Prostate Cancer: Radical Prostatectomy

Raul Parra MSK urologic cancer surgeons such as Raul Parra offer many of our patients the option of having minimally invasive surgery using the da Vinci® Surgical System, which magnifies the prostate and surrounding area tenfold.

Radical prostatectomy (surgery to remove the prostate gland) is the standard treatment option for many men with prostate cancer.

With radical prostatectomy, we remove the entire prostate, some tissue surrounding the gland, and the seminal vesicles (small glands that help produce semen). In some cases, we also remove a number of nearby lymph nodes at the same time.

Inspecting the lymph nodes can be an important step in determining whether your cancer has spread beyond the prostate and whether you should consider radiation therapy or systemic therapy (such as chemotherapy, hormone therapy, biologic therapy, or immunotherapy) following surgery

Surgery to remove the prostate may be an option for you if:

  • You’re newly diagnosed with early-stage, localized prostate cancer for which active surveillance is not an appropriate approach, and you have a long life expectancy. For men in this situation, radical prostatectomy alone can often eliminate the cancer.
  • You have a rising PSA level after initial treatment with focal therapy, indicating that the cancer wasn’t completely eliminated.
  • You have a more advanced tumor that could safely be removed with surgery. In this situation, we often perform radical prostatectomy in combination with other treatment approaches.

If your cancer returns after you’ve received radiation therapy, you may do better with a type of surgery called salvage radical prostatectomy.

Radical prostatectomy is complex and requires a high level of technical precision. The prostate is surrounded by nerves and structures that are important to your ability to have normal urinary and sexual function. We take extreme care to minimize injury that can lead to side effects, such as incontinence (the involuntary loss of urine) and erectile dysfunction.

The good news is that over the past few decades, technical refinements in radical prostatectomy have dramatically reduced the number of complications with this surgery. For example, we’ve developed techniques to incorporate the results of imaging tests into our surgical planning, enabling us to avoid injuring important structures, minimize the risk of incontinence, and maximize the chance of maintaining sexual function.

Although results for individual patients vary, studies have shown that surgeons who regularly perform radical prostatectomies have fewer complications on average than those who do these surgeries less often. Our surgeons are among the nation’s most experienced in conducting prostate operations, and we’re continually working to improve the safety and effectiveness of radical prostatectomy through our clinical trials.

MSK’s Approach to Radical Prostatectomy

Our 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 you choose, our goal is to remove your cancer completely and preserve normal urinary and sexual function.

And with all approaches, we’ve developed and use innovative techniques to preserve the tiny nerves and blood vessels attached to the prostate that help control erections. These and other advances in nerve-sparing surgical techniques have made some of the complications of prostate cancer surgery less common and more manageable. We’ll work closely with you and your medical team to manage any short- or long-term side effects you may experience.

Ultimately, your preferences determine which approach your surgeon takes.

Minimally Invasive Surgical Options

In minimally invasive surgical procedures, we make several small incisions in your abdomen and insert a tiny, lighted telescopic camera called a laparoscope, along with specially designed surgical instruments that a surgeon uses to perform the operation.

When you have minimally invasive surgery, you’re likely to have less discomfort after the procedure and a faster recovery than with a traditional open surgical approach, in which incisions are larger and more extensive. Many men who have their prostates removed in a minimally invasive operation are able to return home the following day.

We offer two types of minimally invasive surgery.

Robot-Assisted Laparoscopic Prostatectomy

Many of our surgeons use 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, a 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 the surgeon to view the surgical site in exquisite detail. The robot then translates the surgeon’s hand, wrist, and finger movements into real-time movements of the instruments inside the patient.

Laparoscopic Radical Prostatectomy

In laparoscopic radical prostatectomy, a surgeon inserts a laparoscope through a small incision in the abdomen. The camera projects a magnified, high-definition image of the surgical area on a screen. Using the projected image as a guide, the surgeon removes the prostate, seminal vesicles, and lymph nodes with specialized surgical instruments.

Salvage Radical Prostatectomy

Many men with localized prostate cancer choose radiation therapy for their initial treatment. However, a rising PSA level and a positive prostate biopsy after radiation therapy may indicate that your cancer hasn’t been completely eliminated or that it has returned.

Our surgeons are highly experienced in performing a procedure called salvage radical prostatectomy, which we do following radiation therapy. Salvage radical prostatectomy destroys the disease in a high proportion of men when the cancer is confined to the prostate or the tissues immediately surrounding it. This procedure has been shown to eliminate prostate cancer for ten years or more.

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.