What You Should Know About Prostate Cancer Surgery

It can be scary to learn that you have prostate cancer. But the good news is that it often can be treated. One choice is treatment with surgery.

Surgery is often used to treat early-stage prostate cancer. The goal is to remove all the cancer. If the cancer has spread outside your prostate, it's less likely you'll have surgery to try to cure it. But surgery still may be able to help relieve your symptoms, such as trouble urinating. Surgery can be used alone or as one part of your treatment plan.

If you're thinking about surgery to treat prostate cancer, be sure you understand the goal of treatment. Read on for more facts to consider.

The type of surgery you have depends on several factors. These include the size and location of the cancer and how much the cancer has spread. Choices include:

This surgery removes the whole prostate gland and some nearby tissue, seminal vesicles, and possibly nearby lymph nodes. The surgeon can do this by making a long cut incision) in your belly (abdomen). Or they may make an incision in the area between your scrotum and anus. This complex surgery requires a skilled, experienced surgeon.

This surgery also removes the whole prostate gland and some nearby tissue, including seminal vesicles and sometimes nearby lymph nodes. But the surgeon uses a few small incisions in the abdomen wall instead of one larger incision. This approach may help you have a shorter hospital stay, less pain, and a quicker recovery.

For this surgery, the surgeon uses a thin, flexible lighted tube (laparoscope) and special small tools. There is a tiny camera at the end of the scope. Your surgeon may also do the surgery with robotic assistance. In that case, they use a control panel to move robotic arms that hold the tools more precisely. The best surgical outcome depends on the surgeon's skill and experience with both types of laparoscopic surgeries.

This surgery removes only a part of the prostate gland. The goal is to relieve symptoms, not to cure cancer. During TURP, the surgeon puts a small tool (resectoscope) inside your prostate through your urethra. There is no incision.

This surgery kills cancer cells by freezing them. The surgeon places a small metal probe in the tumor through a tiny incision. Then they put liquid nitrogen into the probe to freeze the cancer cells. This treatment may be appropriate for early-stage prostate cancer. Or for cancer that returns after radiation therapy.

Surgery can treat or even cure prostate cancer. But it has risks, too. For a smoother experience, make sure you understand these risks before your procedure.

In the short term, you and your health care team should watch for:

• Reactions to anesthesia
• Excess bleeding
• Infection
• Blood clots
• Damage to nearby organs or tissue

Also look out for side effects, such as:

• Incontinence. This is when you have trouble controlling your urine. You might have slight leakage or dribbling. Or you could have a complete loss of bladder control. These problems are often worse just after surgery. Sometimes they can be long-lasting. But normal bladder control usually returns a few weeks or months after surgery.
• Erection problems, including erectile dysfunction or impotence. Most likely, you will not be able to get a spontaneous erection for a few months or longer after surgery. But in time, you may be able to get an erection and have sex. You may be at higher risk for erectile dysfunction if you are older, had erectile problems before surgery, and the nerves controlling the ability to have erections are damaged or removed during surgery. You won't ejaculate semen, though. That isn't possible after your prostate gland is removed. If you have erection problems after surgery, ask your doctor about medicines or devices that might help.

Everyone is different. Your doctor can't say for sure if you'll have side effects. But talking with them about possible issues will help you better prepare.

Before your surgery, you'll have a chance to talk with your surgeon about the details and what to expect. Then you'll sign a consent form giving them permission to do the surgery.

You'll also speak with an anesthesiologist. This is a doctor who will give you medicine (general anesthesia) that lets you sleep comfortably during surgery. During the procedure, they will watch your vital signs to keep you safe. This includes your blood pressure, heart rate, and breathing. They will ask about your health history, medicines you take, past problems with anesthesia, and allergies. After talking, you'll sign a consent form giving them permission to administer anesthesia.

Having surgery can be stressful. But knowing what to expect can help.

On the day of surgery, your health care team will take you into the operating room. The team will include the anesthesiologist, the surgeon, and nurses.

During a typical surgery you can expect that your doctors will:

• Move you onto an operating table.
• Give you compression stockings to wear to help prevent blood clots.
• Place electrocardiogram (ECG) electrodes on your chest to track your heart rate and rhythm. They'll also place a blood pressure cuff on your arm.
• Give you anesthesia through an I.V. (intravenous) tube in your hand or arm.
• Do the surgery.
• Put a tube called a urinary catheter into your bladder. This is to help drain urine from your bladder. How long the catheter will stay in place depends on the type of surgery. It may stay in for at least a few days, or for up to 1 or 2 weeks. You will be taught how to care for the urinary catheter while at home. You will return to your surgeon's office to remove it.

After surgery, you'll wake up in the post anesthesia care unit (PACU). Your doctors will watch you closely as you wake up from anesthesia. They'll give you medicine to treat pain as needed. Once you're awake and stable, you'll move to your hospital room. You might need to stay there for one or more nights depending on the type of surgery you had.

Try to take good care of yourself as you recover by following your doctors' advice and instructions. Make sure to keep any follow-up appointments with your surgeon and other doctors. If you have any questions or concerns, know how to contact your health care team after hours, and on weekends and holidays. They will be there to help. Together, you can stay on the path to healing after prostate surgery.