Our Prostate Nomogram Our Prostate Nomogram helps physicians and patients decide which treatment will result in the greatest benefit 
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The goal of prostate cancer surgery is to eliminate a patient's cancer completely while preserving normal urinary and sexual function. Surgeons who see more cases and who have more surgical experience are more likely to achieve these goals and reduce the chance that a patient's disease will recur. Memorial Sloan-Kettering's surgeons performed nearly 800 radical prostatectomies last year.
Radical Prostatectomy
To treat prostate cancer, surgeons generally will remove the prostate, as well as some tissue surrounding it (a procedure called radical prostatectomy). A sample of the lymph nodes in nearby tissue is also usually taken to determine whether the cancer has spread beyond the prostate. Seventy-five percent of men treated with surgery will never have a recurrence of their cancer.1
A radical prostatectomy can be performed using either traditional "open" surgery or a minimally invasive procedure known as laparoscopic radical prostatectomy. Through the laparoscopic and robotic-assisted laparoscopic approach, the surgeon performs a prostatectomy using specialized tools inserted through tiny incisions in the pelvic area. The general advantages of this approach are reduced blood loss, quicker recovery, and a better cosmetic result.
To learn more about this approach, visit the Minimally Invasive Surgery section of this overview.
Salvage Surgery
Salvage treatment refers to treatment after failure of radiation therapy. Salvage treatment options vary widely for men with local recurrence of prostate cancer after radiation therapy. Options include continued observation; immediate, continuous, or intermittent hormonal therapy; or further local therapy with radio-frequency thermal ablation, high-intensity focused ultrasonography (known as HIFU), salvage cryoablation, salvage brachytherapy, or salvage radical prostatectomy. Of these treatments, only salvage radical prostatectomy has been shown to eliminate cancer for ten years or more.2
While technically challenging, salvage prostatectomy provides excellent local control of prostate cancer. Salvage radical prostatectomy offers immediate intraoperative and postoperative results similar to those for men undergoing standard radical prostatectomy.
Candidates for salvage prostatectomy should be otherwise healthy, with a life expectancy of greater than ten years, and have a cancer that was initially -- and is still potentially -- curable with radical prostatectomy. The chance for a cure with salvage prostatectomy is substantially greater in those with cancer confined to the prostate. Surgery can be safely performed after unsuccessful external beam radiotherapy, brachytherapy, or combinations of these techniques.
Managing the Side Effects of Surgery
For patients who have undergone surgery or radiation therapy or who have used hormone therapies for advanced disease, Memorial Sloan-Kettering has experts in sexual dysfunction and urinary dysfunction.
Our sexual medicine team is composed of physicians, nurse practitioners, and psychologists, and is recognized as being at the forefront of the management of and research into treatments for sexual problems in prostate cancer patients. The goal of this program is to minimize the effects of prostate cancer treatments on a patient's sexual health through sexual rehabilitation.
Infertility occurs when surgeons remove the seminal vesicles (where semen is made) along with the prostate during a radical prostatectomy. Men who want the option to have children should talk to their doctor about storing sperm (sperm banking) prior to surgery.
For additional information about sexual health, visit that section on our Web site.
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Urinary Incontinence
Urinary incontinence (involuntary loss of urine) is one possible consequence of surgery. Improved surgical techniques have reduced the chances that a man will experience incontinence. Temporary urinary incontinence usually resolves within a few months of surgery and is treated with pelvic floor exercises. However, about 5 to 10 percent of all men will have permanent mild stress incontinence, in which a small amount of urine passes while coughing, laughing, or exercising. This condition can often be treated with a regimen of pelvic floor exercises alone, but can also be treated with an injection of bulking agents such as collagen, a male bulbourethral sling, or in severe cases an artificial urinary sphincter.
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Erectile Dysfunction
Temporary erectile dysfunction, or impotence, is common after surgery, even in cases in which surgeons have used a sophisticated procedure to leave the nerves intact. Erectile dysfunction may occur when the nerves that run along two sides of the prostate, and control the blood flow to the penis, are injured during the operation. Recovery of full erections may take as long as three years after the operation. We have an active medical program of penile rehabilitation to facilitate this recovery process. Men are encouraged to use prescription drugs, penile injections, or other devices to assist with erections soon after the operation.
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Nerve-Graft Surgery
Because the nerves responsible for erections are close to the prostate, one or both of these nerves sometimes must be removed to ensure that the cancer is completely eliminated. Surgeons at Memorial Sloan-Kettering may offer these patients nerve-graft surgery. In this technically demanding procedure, the surgeon replaces the nerves next to the prostate with a nerve from the foot, which can for some men help to restore sexual function. Results of this technique indicate that about half of patients who have had nerve grafts on both sides of the prostate recover their ability to have erections and another quarter recover their ability to have partial erections. The technique is currently available at only a small number of hospitals.
Surgeons at Memorial Sloan-Kettering are involved in a number of research studies to advance the care and outcomes of men with prostate cancer. Speak with your physician to find out more about studies for which you might be eligible.
