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Prostate Cancer Surgery

Prostate cancer surgery  also known as a radical prostatectomy,  is a surgical procedure whereby the prostate gland and attached seminal vesicles are removed. Lymph nodes near the prostate are usually removed at the same time. Radical prostatectomy is one option for men with clinically localized prostate cancer.

Potential advantages include the following:

1) once the prostate is removed and studied by a pathologist, one has an accurate assessment of cancer aggressiveness (extent and grade),

2) follow-up after surgery is relatively straightforward, the serum PSA level should be undetectable. Recurrence of cancer is relatively easy to detect because of this.

3) radiation can be given after surgery, if necessary, with a low risk of any additional side effects and

4) surgery appears to be associated with a very low risk of late (i.e. beyond 5 years) local recurrence if careful and sensitive PSA testing is performed.

Patients who are in good health, have a long life expectancy and have cancers which appear to be confined to the prostate gland are candidates for radical prostatectomy. The procedure is associated with a limited risk of side effects and major complications are very rare.  Some men may be candidates for a nerve-sparing radical prostatectomy whereby sexual function preservation is attempted (though can not be guaranteed).

Prostate Cancer Surgery From A Patients Point of View

Radical Prostatectomy
- A Patient Guide    
page 1 of 6 pages- follow the links at the bottom of each page

Peter Carroll, MD, FACS, Department of Urology,  Comprehensive Cancer Center

University of California, San Francisco 

information last updated on July 2006

What is a radical prostatectomy?

A radical prostatectomy is surgery to remove the entire prostate gland and regional lymph nodes after a diagnosis of prostate cancer is made. Radical prostatectomy is one of many options for the treatment of prostate cancer. You should discuss all options with your physician.

Radical prostatectomy can be done via an incision made in the abdomen (radical retropubic prostatectomy) or in the perineum, the area between the scrotum and the anus (radical perineal prostatectomy). Alternatively, it may be done with laparoscopy (laparoscopic radical prostatectomy). Laparoscopy is a technique is which surgery is performed by making small incisions and passing specially designed telescopes and instruments into the body.

  Laparoscopic radical prostatectomy is a new technique, which may result in less discomfort and earlier return to work. Whether or not it results in the same level of cancer cure and preservation of urinary continence and sexual function is unknown at this time.

In addition to removing the prostate gland, the lymph nodes in the area of the prostate may be removed either before or during the same operation. This is done in order to determine if there has been spread of the prostate cancer to the lymph nodes. This procedure is called pelvic lymph node dissection.. The risk of having cancer in the lymph nodes can be estimated and only men with a moderate or high risk of pelvic lymph node metastases need to undergo pelvic lymph node dissection. This includes men with PSA values in excess of 15 ng/ml or high-grade cancers.

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