| Surgical removal of the prostate, referred to as radical prostatectomy, is a popular form of treatment for American men, and is especially valuable for young men with organ-confined cancer.
There are three open prostate cancer surgery principals to radical prostatectomy:
Retropubic prostatectomy: Removal of the prostate through an incision in the lower abdomen.
| Advantages |
Disadvantages |
- Best for large cancer
- Most definitive treatment available
- Optimal surgical margins
- Pelvic lymph node dissection allows accurate staging
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- Major surgery
- Difficult for men with other health problems
- Risk of blood loss and transfusion
- Impotence rate high
- Risk of incontinence
- Doesn’t treat cancer if already metastasized
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Nerve-sparing prostatectomy: A variation on retropubic prostatectomy in which the surgeon preserves the nerves and blood vessels at the edge of the prostate, thereby preserving potency in many men.
| Advantages |
Disadvantages |
- Most definitive treatment available
- Greatest probability of retaining potency after radical prostatectomy
- Optimal surgical margins
- Pelvic lymph node dissection allows accurate staging
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- Major surgery
- Not possible with large cancer
- Riskier than other methods when cancer is bilateral
- No guarantee that potency will be retained
- Risk of blood loss and transfusion
- Risk of incontinence
- Doesn’t treat cancer if already metastasized
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Perineal prostatectomy: Removal of the prostate through an incision in the skin between the scrotum and anus.
| Advantages |
Disadvantages |
- Most definitive therapy available
- Best for overweight men
- Safest for men with other health problems
- Easiest access to the prostate
- Shortest operating time for some surgeons
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- Major surgery
- Poor for large cancer
- Does not allow intraoperative lymph node dissection
- Least successful surgery for avoiding positive margins
- Risk of blood loss and transfusion
- Impotence rate high
- Risk of incontinence
- Doesn’t treat cancer if already metastasized
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Each of these approaches has advantages and disadvantages. If you elect surgery, have your doctor explain his or her preference and the reason for that preference. It is likely that a surgeon is only proficient in one or two of these methods. Specifically, find out how many of each operation the surgeon has performed in the past year or so.
An alternative to open prostate cancer surgery is Laparoscopic Radical Prostatectomy. Patients experience less pain, less bleeding and faster recovery according to American Cancer Society. To find out more please visit www.laprp.com.
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