Prostate Cancer Slideshow Pictures Medical Illustrations of the Prostate Image Collection Screening Tests Every Man Needs Slideshow Pictures

Medical Author:

Kevin C. Zorn, MD, FRCSC, FACS

Coauthor:

Gagan Gautam, MD, MCh (Urology)

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Surgery

Radical prostatectomy is surgical removal of the entire prostate. This operation is indicated for cancer that is limited to the prostate and has not invaded the capsule of the prostate, any other nearby structures or lymph nodes, or distant organs.

• The entire prostate, seminal vesicles, and ampulla of the vas deferens are removed, and the bladder is connected to the membranous urethra to allow free urination.



• Complications of this procedure include urinary incontinence and impotence. Newer techniques spare the nerve that controls urination and erection. Of men who undergo these newer techniques, 98% are continent, and 60% are able to have an erection.



• Radical prostatectomy can be combined with radiation therapy in men with cancer that is even further isolated in the prostate area. There is an excellent survival rate if cancer has not spread.



• Be certain you understand the risks and benefits of this procedure before deciding to go ahead.



• Radical prostatectomy can be performed by open surgery, laparoscopic surgery, or by robotic surgery (robotic assisted radical prostatectomy). Currently, almost 70% of radical prostatectomy surgeries in the U.S. are performed with the help of the Da Vinci robotic system. For robot-assisted surgery, five small incisions are made in the abdomen through which the surgeon inserts tube-like instruments, including a small camera. This creates a magnified three-dimensional view of the surgical area. The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. The instrument tips can be moved in a variety of ways under the control of the surgeon to achieve greater precision in surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancer-free survival rates, urinary continence, and sexual function. However, in terms of blood loss during surgery and pain and recovery after the procedure, robotic surgery has been shown to have a significant advantage.

Transurethral resection of the prostate (TURP) is an alternative to radical prostatectomy.

• Only part of the prostate is removed by an instrument inserted through the urethra.



• An electric current passes through a small wire loop at the end of the instrument. The electrical current cuts away a piece of the prostate.



• This procedure is used to remove tissue that is blocking urine flow in patients with extensive disease or those that are not fit enough to undergo radical prostatectomy. It is not considered a standard-of-care procedure for if cure is intended.