Roswell Park has performed more than 3,500 robot-assisted radical prostatectomies, making our surgeons some of the most experienced in the nation
Surgery for prostate cancer involves an operation called radical prostatectomy. This removes the entire prostate gland and some surrounding tissue, the seminal vesicles and sometimes nearby lymph nodes.
Roswell Park performs all prostate cancer surgeries with minimally invasive robotic surgery that typically results in easier recovery, less pain and fewer complications. In some patients, we are able to preserve continence and sexual function using specific surgical techniques that we developed here at Roswell Park:
- Urethral-sparing approach that results in faster recovery of urinary control
- Hydrodissection technique that uses saline to gently push the nerves responsible for erectile function away from the prostate during prostatectomy for better preservation.
Who should consider surgery for prostate cancer?
Your doctor will discuss whether surgery might be an option for you based on several factors, including how aggressive your cancer is (based on your risk assessment group), your age, health and life expectancy, as well as the risk for side effects, such as incontinence and erectile dysfunction. Surgery may be one of your options to consider if:
- Your prostate cancer is contained within the prostate gland.
- You are younger than age 65-70, with 10 years or more life expectancy, and you want the cancer removed.
- Your cancer has grown rapidly or increased aggressiveness during active surveillance.
- You have advanced tumors and surgery can be safely combined with radiation or hormone therapy to improve your outcome.
- You have existing problems with urination (surgery can treat both the cancer and the urinary symptoms).
Who should avoid or delay surgery?
Surgery may not be the best first choice for everyone. Other treatment options like active surveillance, focal therapy with HIFU, or radiation are often preferred for men with:
- Low-risk cancer. These slow-growing tumors do not pose an immediate threat to life.
- Older age or poor health. The risks of surgery may not outweigh the potential benefits for men with a life expectancy under 10 years or with severe medical conditions, such as advanced heart disease.
Pelvic floor rehabilitation
Pelvic floor rehabilitation is a type of physical therapy that can help you to isolate and control the muscles around your bladder. After prostate removal surgery, you will no longer have the prostate or internal sphincter to support your bladder, which can make it difficult to hold your urine. Pelvic floor contraction exercises can help you strengthen these muscles and gain better control of urination.
Roswell Park’s Rehabilitation team has therapists specifically trained in pelvic floor therapy.
From our blog: Pelvic floor therapy can treat bladder, bowel and sexual function problems
Roswell Park offers private, one-on-one pelvic floor therapy. A session with one of our pelvic floor therapists offers a safe and private place to discuss these personal and important aspects of health.
Prostate cancer surgery FAQs
Most men do not have a recurrence after prostate surgery. It can occur however, due to remaining microscopic cancer cells. This occurs in roughly 30% of patients. The greatest risk for recurrence is during the first five years after surgery. The more years that pass after surgery, the less likely it becomes.
Your personal risk will depend on several factors including how aggressive your cancer is, and whether cancer was found outside of your prostate or in the surgical margin after it was removed.
Fear and anxiety about cancer recurrence is understandable. That’s why it’s important to continue follow-up visits with your care team who will closely monitor you. Most men who experience a recurrence have what’s called a biochemical recurrence, which means your PSA has increased to a certain level. This is not an immediate medical emergency. You and your care team have time to evaluate your options and decide on your next steps.
The procedure is performed under general anesthesia and you will likely remain in the hospital overnight. A soft plastic tube called a Foley catheter will be inserted into your bladder to drain your urine into an attached collection bag. This is temporary and will be removed within 7 to 14 days. Our team will teach you how to care for your catheter a home to prevent infection and complications.
It is normal to have some pain after minimally invasive surgery and is usually managed well with non-narcotics like acetaminophen and ibuprofen or a patient-controlled analgesia (PCA) pump. Healing pads and ice packs can help reduce swelling.
Patients usually are able to go home the next day. You will be given instructions on how to care for your wound and catheter, limit your activity, and manage any pain.
Side effects of surgery to remove the prostate may include changes to your urination and sexual function. Urinary side effects may include needing to empty your bladder more frequently, and the feeling you get from your bladder when it needs to be emptied may change initially. You may need to wear an underwear liner and use pelvic floor exercises until you can recognize these new feelings in your body. Problems with leakage tend to resolve within 3 to 12 months. If yours persist, talk to your physician about treatments that can help.
You may experience some changes to your sexual function. This may range from a temporary change in your libido or sex drive to longer term physical changes. Coping with sexual changes after treatment can be difficult. It’s important that you speak openly about these with your physician because a number of treatment options are available.
At Roswell Park, our team consistently performs above the national average in preventing those side effects.