Once the prostate cancer has spread beyond the prostate gland itself, complete removal is the most common treatment. This procedure is called a radical prostatectomy. In this operation, the surgeon removes the whole prostate gland, seminal vesicles, and surrounding tissues. There are different ways this procedure can be done. Radical retropubic prostatectomy and Radical Perineal Prostatectomy are the top two methods, with the use of laparoscopic and robotic approaches on the rise.
Radical Retropubic Prostatectomy
For this operation, a surgical incision is made in your lower abdomen, from your belly button to your pubic bone. You will be under anesthesia for this procedure. The method of anesthesia will be up to you and your doctors but could range from a spinal epidural to being completely put under. Epidurals only number the lower half of the body, and in this case, you would also be given a sedative to help keep you calm and relaxed, most likely sleeping.
If your surgeon suspects that the cancer has spread to lymph nodes or other areas based on the results from the previous test, they might also discuss removing the lymph nodes as well. This is called a lymph node biopsy. In certain circumstances, these cells are tested while the surgery is happening. If there are cancer cells found outside of the margins and in the lymph nodes, there is a chance the surgery could be stopped, as the chances of “curing” the cancer at this stage is much harder and requires other forms of treatments.
During your surgery, a catheter will be put in place in your penis to help drain your bladder with no effort. A catheter is a thin, flexible tube that usually stays in place for one or two weeks while you regain your strength and heal. Once the catheter is removed, you will be able to urinate regularly again. With this type of prostatectomy, your activities will be limited for a few weeks, and your hospital stay will be a few days long.
Radical Perineal Prostatectomy
During this style of prostatectomy, the incision is made in the skin between the anus and scrotum, also called the perineum. This style of surgery is not as common because it highly effects the penile tissues, and often leads to erection problems. This is a shorter length surgery, however, but could be beneficial to someone who is not worried about erections and you do not need any lymph nodes removed.
This surgery also requires the installation of a catheter for up to two weeks while the healing process happens. Once removed, normal urination will resume.
Laparoscopic and Robotic Methods
Both laparoscopic and robotic prostatectomies are newer in style and innovation and are still being researched and perfected. If you are curious about these types of procedures, be sure to speak with your doctor and voice your questions. Some doctors are more experienced with this type of surgery than others.
With a laparoscopic radical prostatectomy, or “LRP,” the surgeon uses long instruments specially made to be inserted into the body via several small incisions. With this method, they can snip the prostate out of place, and remove through the same small holes. One of the inserted instruments is a camera to ensure the surgeon can see everything that is happening during the procedure.
Laparoscopic prostatectomies have shown certain advantages over open radical prostatectomies, although not enough testing has yet been done for the results of long term studies. Some of the reported advantages are less pain, less blood loss, shorter hospital stays, and a faster rate of recovery time. The rates of side effects from this type of surgery are similar to that of the open radical prostatectomy; erection problems and urine leakage are still reported in some cases. Recovery of bladder control with this method has been reported to take longer in some cases (NIH).
The robotic prostatectomy is the laparoscopic method but done using an entirely robotic system. This is a newer technology entering more hospitals nationwide. With these robotic machines, the surgeons sit at a control panel and move the arms through several small incisions in the patient’s abdomen. Studies report that robotic surgery allows for more precision when using the small instruments in such a delicate area. Even fewer surgeons are currently trained on robotic machines. If this is a style of surgery you are interested in, it is best to consult your doctor for a referral.
Side Effects of Prostate Removal Surgery
There are two major side effects of a radical prostatectomy that are reported to affect the most prostate cancer survivors for some amount of time. Urinary incontinence, which is the inability to control urine output, and erectile dysfunction, which is a problem getting, keeping, and maintaining an erection. These are common side effects that are most seen with many types of prostate cancer treatment, cancer treatments, and autoimmune protocol treatments as well.
There are three levels of urinary incontinence. Some have stress incontinence, which is the uncontrolled expelling of urine when you laugh, cough, sneeze, or even exercise. This is the most common type after prostate surgery and is usually caused from the sphincter and valve in the bladder being off sync. Prostate cancer treatments damage the muscles and nerves that keep those muscles working in sync together. Another type is overflow incontinence, which occurs when men cannot empty their bladders. This resembles the dribbling urine stream, interrupted flow, and forcing the urine out. This is usually caused by blockage or scar tissue. The last type is urge incontinence, which is the sudden need to urinate. This happens because the bladder becomes to sensitive when stretched full of urine. In certain serious circumstances, men who lose all ability to control their urine after surgery have what is called continuous incontinence.
Erection problems are common and referred to as erectile dysfunction. Another term for this is impotence. In men, erections are controlled by two small groups of nerves that run on either side of the prostate. If you are capable of achieving an erection before the surgery, your surgeon will take extra care not to disturb those important nerves. However, if the cancer has spread, those nerves will need to be removed as well.
Once the nerves have been removed, the ability for spontaneous erections will diminish. The ability to have an erection, however, will still be there. There are many ways to help the body achieve and hold an erection. While all men can expect some change and decrease in their erection ability with any prostate treatment, the ultimate outcome depends on the man, his age, health, erection ability prior to surgery, and if the nerves remained intact or were removed.
If you have had any sort of prostate surgery, expect the ability to achieve an erection to return slowly and be prepared for things to feel different, with new or altered pleasure points. For some men, regaining the ability to have an erection can take from two months to three years. Most doctors encourage any and all attempts at erection once the body has healed enough from surgeries. Some refer to this treatment as penile rehabilitation. During this time, your doctor might offer you some medications to assist in achieving said erection.
There are a few types of aides that would help you in treating erectile dysfunction. Some are:
Medications like Viagra, Levitra, and Cialis prescribed by your doctor. These medications can interact with other medications, so be sure to cover everything you are taking with your doctor any time you begin a new medication.
Alprostadil is a human-made version of the naturally occurring prostaglandin E1, which helps produce and keep erections. This is injected into the base of the penis minutes before sexual activity, with possibilities to increase the dosage to prolong the erection. The side effects reported are not serious, and many enjoy this method of achieving an erection.
Another option for obtaining an erection is a vacuum pump device that are placed over the penis, and the air pumped out of the chamber; thusly drawing blood into the penis, producing an erection. Using a rubber ring, or cock ring, the erection is maintained once the pump is removed.
If these methods fail, penis implants might be your saving grace. There are a multitude of implant types, including silicone and inflatable devices. A small operation is needed to install these, but after a short healing period, reports state that erections return with lots of practice.
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Secondary Side Effects from Prostate Removal Surgery
As with any surgery, there are often secondary side effects and issues that arise. Some of the other top reported side effects and concerns with prostate removal surgeries are changes in orgasm, loss of fertility, lymphedema, change in penis length, and the increased risk of hernias.
There are changes in orgasm because after the surgery, there will be no ejaculation of semen. In other words, the orgasm which can still be very pleasurable and deep, is dry. This happens because the organs and pieces that helped create the semen and fluids have been cut, removed, or damaged. In some men, they report their orgasms are not as powerful as they were prior to surgery.
Because the vas deferens are cut during prostate surgery, there is no longer a set path for the semen to take to exit the body. This means that the man cannot have a child the natural way, but still may be possible by extraction and implantation. If you are still considering having children, talk with your doctor as soon as possible in the process to ensure all of your life’s goals can still be achieved.
A rare, but very possible side effect from removing any lymph nodes around the body or prostate. Fluid can collect in the legs, genital region, or other body areas and cause great pain over time. This can be treated with physical therapy, although it may never completely be cured.
Any type of prostatectomy increases the chance of a male getting a future inguinal hernia in his groin area. These are common and can be treated. Another issue that affects men mentally is the change in penis length. After these surgeries, there is a reported shrinkage in many men, which is attributed to the shortening of the urethra when a part is removed along with the prostate gland.