Radical Prostatectomy (RP)
Synonyms: Surgical resection of Prostate Gland, Prostate Operation
What is Prostatectomy?
Prostatectomy is the surgical removal of prostate gland.
Where can I get Radical Prostatectomy?
Cost of procedure performed in the US: $4,000 to $8,000.
All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.
Some terms to remember -
- Open Radical Prostatectomy - In Open Radical Prostatectomy, the prostate gland is removed through an incision in the abdomen. Open Prostatectomy Surgery is usually done to remove cancer of the prostate gland.
- Radical Prostatectomy (RP) - This is a surgical procedure in which the entire prostate gland and seminal vesicles are removed. The lymph nodes from the surrounding area may either be removed or only biopsy material may be obtained.
- Radical Retropubic Prostatectomy (RRP) - This is a commonly used method for Prostatectomy. In Radical Retropubic Prostatectomy, an incision is made from the navel to the pubic bone in the lower abdomen. Prostate gland and seminal vesicles along with abdominal lymph nodes are removed.
- Radical Perineal Prostatectomy (RPP) - In this method, an incision is made in the perineum which is the area between the anus and the scrotum. This is a less popular approach as the nerves in the area can easily be damaged and access to the lymph nodes is difficult. However, Radical Perineal Prostatectomy is much less painful and requires a shorter hospital stay.
- Laparoscopic Surgery - In Laparoscopic Surgery, a Laparoscope (an illuminated viewing instrument) is used to examine and remove the prostate gland. This method of prostatectomy requires much smaller incisions ('key hole' approach) and, like other laparoscopic procedures, can be categorized as Minimally Invasive. Laparoscopic Surgery requires a shorter hospital stay, heals quickly and is less painful.
- Radical Laparoscopic Prostatectomy (RLP) - In this procedure, your surgeon will insert a laparoscope in your abdomen through three small incisions and remove the prostate gland. However, this approach requires excellent expertise of your surgical team and is not performed at all surgical facilities.
- Robotic Radical Laparoscopic Prostatectomy (RRLP) - In this method, robotic arms are used to perform the surgical technique under 3-dimensional view.
This system may provide improved visualization of the critical structures surrounding the prostate and may allow more accurate surgical cuts.
- Transurethral Resection of Prostate Gland - This method of Prostatectomy is used to remove non-cancerous enlargement of the prostate gland (Benign Prostatic Hypertrophy) in which the enlarged part of the prostate gland compresses on the urethra, resulting in urinary problems like frequency and urgency of urination. Most men over 50 years of age experience this problem which can be easily corrected by Transurethral Resection of Prostate Gland.
Who is an ideal candidate for Radical Prostatectomy?
If you have prostate cancer that is localized and has not advanced (metastasized) and are strong enough to undergo a major surgery, then you are an ideal candidate for Radical Prostatectomy.
How do I prepare for Radical Prostatectomy?
Routine blood and urine analysis, Prostate Specific Antigen (PSA) level, CT of abdomen and chest x-ray will be requested by your physician on your pre-oparative consult. Inform your physician about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before Radical Prostatectomy. Stop smoking a few weeks before Radical Prostatectomy to prevent healing problems during recovery period. Do not eat or drink anything for at least 10 hours before the Radical Prostatectomy surgery. You will be instructed to be hospitalized the night before the surgery.
What does the procedure for Radical Prostatectomy involve?
- Open Radical Prostatectomy - An incision is made in the abdomen (either retropubic or perineal approach). The entire prostate gland and seminal vesicles are removed, the urethra is sewn back to the urinary bladder and a catheter is inserted which stays in for about 3 weeks. The entire procedure takes about 3 hours and is performed under general anesthesia. The surgeons world wide have mastered what is called the 'nerve saving technique' of prostatectomy. In this technique the prostate gland and the surrounding tissues are carefully dissected out to avoid damaging the nerve bundles responsible for erection. The only downside to this technique is that in doing so, the surgeon may unknowingly leave behind some cells and the cancer may recur. This method is of choice only if the prostate cancer is localized in it's early stages.
- Laparoscopic Radical Prostatectomy - The entire procedure takes about 3 - 4 hours and is performed either under general anesthesia or spinal block with sedation. In Laparoscopic Radical Prostatectomy, 3 - 4 small incisions are made to ensure a 3 dimensional view of the inside of the abdomen and completely remove the prostate gland. As mentioned earlier, this surgery is quite difficult and is certainly a challenge for your surgical team.
What is the recovery period like following Radical Prostatectomy?
You will spend the next couple of hours in the recovery room under observation following Radical Prostatectomy. Your vital signs, circulation and respiration will be closely monitored. You will also be closely monitored for any immediate post-operative complications like excessive bleeding. If you have had Laparoscopic Radical Prostatectomy, then your hospital stay would be 2 days. Your catheter will be removed on the seventh post-operative day and you will be able to return to your normal daily activities in about 4 weeks. If you have had Open Radical Prostatectomy, then you will probably stay in the hospital for 4 - 5 days, your catheter will be removed after 3 weeks and you will be able to get back to your normal daily activities in 6 - 8 weeks.You will be prescribed pain medication to alleviate pain and discomfort during the initial post-operative period. Your surgeon will provide you with post-operative follow up guidelines which will include regular rectal examination, monitor PSA (Prostate Specific Antigen) levels, and biopsies of suspected tissues (if needed). Post operative follow up after Radical Prostatectomy is recommended every 3 months for the first year and every 6 months thereafter.
What is the outcome of Radical Prostatectomy?
Radical Prostatectomy is quite successful in eradicating cancer of the prostate (stage I and II). The success rate of Radical Prostatectomy is about 85%. A useful indicator for complete prostate cancer eradication is PSA level which may drop to zero following Radical Prostatectomy. You might loose your ability to have an erection (85%) after Radical Prostatectomy which may return in the next few months or years especially if you are 60 years of age or below. It is not uncommon to have urinary incontinence following Radical Prostatectomy.
B . R . A . N . D . of Radical Prostatectomy
Benefits of Radical Prostatectomy
- Radical Prostatectomy removes the cancer containing prostate gland and the lymph nodes in the vicinity. Open Surgery approach gives your surgeon a larger area to work in, better access to the prostate gland, seminal vesicles and the lymph nodes and is used more commonly world wide. Laparoscopic Radical Prostatectomy has a shorter hospital stay, quicker and less painful recovery. However, it requires a highly skilled surgical team to perform this challenging procedure.
Risks of Radical Prostatectomy
- Urinary incontinence
- Impotence (Erectile Dysfunction)
- Injury to the urethra, rectum or ureters
- Wound infection
- Swelling of penis and scrotum
- Injury to surrounding tissues and nerves
- Bruising or hematoma formation
Alternatives to Radical Prostatectomy
- Watchful waiting - If you choose not to have Radical Prostatectomy, then your physician will keep a close watch on the progression of your disease. During watchful waiting period, your surgeon will monitor your Prostate Specific Antigen (PSA) levels, perform digital rectal exams (DRE), or other tests on a regular basis.
- Brachytherapy - In this treatment, small radioactive pellets (about the size of a grain of rice) are implanted into the prostate where they irradiate the cancer cells from inside the gland. This alternative to Radical Prostatectomy is widely used especially in elderly patients and those who are not strong enough to with stand a major surgery.
- Cryotherapy - This method of treatment is also called Cryosurgery. In this treatment, cancer cells are frozen to stop their further growth and spread. Cryotherapy destroys the cancer cells along with normal prostate cells.
- External beam radiation therapy (EBRT) - In this treatment a beam of radiation from an external source targets the cancer cells, damages the genetic material inside the cells resulting in cell death (apoptosis)
- Hormonal therapy - Administration of estrogen or Luteinizing Hormone Releasing Hormone (LHRH) prevents the testicles from producing male hormone (testosterone)
- Orchiectomy - Surgical removal of the testes does not cure the prostate cancer however, it regresses the tumor and stops it from growing any further.
- Transuretral Resection of the Prostate - This is definitely not a treatment of choice for prostate cancer as only a portion of the prostate gland is removed in small pieces and the entire prostate gland cannot be approached through the urethra.
- Transurethral Incision of the Prostate (TUIP) - A small incision is made in the prostatic tissue to enlarge the lumen of the urethra and bladder outlet.
- Transurethral laser incision of the prostate (TULIP) - In this treatment laser is used to damage and destroy the prostate tissue
- Visual Laser Ablation (VLAP) - Laser energy is used to destroy the prostate tissue.
- Microwave therapy of the prostate, balloon dilation of the prostatic urethra, and placement of prostate stents - The goal of these methods is to stretch open the narrowed urethral passage through the prostate gland.
- Electrovaporization of the prostate (Transurethral Vaporization of the Prostate or TUVP) - In this method the electrode conducts a high voltage electrical current that vaporizes the prostate tissue upon contact.
Now or Never
- As mentioned above, prostate cancer has many treatment options. There are many variables such as your age, disease state and your general health to consider which treatment is best for you. It is truly challenging to make the right choice.
Decision to have Radical Prostatectomy
- Your experienced and dedicated surgical team can help you make the right decision. Appropriate and timely treatment of prostate cancer can prevent disease progression and reduce morbidity and mortality from it.
Your Questions Answered on Radical Prostatectomy
B.R.A.N.D. of Radical Prostatectomy
Urogenital Surgery References