Prostatectomy refers to the surgical removal of a part or the whole of the prostate gland. Prostatectomy is the therapeutic approach commonly chosen to treat patients with prostate cancer that has not yet spread beyond the prostate gland, and the surgery is therefore a suitable option for patients with stage T1 or T2 prostate cancer.
The most common form of prostatectomy is radical prostatectomy which involves removal of the entire prostate gland along with some of the surrounding tissue and the seminal vesicles.
Types of radical prostatectomy
There are several forms of radical prostatectomy and these include:
Open approach or traditional prostatectomy
Here the surgeon operates through a single long incision in the patient's flesh and removes the prostate gland and surrounding tissues. There are two forms of open prostatectomy:
Radical retropubic prostatectomy - For this procedure, the incision is made between the navel and the pubic bone The prostate gland and surrounding tissues as well as sometimes the lymph nodes are carefully removed while special attention is paid not to damage the bundles of nerves on either side of the gland because they control erection. This is called the nerve-sparing approach. If the cancer is growing very near to the nerves or already involves the nerves, they will need to be removed and the patient will no longer be able to achieve spontaneous erections.
Radical perineal prostatectomy - For this procedure, the incision is made in the flesh between the anus and the scrotum and the prostate gland is removed. This approach is less popular as it does not allow for lymph node removal and the nerves cannot be spared easily. On the other hand, the procedure is faster than radical retropubic prostatectomy and recovery may be less painful. This procedure may therefore be preferred by individuals who do not want the nerve sparing procedure and do not need their lymph nodes removed.
Laparoscopic radical prostatectomy
This modern form of radical prostatectomy involves only small incisions being made for the insertion of a fibre-optic instrument and four trocars or cutting instruments. These are used to separate and remove the prostate, nearby tissue and lymph nodes. Compared with open prostatectomy procedures, this more modern approach causes significantly less bleeding, allowing a more stable operative procedure and minimizing the need for transfusion or longer hospital stays and recovery time.
Robotic-assisted laparoscopic radical prostatectomy (RALRP)
Another recent approach is RALRP where, again, only small incisions are made in the patient's abdomen but, during this procedure, the insertion and manipulation of the surgical instruments is controlled remotely using a robotic interface. The surgeon sits at a control panel a little distance form the operating table and controls the instruments using robotic arms.
The advantages of RALRP are similar to those of direct LRP, with the patient losing less blood and less likely to suffer pain or require a long hospital stay or recovery time. However, so far, there seems to be no significant benefit of RALRP over direct LRP.
Reviewed by Sally Robertson, BSc