Surgical removal of the prostate gland (prostatectomy) is one of the most common treatments for men with prostate cancer. Until recently, doctors had two choices for performing a prostatectomy:

• Standard surgical procedure ("open" removal): This involves cutting a 4 – 10" surgical incision through which the prostate is removed. The recovery from this surgery is lengthy because of the time the operation takes, the amount of blood loss and the trauma of the procedure.
• Laparoscopic approach: The laparoscope is a rigid tube with a light and camera on the end. This surgery involves making a few small incisions (each less than 1/2 inch in length) rather than the one large cut made during the open approach. The laparoscope is inserted through one of the incisions and long-handled surgical instruments are inserted through other incisions. While looking through the eyepiece at the end of the laparoscope, the surgeon manipulates the instruments and removes the prostate. Smaller incisions mean less trauma and blood loss, a lower risk of infection, and a reduced recovery time. In 2004, computer-assisted robotic surgery became available.

What Happens During Surgery?

During the radical prostatectomy, your doctor carefully examines all of the organs and tissue in the area around the prostate gland to check for any visible signs of cancer located outside the gland. Your doctor may remove the lymph nodes in the region of the prostate and may have a pathologist examine them under a microscope to see if they contain cancer. If the lymph nodes are free of cancer, your doctor removes the prostate gland, the part of the urethra that passes through it and both seminal vesicles. Sometimes the cancer has spread to these areas. Once all of the tissue is removed, the urologist will stitch the remaining urethra to the opening of the bladder. A Foley Catheter will be inserted to drain urine after surgery and allow the area to heal. Then the incision is closed. The skin is closed with sutures that dissolve on their own.

Side Effects

The main side effects of radical prostatectomy (RP) are incontinence and ED.

Normal bladder control usually returns within several weeks or months after surgery. Passing a small amount of urine when coughing, laughing, sneezing, or exercising may last a long time in up to 35% of men. Some patients (between 1% and 5%) have more serious stress incontinence, which may be permanent.

During the first 3 to 18 months after a radical prostatectomy, most men will have erectile dysfunction and will need to use medicines or other treatments if they want to have an erection. The effect of this operation on a man's ability to achieve an erection is related to the patient's age, his ability to get an erection before the operation, and whether nerve-sparing surgery was done.

Nearly all men who have an RP should expect some permanent decrease in their ability to have an erection, but younger men may expect to retain more of their ability. If the surgeon does not remove the nerves on either side of the prostate during prostatectomy, the impotence rate is between 25% and 30% for men under 60. But it occurs in 70% to 80% of men over 70, even if nerves on both sides are not removed.

Incontinence and ED are reported less often among men treated at major cancer centers, such as Roswell Park, where this type of surgery is performed on a more routine basis.