December 15th, 2015
The prostate is a male gland underneath the bladder and in front of the rectum that produces fluids that carry sperm. Prostatectomy is the surgery to remove part or the entire prostate. There are several different types of prostatectomies depending on the stage of cancer and your age.
Surgery is a common way to cure prostate cancer if it has not yet spread outside the prostate gland, and radical prostatectomy is the most common form. Typically, a surgeon removes the entire prostate gland and some tissue around it. This procedure is called a radical prostatectomy. Radical prostatectomy is better suited for younger men who have a fast growing tumor that needs intense and quick treatment. If you are older with a slow growing tumor, many doctors believe it isn’t worth the risk of side effects – most men in this category are likely to die of old age or another cause before prostate cancer becomes deadly. The main possible side effects of radical prostatectomy are urinary incontinence (inability to control urine) and erectile dysfunction.
During nerve-sparing prostatectomy, a surgeon cuts the edge of the prostate in order to spare the nerves. Sometimes this is not possible because the cancer extends beyond the prostate. Also possible is the ability to graft nerves from another part of the body to the end of the cut erectile nerves. A surgeon won’t know if nerve sparing is possible until surgery begins. This is the best way to preserve long-term erectile function.
Less invasive than radical prostatectomy, a camera is inserted through the abdomen and a robotic instrument is directed to the prostate gland and surrounding tissue. Though it causes less pain, the sexual and urinary side effects are similar to a radical prostatectomy.
Because prostate cancer can grow slowly, some men benefit most from active surveillance. This includes monitoring the cancer closely with blood tests, digital rectal exams, and ultrasounds to ensure the cancer is not growing.
The likelihood of cancer spreading depends on the aggressiveness of the cancer and age. More than 80% of men who undergo a radical prostatectomy lived at least 10 years, and 60% lived at least 15 years. For men younger than 65 who have early-stage cancer, those who had surgery lived longer than those who used active surveillance. Men older than 65 with early-stage cancer and underwent surgery lived just as long as men who underwent active surveillance.
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