Lesson 3: Prostate Cancer Treatment Options
Radical Prostatectomy
This operation removes the entire prostate gland plus some tissue around it and is used most often if the cancer is thought not to have spread outside of the gland. The patient is either under general anesthesia (asleep and totally unconscious) or under spinal or epidural anesthesia (the same type of anesthesia often given to women during childbirth to numb the lower half of the body) with sedation during the surgery.
Retropubic approach Perineal approach
Fig 3. Radical Prostatectomy
There are two main types of radical prostatectomy: radical retropubic prostatectomy and radical perineal prostatectomy. In the retropubic operation, the surgeon makes a skin incision in the lower abdomen. The surgeon can remove lymph nodes during this operation through the same incision. A nerve-sparing radical retropubic prostatectomy is a modification of this operation. During this procedure, the surgeon carefully feels the small bundles of nerves on either side of the prostate gland. If it appears that the cancer has not spread to these nerves, the surgeon will not remove them. Because these are the nerves that are needed for erections, leaving them intact lowers (but does not eliminate) the risk of impotence (not being able to have an erection) following surgery.
The radical perineal prostatectomy removes the prostate through an incision in the skin between the scrotum and anus. Nerve-sparing operations are more difficult by this approach and lymph nodes cannot be removed through this incision. If lymph node examination is needed for men having a radical perineal prostatectomy, the surgeon can remove some lymph nodes through a very small skin incision in the abdomen or by using a laparoscope. A laparoscope is a long slender tube through which a surgeon can view and remove lymph nodes near the prostate gland. (National Comprehensive Cancer Network)
Other considerations: The prostate surgery can be carried out in most hospitals so chances are you will not have to relocate to be treated. You will be in the hospital 3 to 5 days, possibly longer if you have an infection. You will likely be off the job up to 6 weeks depending on the type of work you do. Keep in mind you won’t be able to do any heavy lifting or strenuous labor during the healing time.
There is a psychological advantage for some men knowing that the cancer is cut out and gone. The other forms of treatment rely upon technology and if your faith in technology is low then surgery may win by default.
There is a chance that the Urologist may not be able to remove all of the prostate cancer cells and will need to refer you, after surgery, for external beam radiation treatment (see below). Treatment courses generally last about 6 to 6.5 weeks and involve the same short and possible long-term side effects as described below. Unfortunately, you will be at risk for side effects from both treatments (some of which may be worse with both treatments, e.g., impotence or incontinence), and the chance of cure with both may not be as high as for radiation therapy alone.
The risk of needing radiation therapy after surgery can be estimated BEFORE surgery using published tables (Kattan nomograms http://www.mskcc.org/mskcc/html/5331.cfm or Partin tables http://www.phoenix5.org/Infolink/partin/... and depends on the T stage, Gleason Score, and pre-surgical PSA. For cancer that has penetrated through the wall of the prostate, the risk is increased. For a typical low-risk patient (T1-2, Gleason <6, PSA < 10), the risk is about 20% while for patients with intermediate risk disease (T1-2, Gleason 7, PSA < 20), the risk approaches 50%.
