Prostatectomy is one of the most commonly-used options in the treatment of prostate cancer. What it means is the surgical removal of all or part of the prostate gland.
Usually, it’s men with early-stage cancer, cancer that is located only in the prostate, who undergo radical prostatectomy. This is a straightforward procedure that consists of the removal of the entire gland along with some surrounding tissue. Men with advanced or recurrent cancer typically have little option but to undergo more complicated surgical procedures.
If you are facing this surgery, here is what you should expect. In the most common type of prostatectomy – a radical retropubic prostatectomy – a small incision is made into the abdomen and the prostate is cut out from behind the pubic bone. Having removed the prostate, the surgeon stitches the urethra directly to the bladder so that urine will continue to flow.
The surgeon will also insert a catheter or tube into the bladder. This is a short-term measure because it usually takes a few days for the body to adapt to the new system. In the meantime, with the catheter in place, urine will flow automatically out of the bladder, through the urethra and into a collection bag without any need for conscious control of the sphincter muscle. You can expect to wear this catheter for up to ten days.
Some surgeons prefer a slightly different form of prostatectomy – the radical perineal prostatectomy. In this procedure, the surgeon makes the incision into the perineum – the space between the scrotum and the anus – and the prostate is removed from behind.
There are other surgical options too. In a nerve-sparing prostatectomy, the surgeon cuts to the very edges of the prostate, taking the utmost care to spare the erectile nerves that run alongside the gland. Unfortunately, in some cases, the cancer may already have spread into these nerves and they too may have to be removed.
If this happens, the surgeon will try to surgically attach or graft nerves from other parts of the body to the ends of the cut erectile nerves. It is not always possible but all efforts will be made to do so.
Another option is laparoscopic surgery. In this procedure, very small incisions are made in the abdomen, into which the surgeon inserts narrow instruments fitted with cameras and/or surgical tools. These will allow the surgeon to see and to operate on internal organs without opening the entire abdomen.
While these procedures are quite different, essentially, all of them offer the same degree of risk and possible benefits. When it comes to making a choice, It’s not the type of surgery that ought to concern you most but the surgeon performing that surgery.
A prostatectomy – no matter which type – is a delicate procedure. The difference between a good and a very good surgeon can be huge when it comes to the eventual outcome and possible long-term side effects.
This means that you should take your choice of surgeon extremely seriously. Ensure that they are someone you can put your utmost confidence in. Make sure they have lots of experience in this particular type of surgery. After all, not all procedures go according to plan. Your surgeon may need to make a split-second decision that will have ramifications for you and your body for the rest of your life. You need to be sure that they will make the right call. Your body, your chances of beating cancer and maybe even your life depend on it.
Once your surgery is complete and successful, you will then be able to embark on recovery. However, you will always have to pay attention to your body in future. If cancer is to recur, you must catch it early. The earlier treatment is begun, the better the eventual outcome.