Prostate cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy. Radical prostatectomy has traditionally been used alone when the cancer is small. In the situation of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival.

• Surgical removal of the prostate, or prostatectomy, is a common treatment either for early stage prostate cancer, or for cancer which has failed to respond to radiation therapy.^[1]
• Radical prostatectomy is effective for tumors which have not spread beyond the prostate.^[2]
• Radical prostatectomy has traditionally been used alone when the cancer is small. In the event of positive margins or locally advanced disease found on pathology, adjuvant radiation therapy may offer improved survival.
• Surgery may also be offered when a cancer is not responding to radiation therapy.

• Common types of radical prostatectomy include:

• Radical retropubic prostatectomy (removing the prostate through an abdominal incision)
• Radical perineal prostatectomy (removing the prostate through an incision in the perineum, the skin between the scrotum and anus)

• Laparoscopic radical prostatectomy (LRP), is a new way to approach the prostate surgically with intent to cure. Contrasted with the open surgical form of prostate cancer surgery, laparoscopic radical prostatectomy does not require a large incision. Relying on modern technology, such as miniaturization, fiber optics, and the like, laparoscopic radical prostatectomy is a minimally invasive prostate cancer treatment.

• Transurethral resection of the prostate, commonly called a "TURP", is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked by prostate enlargement. TURP is generally for benign disease and is not meant as definitive treatment for prostate cancer. During a TURP, a small instrument (cystoscope) is placed into the penis and the blocking prostate is cut away.^[3]

• Loss of urinary control
• Impotence^[4]

• In metastatic disease, where cancer has spread beyond the prostate, removal of the testicles (called orchiectomy) may be done to decrease testosterone levels and control cancer growth.^[5]

• Psychological effects^[6]
• Loss of libido
• Less reversible impotence
• Hot flashes
• Osteoporosis

• Cryosurgery is another method of treating prostate cancer in which the prostate gland is exposed to freezing temperatures. It is less invasive than radical prostatectomy, and general anesthesia is less commonly used.

• Under ultrasound guidance, metal rods are inserted through the skin of the perineum into the prostate. Highly purified Argon gas is used to cool the rods, freezing the surrounding tissue at −186 °C (−302 °F). As the water within the prostate cells freeze, the cells die. The urethra is protected from freezing by a catheter filled with warm liquid.

• Cryosurgery generally causes fewer problems with urinary control than other treatments, but impotence occurs up to ninety percent of the time.^[7]

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