Prostate Cancer: Radical Prostatectomy

Pictured: James Eastham James Eastham and our highly experienced team of urologic surgeons are experts in nerve-sparing and minimally invasive techniques for lessening treatment-related side effects.

Radical prostatectomy — surgery to remove the prostate gland — is the standard treatment option for many men with prostate cancer. Surgery to remove the prostate may be an option:

  • If you are newly diagnosed with early-stage localized prostate cancer that is not appropriate for an active surveillance approach, and you have a long life expectancy. For men in this clinical state, radical prostatectomy alone can often eliminate the cancer.
  • If you have a rising PSA level after initial treatment with focal therapy — indicating that the cancer was not completely eliminated.
  • If you have a more advanced tumor that could safely be removed surgically. In these cases, radical prostatectomy is often performed in combination with other treatment approaches.
  • If you experience recurrent prostate cancer after you have received radiation therapy. In this circumstance, you may be a candidate for another type of surgery called salvage radical prostatectomy.
Pictured: Vincent Laudone
Video

There are several techniques for prostate surgery, but the most important factor in ensuring a good outcome is your surgeon’s experience.

(10:00)

Radical prostatectomy is a complex procedure that requires a high level of technical precision. The prostate is surrounded by nerves and structures that are important for urination and sexual function, and so care must be taken to minimize injury that can lead to side effects such as incontinence and erectile dysfunction. Technical refinements in radical prostatectomy have dramatically reduced the incidence of these complications in the last 25 years.

While the main goal is to completely remove the cancer, Memorial Sloan Kettering surgeons have developed techniques to integrate the results of imaging studies into our surgical planning. This allows us to avoid injuring these structures, minimizing the risk of incontinence and maximizing the chance of maintaining potency.

Although results for individual patients vary, studies have shown that surgeons who regularly perform radical prostatectomies have fewer complications on average than those who perform these surgeries less often.(1),(2),(3) Prostate surgeons at Memorial Sloan Kettering are among the most experienced in the country. We are also continually working to improve the safety and effectiveness of radical prostatectomy through our clinical trials.

Memorial Sloan Kettering's Approach to Radical Prostatectomy

Memorial Sloan Kettering's prostate surgery team includes experts in several approaches for prostate cancer, including traditional “open” surgery and minimally invasive techniques such as robot-assisted surgery and laparoscopic surgery. Regardless of which surgical approach is recommended, our surgeons have developed and utilize innovative techniques to preserve the tiny nerves and blood vessels that are attached to the prostate and help control erections. They have also developed methods to ensure urinary control is maintained. The procedure you choose may depend in part on your own preferences.

In any type of radical prostatectomy, surgeons remove the entire prostate, some tissue surrounding the gland, and the seminal vesicles (small glands that help produce semen).

In addition, surgeons at Memorial Sloan Kettering often remove a number of nearby lymph nodes at the same time that they remove the prostate. Investigating the lymph nodes can be an important step in determining whether the cancer has spread beyond the prostate, and whether radiation therapy or systemic therapies (such as chemotherapy, hormone therapy, biologic therapies, or immunotherapy) might be required following surgery.

No matter which surgical approach you choose, our goal is to remove your cancer completely and preserve normal urinary and sexual function.

Minimally Invasive Surgical Options  

In minimally invasive surgical procedures, several small incisions are made in the abdominal wall. These allow the insertion of a tiny, lighted telescopic camera called a laparoscope, along with specially designed surgical instruments that a surgeon uses to perform the procedure.

When you have minimally invasive surgery you are likely to have less postoperative discomfort and a faster recovery than with a traditional open surgical approach. Many men who have their prostates removed in a minimally invasive operation are able to return home the following day.

There are two types of minimally invasive surgery.

Robot-Assisted Surgery

Video

MSKCC minimally invasive surgery expert Vincent Laudone explains how robotic surgery is used to treat prostate cancer and other urologic cancers.

(5:00)

Many of our surgeons routinely use a minimally invasive procedure called robot-assisted laparoscopic prostatectomy. This sophisticated surgical tool offers much finer precision than is possible with any other surgical technique.

Using a device called the da Vinci® Surgical System, the surgeon performs the operation while seated at a console that has a viewing screen as well as hand, finger, and foot controls. The screen projects a three-dimensional image, magnified tenfold, of the prostate and the surrounding area. This allows a surgeon to view the surgical site in exquisite anatomical detail. The robot then translates the surgeon’s hand, wrist, and finger movements into real-time movements of the instruments inside the patient.

Laparoscopic Prostatectomy

Another minimally invasive technique is laparoscopic radical prostatectomy. A thin lighted tube with a camera at its tip (called a laparoscope) is inserted through a small incision in the abdomen. The camera projects a magnified, high-definition image of the surgical area onto a screen. Using the projected image as a guide, the surgeon removes the prostate, seminal vesicles, and lymph nodes with specialized surgical instruments.

Expertise in Salvage Radical Prostatectomy

Many men with localized prostate cancer choose radiation therapy for their initial treatment. However, a rising PSA and a positive prostate biopsy after radiation therapy may indicate that the cancer has not been completely eliminated or has returned. A radical prostatectomy that is performed following radiation therapy is called salvage radical prostatectomy. Salvage radical prostatectomy can eradicate the disease in a high proportion of patients when the cancer is confined to the prostate or the tissues immediately surrounding the gland. This procedure has been shown to eliminate prostate cancer for ten years or more.(4)

Our Publications Read journal articles from our minimally invasive surgery experts Go »

Salvage radical prostatectomy can be more technically challenging than a radical prostatectomy that is performed when the cancer is first diagnosed and before radiation therapy has been given because of the effects of radiation on the prostate gland. Surgeons at Memorial Sloan Kettering are highly experienced in performing this procedure.

Managing Side Effects of Surgery

Advances in nerve-sparing surgical techniques have made some of the complications of prostate cancer surgery less common and more manageable. Still, surgery can cause short- and long-term complications. Memorial Sloan Kettering has experts who will work closely with you and your medical team to manage any side effects you may experience, such as urinary incontinence and sexual dysfunction.

Learn more about how we help in managing the side effects of prostate cancer surgery.