Definition:
Radical prostatectomy is surgery to remove all of the prostate gland and some of the tissue around it, to treat prostate cancer. See also: Prostate resection - minimally invasive
Alternative Names:
Prostatectomy - radical; Radical retropubic prostatectomy; Radical perineal prostatectomy; Laparoscopic radical prostatectomy; LRP; Robotic-assisted laparoscopic prostatectomy; RALP; Pelvic lymphadenectomy
Description:
There are four main types of radical prostatectomy surgery. These procedures take about 3 to 4 hours: - Radical retropubic prostatectomy: Your surgeon will make an incision (cut) starting just below your belly button and reaching to your pubic bone. The entire surgery should take 90 minutes to 4 hours.
- Laparoscopic radical prostatectomy: The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This helps the surgeon see inside your belly during the procedure.
- Robotic-assisted laparoscopic prostatectomy: Sometimes laparoscopic surgery is done using a robotic system. The surgeon moves the robotic arm while sitting at a computer monitor near the operating table. Not every hospital can do robotic surgery.
- Radical perineal prostatectomy: Your surgeon makes a cut in the skin between your anus and base of the scrotum (the perineum). The cut is smaller than with the retropubic technique. This makes it harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. Perineal surgery usually takes less time than the retropubic way. There is also less blood loss.
For these procedures, you will be asleep (under general anesthesia) or receive medicine to numb the lower half of your body (spinal or epidural anesthesia). - The surgeon removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid filled sacs next to your prostate, are also removed.
- The surgeon tries carefully not to damage nerves and blood vessels.
- The surgeon reattaches the urethra to a part of the bladder called the bladder neck. The urethra is the tube that carries urine from the bladder out through the penis.
- Many surgeons will also remove lymph nodes in the pelvis to check for cancer.
- The surgeon may leave a drain, called a Jackson-Pratt drain, in your belly to drain extra fluids after surgery.
- A tube or urinary catheter is left in your bladder to drain urine.
Why the Procedure Is Performed:
Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. Healthy men who will probably live 10 or more years often have this procedure. Other treatment options for prostate cancer are: - External beam radiation therapy
- Implant radiation therapy (brachytherapy)
- Hormone therapy (androgen deprivation therapy)
- Cryotherapy of the prostate
- Visits with your doctor and tests to check for changes in your prostate cancer (called active surveillance)
Sometimes, your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.
References:
Su L, Smith JA. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 99. Walsh PC, Partin AW. Anatomic radical retropubic prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 97. Hartke DM, Resnick MI. Radical perineal prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 98.
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