What Are Surgical Options for Prostate Cancer?

Undergoing surgery to treat prostate cancer or prostate cancer symptoms is a big decision. Surgical treatment options are usually invasive and can require long recovery times. They can also have post-treatment side effects that could impact quality of life, including erectile dysfunction, urinary problems, and loss of fertility.

Choosing a surgical treatment option is a decision made with your doctor and healthcare team. They will be able to help you weigh the pros and cons of every treatment option, and also inform you on what options may be the most effective for your specific situation.

There are three main surgical procedures used for prostate cancer, but not all are performed with the intent to cure. Surgeries such as a transurethral resection of the prostate (TURP) only aim to improve prostate cancer-related symptoms. The other two treatment options include radical prostatectomy and orchiectomy.

Prostate cancer surgery options

For any surgical procedure to be performed, your consent is mandatory. This allows you to take the time you need to research or cope with the next steps in your treatment plan and determine if you are comfortable with the route being taken. It’s important to ask any questions you may have and to find a doctor or healthcare team that allow you to have an open line of communication with them, in case any additional questions arise later. Your surgical healthcare team will include your surgeon (typically an urologist), an anesthesiologist, nurses, and possibly even physiotherapists and dieticians. These individuals will work together to help get you through the surgical and recovery processes.

Radical prostatectomy

When a case of prostate cancer is detected and treated before it has spread beyond the prostate gland, the entire prostate gland can be removed, thus, eradicating the cancer. During a radical prostatectomy, the entire prostate gland is taken out, as well as the seminal vesicles (the glands that secrete fluid that will eventually become part of the semen) and other surrounding tissue. In some cases, local lymph nodes may also be removed during a radical prostatectomy, if it is determined that the cancer has spread to these nodes and that it hasn’t advanced further. Radical prostatectomies aim to cure the prostate cancer.

There are two main types of radical prostatectomy: open surgery and minimally invasive laparoscopic surgery. Open radical prostatectomies are performed less often than their minimally invasive counterparts. Open surgery involves making one long incision into the body, and typically leads to longer recovery times, more blood loss, and a longer hospital stay than minimally invasive (laparoscopic) prostatectomies.

Minimally invasive radical prostatectomy is a newer type of prostate cancer surgery that has arisen as a result of many technological and imaging advances. Several smaller incisions are made into the body and long surgical tools are navigated inside. The surgeon can either be manually guiding these tools during the procedure, or can use a control panel to guide robotic arms. In either instance, the success of the procedure is tied greatly to the surgeon’s level of skill, both in manually guiding the tools, or in navigating the robot’s control panel efficiently and effectively.^1-3

Transurethral resection of the prostate

Transurethral resection of the prostate, or TURP, is not used as a curative treatment option in prostate cancer. Instead, it is used as a palliative care measure, meaning a treatment designed to treat or reduce the symptoms of an underlying condition, but not to treat the condition itself. When a prostate cancer tumor grows to the point that it begins pushing on the urethra, the tube that carries the urine from the bladder and out of the body, bladder or urinary issues may occur. By removing the part of the cancer or prostate that is now pushing on the tube, some of these symptoms may be alleviated.^1,4,5

Orchiectomy

An orchiectomy is a surgical procedure that may be performed on men with prostate cancer. However, instead of operating on prostate cancer cells or developed tumors, the surgery involves the removal of the testicles or the tissues that line the testicles. An orchiectomy serves as a treatment option in the form of hormone therapy. Removing the testicles, or the tissue that lines the testicles and produces testosterone, can lower overall levels of testosterone in the body. Prostate cancer cells are often fueled to grow by androgens like testosterone. When the supply of these tumor-fueling androgens is depleted or reduced, tumor cells may be “starved off” and stop growing.

It is important to note that orchiectomies are not intended to cure your cancer, but rather is performed to try to shrink existing tumors, prolong survival, and relieve pain. While having an orchiectomy may cut back on money, time, and other treatment hassles, it is important to recognize that the results of an orchiectomy are permanent.^6-8