Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

c. Radical Prostatectomy

The concept behind the surgical approach toward cancer treatment is simple: isolate the tumor and cut it out. Unfortunately, in practice, nothing is that simple.

"Prostate cancer" is really misleading; a better term would be "prostate cancers." Unlike breast cancer, which grows from a single tumor and spreads outward, prostate cancer is actually a number of small tumors scattered throughout the prostate. So cutting the tumor out of the prostate is not really an option. Instead, the entire prostate plus some surrounding tissue is removed, including the nearby seminal vesicles.

In the most common type of surgery, known as radical retropubic prostatectomy, an incision is made in the abdomen and the prostate is cut out from behind the pubic bone (hence the term retropubic, meaning behind the pubis, the front part of the pelvis). As we noted above, the urethra, the narrow tube that runs the length of the penis and that carries urine from the bladder out of the body, runs directly through the prostate on its way out of the bladder. Therefore, after removing the prostate, the surgeon must stitch the urethra directly to the bladder so urine is once again able to flow.

Note that because it typically takes a few days for the body to get used to this new setup, the surgeon will insert a catheter, or tube, into the bladder. With this in place, urine flows automatically out of the bladder, down the urethra, and into a collection bag without the need for conscious control of the sphincter. The catheter is usually kept in place for about a week to 10 days, after which the stitches have healed enough that the system should be able to work on its own. Because the average hospital stay is shorter than the average time that the catheter is left in the bladder, you’ll need to visit with your doctor or nurse to have the catheter removed.

Another type of surgery, known as radical perineal prostatectomy, is performed less frequently these days. In this approach, the surgeon makes the incision in the perineum, or the space between the scrotum and the anus, and the prostate is removed from behind. Although there is typically less blood loss with this approach, most surgeons find it harder to see the surrounding structures so the precision required to preserve both urinary and erectile function is more difficult to achieve.