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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016

4 Overview of cancer treatments

Surgical treatment

Surgical treatment

Surgical treatment may be an option if you are

healthy enough to have an operation. The goal of an

operation is to remove all the cancer from your body.

To do so, the tumor will be removed along with some

normal-looking tissue around its rim. The normal-

looking tissue is called the surgical margin. Other

tissue may be removed along with your prostate as

described next.

Radical prostatectomy

A radical prostatectomy is an operation that removes

the entire prostate, seminal vesicles, and sometimes

other tissue. It is often used when the tumor appears

not to have grown outside the prostate—T1 and T2

tumors. Less often, it is used when the tumor has

grown outside the prostate but not into other organs.

There are four main types of radical prostatectomy.

These types are described in this section.

Results of a prostatectomy may be related to the

experience of the surgeon. Surgeons who are

experienced have better results. When choosing your

surgeon, ask how many of these operations he or she

has done. Going to a surgeon who has and continues

to do many radical prostatectomies may result in

a better outcome. Talk to other men with prostate

cancer about their experiences.

There are a few steps to prepare for an operation.

You may need to stop taking some medications

to reduce the risk of severe bleeding. Eating less,

changing to a liquid diet, or using enemas or laxatives

will empty your bowel. Right before the operation, you

will be given anesthesia. Anesthesia may be general,

spinal, or epidural.

After a radical prostatectomy, a catheter will be

inserted into your urethra to allow your urethra to

heal. It will stay in place for 1 to 2 weeks. You will be

shown how to use it while you’re at home. If removed

too early, you may lose control of your bladder

(urinary incontinence) or be unable to urinate due to

scar tissue.

Open radical prostatectomy

Open radical prostatectomy removes the prostate

through one large cut. Your surgeon can make the cut

in one of two places.

Radical retropubic prostatectomy

. This surgery

removes tissue through a cut that runs from your

belly button down to the base of your penis. During

the operation, you will lie on your back on a table with

your legs slightly higher than your head.

Before removing your prostate, some veins and your

urethra will be cut to clear the area. Your seminal

vesicles will be removed along with your prostate.

After removing your prostate, your urethra will be

reattached to your bladder.

Your cavernous nerve bundles are on both sides of

your prostate. They are needed for natural erections.

A nerve-sparing prostatectomy will be done if your

cavernous nerves are likely to be cancer-free.

However, if the cancer involves them, one or both

bundles of nerves will be removed. If removed, good

erections are still possible with aids, and orgasms can

occur with or without these nerves.

It takes between 90 minutes and 3 hours to complete

this operation. You may stay 1 to 2 days in the

hospital. It takes about 2 weeks to feel very well, and

4 to 6 weeks to resume all normal activities.