Surgical removal of the prostate is felt to be the standard therapy for localized prostate cancer. Simply, the entire prostate is removed and the bladder is reconnected to the urethra (channel through the penis). Removal of part of the prostate or just the cancer is not recommended. Too many prostate cancers have multiple areas of involvement within the gland that are undetected, making partial removal a poor choice. Also, partial prostatectomy is not technically feasible.
The major advantages of total prostate removal is the simple fact that if the cancer is localized to the prostate, as we believe, then removal of the prostate will cure the cancer -- it is out!
Incontinence — 2-4% of men will have permanent problems with urinary control--they will require some form of protection (diapers or pads). In those rare cases, a surgical appliance can be implanted to control incontinence if it does remain a problem.
Impotence — The nerves that stimulate erections run adjacent to the prostate on their way to the penis. If all of these nerves are removed during total prostatectomy, impotence (inability to achieve an adequate erection) will result. In certain circumstances, some of the nerves that create erections can be spared with a success rate between 40-70%. Not every male is a good candidate for nerve sparing because of the extent of disease. Patients who develop impotence, and even those whose erections were not adequate before the surgery can be treated with a variety of modalities. Treatment of impotence in post-prostate surgery includes vacuum pumps, self injections of medications and placement of prostheses -- all of which work, and work well in selected patients.
Blood Loss — Radical prostatectomy carries with it an average blood loss of greater than one unit of blood. On occasion, the blood loss can be more than three or even four units. To prevent the use of bank blood we have been asking patients to store their own blood for subsequent use, if needed. Easy to do, and clearly the safest way to receive blood.
Surgical Complications — Pain, infection, anesthetic problems, pneumonia, blood clots, and heart problems can occur with any major operation. Unique to prostatectomy are injury to the rectum (adjacent to the prostate), and scarring of the new connection between the bladder and urethra, which might require stretching, in the office or in day surgery.
Recovery Time — The operation lasts two to three hours and the hospitalization usually lasts 2 to 3 days. All patients go home with a catheter in place, continually draining the urine into a special leg bag. You will be seen two weeks after discharge from the hospital to have the catheter removed. Most men have poor urinary control at the beginning and will require some form of protection, such as a diaper. Within three weeks, most men have achieved reasonably good control and require minimum protection and have resumed their normal activities. Sometimes, the recovery is slower, but rarely more than three to six months.