Goals of surgery for prostate cancer

Prostate cancer surgery can be done for different reasons. Most often, surgery is a treatment for early-stage prostate cancer. In this case, the goal of the surgery is to remove all of the cancer.

Surgery to try to cure the cancer is less likely to be an option if the cancer has spread outside of the prostate. In this case, surgery may be done to help relieve symptoms from the cancer, such as trouble urinating. But this surgery won’t remove all of the cancer.

If you’re considering surgery to treat your prostate cancer, be sure you understand what the goal of the surgery is.

Types of surgery for prostate cancer

Prostate cancer can be treated with:

• Radical prostatectomy. This surgery removes the whole prostate gland and some nearby tissue. The surgery may be done with a long cut (incision) in the belly (abdomen). Or it may be done with an incision in the area between the scrotum and the rectum (perineum).

• Laparoscopic radical prostatectomy.  This surgery also removes the whole prostate gland and some nearby tissue. It’s done with a few small incisions instead of one larger incision. A laparoscope is used to do the surgery. This is a thin, flexible lighted tube with a tiny camera at the end. Special small tools are used with the scope. The surgery may also be robotic-assisted. This means it’s done by a healthcare provider using a control panel to move robotic arms that hold the tools. Laparoscopic surgery can lead to a shorter stay in the hospital, less pain, and quicker recovery time. This is because it uses small incisions.

• Transurethral resection of the prostate (TURP).  This surgery removes part of the prostate gland. It’s done with a small tool that’s put inside the prostate through the urethra. There is no incision with this method. TURP is used to relieve symptoms. It’s not used to cure cancer.

• Cryosurgery (cryotherapy).  This surgery kills cancer cells by freezing them. This is done with a small metal tool placed in the tumor. The healthcare provider makes a tiny incision in the skin and inserts a thin metal probe into the prostate. Liquid nitrogen is then put into the probe to freeze the cancer cells. This treatment may be used in early stage prostate cancer or if the cancer returns after radiation therapy.

Risks and possible side effects of surgery

All surgery has risks. The short-term risks of surgery for prostate cancer include:

• Reaction to anesthesia

• Excess bleeding

• Infection

• Blood clots

• Damage to nearby organs or tissue

The possible long-term side effects include:

• Incontinence. Incontinence is trouble controlling urine. This can range from slight leakage or dribbling of urine to complete loss of bladder control. Problems urinating are usually worse just after surgery. For many men, normal bladder control returns a few weeks or months after surgery. Some men may have long-lasting problems.

• Erection problems (erectile dysfunction or impotence).  For a few months after surgery, most men won’t be able to get an erection. But in time, many men will be able to get an erection that allows them to have sexual intercourse. They won’t ejaculate semen because removal of the prostate gland prevents that process. The effect of surgery on a man’s ability to achieve an erection is related to the extent of the surgery, the man’s ability to have an erection before surgery, and the man’s age. But most men who have surgery should expect some decrease in their ability to have an erection. For men who have erection problems after surgery, different types of medicines or devices might be helpful.

Talk with your healthcare provider about the chances of side effects affecting you after surgery. Keep in mind, though, that a provider can only give you their best estimates. No one can guarantee that you will or won’t have side effects.

Getting ready for your surgery

Before you have surgery, you will talk with your surgeon. After you have talked about all the details of the surgery, you’ll sign a consent form. This gives the surgeon permission to do the surgery.

You’ll also talk with an anesthesiologist and sign a consent form giving them permission to administer anesthesia. Your anesthesiologist is a healthcare provider who will give you the medicine (general anesthesia) that prevents pain and allows you to sleep during surgery. They also watch you during surgery to keep you safe. They will ask about your health history, prescription and over-the-counter medicines you take, and allergies.

What to expect during surgery

On the day of surgery, you’ll be taken into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and nurses.

During a typical surgery:

• You’ll be moved onto the operating table.

• You may need to wear special compression stockings on your legs. These are to help prevent blood clots.

• You’ll have electrocardiogram (ECG) electrodes put on your chest. These are to keep track of your heart rate. You’ll also have a blood pressure cuff on your arm.

• You’ll be given anesthesia through an IV (intravenous) tube in your hand or arm.

• When you’re asleep, the surgeon will do the surgery.

• A urinary catheter will be put into the bladder during surgery. It will be kept in place for at least a few days.

What to expect after surgery

You’ll wake up in the post anesthesia care unit (PACU). You’ll be watched closely by healthcare providers. You’ll be given medicine to treat pain. Once you’re awake and stable, you’ll move to your hospital room. Depending on the type of surgery, you might need to stay in the hospital for one or more nights.

Follow-up care

After surgery, you’ll have follow-up appointments with your surgeon and other healthcare providers. Make sure to keep your appointments. If you have any problems or concerns, contact your healthcare team.