Types of Surgery
According to Medline there are four main approaches that surgeons can take when performing prostate cancer surgery. The simplest approach is called a radical retropubic prostatectomy. With this approach, the surgeon accesses the prostate by making an incision from just below the belly button to the pubic bone. Another approach is the laparoscopic radical prostatectomy, in which several small cuts are made instead of one large cut. With this approach, a small flexible camera (called a laparoscope) is used to help the surgeon see the prostate. Then, specialized tools are used to help cut the prostate away. Some hospitals have the ability to perform robotic-assisted laparoscopic procedures, in which the surgeon is able to control a robotic arm to perform the surgery. Finally, some surgeons prefer to perform a radical perineal prostatectomy. This procedure involves the making of a cut from the anus to the base of the scrotum. Because this cut is smaller, there is less bleeding and the surgery is faster. However, there is an increased risk of nerve damage with this approach.
Procedure
The American Urological Association Foundation notes that, regardless of the approach, once the incision is made, the surgeon will work to gain access to the prostate gland by pushing other tissue out of the way. The surgeon then removes the prostate while attempting to not damage any of the nerves or blood vessels in the area. Because the prostate surrounds a small part of the urethra, which is the tube that urine passes through during urination, a small section of the urethra is also removed. The surgeon will then reattach the rest of the urethra to the bladder. Many surgeons also remove some of the nearby lymph nodes to see if the prostate cancer has spread. At the end, the surgeon will sew the patient back up and allow him to recover.
Analysis and Recovery
Typically, while the patient is recovering, the prostate tissue as well as any lymph nodes are sent to a pathologist for further analysis. The pathologist will be able to place some of the removed tissue on a glass slide and look at it under a microscope. This will allow the pathologist to look at the cancer cells and see how abnormal they are (which can be helpful for determining the patient's prognosis) as well as look at the lymph node tissue to see if the cancer has spread to the lymph nodes. Generally, the patient will need to stay in the hospital for one to four days (unless he has received laparoscopic surgery, in which case he will not need to stay in the hospital overnight). Although the patient will need to stay in bed until the morning after the surgery, afterward he will be encouraged to be as active as possible.
