robotic assisted laparoscopic radical prostatectomy is associated with less postoperative discomfort and sooner return to full activity, as well as less intraoperative blood loss.

In some men, a pelvic lymph node dissection may be recommended depending on the Gleason score, PSA, and radiologic findings. This involves removing lymph nodes in the pelvis that are common sites for prostate cancer to spread. This may be performed at the time of the radical prostatectomy or rarely as a separate procedure prior to definitive therapy.

Side effects of radical prostatectomy may have a significant impact on quality of life. Thus, it is essential that you discuss with your surgeon prior to the surgery the risk of such side effects occurring, as well as treatments that can occur after surgery to treat such sides effects.

Erectile dysfunction is a side effect of radical prostatectomy. The risk of developing erectile dysfunction varies with your age, erectile function status prior to surgery, and the need to remove one, both, or neither of the pelvic nerve bundles during the radical prostatectomy. The pelvic nerve bundles lie on either side of the prostate, just outside the capsule or outer edge of the prostate. The pelvic nerve bundles are involved in the erectile process, the ability to have an erection. Impotence -- or the inability to have and sustain an erection of a quality sufficient for successful intercourse -- can occur after radical prostatectomy due to trauma, damage, or removal of the pelvic nerve bundles. Nerve-sparing radical prostatectomy can be performed in select individuals with lower risk prostate cancer. Even after nerve-sparing radical prostatectomy, one may experience transient erectile troubles related to reversible trauma to the nerves during surgery. Specialists treating erectile dysfunction may recommend penile rehabilitation therapy in hopes of helping the nerves recover their function better and faster after radical prostatectomy.

Urinary incontinence is another risk after radical prostatectomy. The radical prostatectomy involves the removal of a portion of the urethra, which passes through the prostate gland. During the procedure, the urethra is sewn back to the bladder. When the prostate gland is removed, there may be some trauma to the sphincter around the urethra, which helps prevent leakage of urine. As with the risk of erectile troubles, the risk of incontinence may vary with your continence status prior to surgery, whether or not you have had prior surgery on the prostate (transurethral prostatectomy [TURP]) and the function of your sphincter muscle prior to surgery.

Both erectile dysfunction and urinary incontinence are treatable conditions. The treatment for either may involve medical and/or surgical therapies. You should discuss such risks and the treatment of these with your surgeon prior to surgery.

Other risks of radical prostatectomy include infection, bleeding, discomfort, and blood clots (deep venous thrombosis [DVT]) and rarely death. To help prevent a DVT, you may be asked to wear special compression devices on your legs or be administered a blood thinner.

Radical prostatectomy is rarely performed as a salvage procedure after other primary therapy, such as radiation therapy, has failed. The risk of complications, erectile dysfunction, incontinence, bleeding, etc., are greater with salvage therapy.

Medically Reviewed by a Doctor on 11/9/2016



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