Radical Prostatectomy (complete tumor removal)
Radical prostatectomy is a surgical treatment option for prostate cancer involving removal of the entire prostate, seminal vesicles, and lymph nodes. Here, we’ll explain what radical prostatectomy is, how it’s performed, its potential benefits, and what to expect during recovery. This surgery is currently the most common treatment approach and is an established, tried-and-tested method. It has been used to treat localized prostate carcinoma for many years.
High Volume Expertise at Fore River Urology
The surgeons at Fore River Urology have been performing radical prostatectomy for many years, consistently improving technique and outcomes for their patients. Their extensive expertise in this operation optimizes cancer cure while securing the best possible quality of life for patients after such procedures. Each operation is customized to the patient’s cancer and quality of life priorities providing true personalized care.
Fore River Urology is a high volume prostate cancer center with multiple surgeons performing radical prostatectomy, offering both open radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy (Da Vinci) to address each individual patient’s clinical situation.
Open or robotic-assisted laparoscopic surgery?
Fore River Urology utilizes both surgical techniques. This makes it possible to tailor the surgical method to each patient’s specific clinical scenario. Most patients are equally suitable candidates for both methods.
Complete removal of the prostate in open surgery
The conventional technique is known as radical retropubic prostatectomy. In this method, the prostate is removed via a vertical midline incision in the lower abdomen below the umbilicus (navel) and the top of the pubic bone. This operation is often performed using microsurgical technology, including special loupes for magnification.
Minimally invasive, robotic-assisted surgery
This method is applied at Fore River Urology using the da Vinci® surgical system. The operating surgeon perf
orms the procedure using a robotic surgical system, which is fitted with surgical instruments and a camera system that provides a three-dimensional vision. Surgeries are performed at Northern Light Mercy Hospital which is part of the Dana Farber Cancer Care Collaborative.
Side effects and risks
Many men shy away from surgery due to fear of incontinence and/or impotence. These issues occur when the neurovascular bundles located very close to the prostate are damaged or removed during the operation, or when the sphincter that controls the flow of urine cannot be entirely spared. At Fore River Urology’s Prostate Cancer Center, we place critical emphasis on preserving patients’ potency and continence when removing the prostate.
Continence
Our patient’s foremost concern about their recovery following prostate cancer treatment is continence. There are many factors that influence this outcome: patient age, any comorbidities, nerve-sparing approach, prior operations, baseline urinary function. However, a decisive factor in preserving continence is dissecting the urethra in a way that preserves the full functional length of the sphincter and reconstructs its proper anatomic fixation within the pelvic floor. This surgical technique is utilized in both surgical methods – in conventional open surgery as well as in robotic-assisted surgery using the da Vinci system. There is no statistical difference between the two surgical techniques in terms of the continence rate.
At 3 months after surgery, ~75% of patients will be either pad-free or utilizing 1 thin pad per day. By 1 year post-surgery, 90% of patients will be pad free with only 1-3% using > 3 pads per day.
However, if patients do have persistent incontinence following radical prostatectomy, there are options available to become pad free such as a male urethral sling or artificial urinary sphincter.
Potency
The majority of men will have some level of decline in their erections, dependent on the specific cancer characteristics, staging, and location within the prostate. However, this decline can be reduced by performing nerve-sparing prostatectomy in appropriately selected patients – namely for those that it will not compromise cancer cure. You should speak with your surgeon about expectations as many men will require medication to enable erections to return to their baseline level.