The surgeon's decision on the type of strategy and surgery to be used, depends on an assessment of the characteristics, size and extent of the tumor.

The decision to proceed with surgery has a curative purpose: the aim is indeed to remove the entire tumor. The surgery is called a radical prostatectomy, and involves the removal of the prostate, the seminal vesicles and lymph nodes in the regions around the prostate and pelvis.The lymph nodes are small glands whose function is to filter fluids and proteins (and possibly tumor cells) presented in the lymphatic vessels.The removal of the lymph nodes is performed in order to ensure a complete removal of the tumor and a more accurate staging of the disease. The surgery is generally performed under 'local-regional' anesthesia, i.e. by a small anesthetic injection at the level of the spine (generally in association with a sedation) or general anesthesia.

Surgical techniques

Stock photo. Posed by model.

• Open surgery It is a fairly complex operation that involves the removal of the prostate through an abdomen incision - from the navel pubis - or the area between the scrotum and anus (this method is rarely carried out). 

• Laparoscopy It is an intervention which is definitely longer than the previous one described but with much shorter recovery time: it is carried out by means of small incisions of about 1 cm in the lower abdomen that allows the insertion of a video camera and appropriate tools in order to proceed with the removal of the prostate.

• Robotic surgery It consists of an intervention that has the same characteristics as the laparoscopy but that also provides the use of a robot.This technique enables surgeons to operate with a visual magnification of about 20 times and with 3D vision, allowing to perform the surgery with a higher accuracy than that of the open surgery or standard laparoscopic surgery. Also, in this case, the recovery times are short, but it requires the use of specialized equipment.

Tissue analysis

The tissues removed during surgery are analyzed in order to obtain additional information on the disease and establish some important parameters such as the extent of the tumor, and then the staging, biological characteristics of the disease, which characterize the aggressiveness. It also undertakes an analysis of adjacent regions of lymph nodes to check the possible presence of cancer cells. It assesses the need to perform an adjuvant therapy, which is used to aid surgery, such as radiation therapy or hormone therapy.

Post-operative and possible side effects

Generally, after surgery, in the absence of complications, the patient is discharged from the hospital after approximately one week.The bladder catheter, which is positioned during surgery, is kept in place for a period of usually from 5 to 10 days, depending on the surgical technique performed. 

During this period, some medicines are administered in order to aid the operative procedure and heal the surgical wound. Considering the scope of the intervention, however, there may be some negative consequences for the patient who underwent radical prostatectomy.The most important side effects may be erectile dysfunction, namely the reduction or absence of an erection, and urinary incontinence. After the removal of the bladder catheter, it is normal to observe the involuntary loss of urine. The recovery of urinary continence requires several months, depending on the type of intervention performed and the choice of surgical technique. 

Rehabilitation plays a crucial role in reducing incontinence and, when possible, should be started before surgery. 30-45 days after surgery, the specialist will check the PSA values, to ensure that the level is within the norms. If such levels were to rise, then the specialist would assess the new findings and evaluate any possible resumption of the tumor.

show more