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Surgical options for prostate cancer treatment

The growth of the popularity of surgery to treat prostate cancer has corresponded with the advent of minimally-invasive surgical options that reduce side effects and promote faster recovery times. Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. Common prostate surgeries are described below.

Radical prostatectomy

An operation called radical prostatectomy completely removes the prostate and nearby tissues. A radical prostatectomy is further described in terms of the incisions used by the surgeon to reach the gland. In a retropubic prostatectomy, the prostate is reached through an incision in the lower abdomen; in a perineal prostatectomy, the approach is through the perineum, the space between the scrotum and the anus.

In radical prostatectomy, the surgeon excises the entire prostate gland, along with both seminal vesicles, both ampullae (the enlarged lower sections of the vas deferens), and other surrounding tissues. The section of urethra that runs through the prostate is cut away (and with it some of the sphincter muscle that controls the flow of urine). Pelvic lymph node dissection is done routinely as part of a retropubic prostatectomy; with a perineal prostatectomy, lymph node dissection requires a separate incision.

daVinci Prostatectomy

da Vinci Prostatectomy is a robot-assisted, minimally-invasive surgery that is quickly becoming the preferred treatment for removal of the prostate following early diagnosis of prostate cancer. With the da Vinci System, surgeons operate through a few small incisions instead of a large open incision - similar to traditional laparoscopy. Learn more >>

Pelvic lymphadenectomy

During this procedure, the surgeon removes lymph nodes in the pelvis. The lymph nodes are then examined for evidence of cancer. If cancerous cells are present, the prostate will not be removed and other treatment options may be recommended.1

Transurethral resection of the prostate (TURP)

In this surgery, tissue is removed from the prostate using a resectoscope (a thin, lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue that is blocking the urethra is cut away and removed through the resectoscope. TURP may be used to relieve symptoms caused by a tumor in the prostate or to alleviate urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH).2

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. Guided by TRUS, the doctor places needles in preselected locations in the prostate gland. The needle tracks are dilated for the thin metal cryo probes to be inserted through the skin of the perineum into the prostate. Liquid nitrogen in the cryo probes forms an ice ball that freezes the prostate cancer cells; as the cells thaw, they rupture. The procedure takes about two hours, requires anesthesia (either general or spinal), and requires one to two days in the hospital.

During cryosurgery, a warming catheter inserted through the penis protects the urethra, and incontinence is seldom a problem. However, the overlying nerve bundles usually freeze, so most men become impotent.

The appearance of prostate tissue in ultrasound images changes when it is frozen. To be sure enough prostate tissue is destroyed without too much damage to nearby tissues, the surgeon carefully watches these images during the procedure. A suprapubic catheter is placed through a skin incision on the abdomen into the bladder so that if the prostate swells after the procedure (which usually occurs), it won't block the passage of urine. The catheter is removed one to two weeks later.

After the procedure, there will be some bruising and soreness of the area where the probe was inserted. You will likely stay in the hospital for one or two days. Cryosurgery is less invasive than radical prostatectomy, so there is less blood loss, a shorter hospital stay, shorter recovery period, and less pain than radical surgery. But compared with surgery or radiation therapy, doctors know much less about the long-term effectiveness of cryosurgery.

Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term (10- to 15-year) follow-up must still be collected and analyzed. For this reason, most doctors do not include cryotherapy among the options they routinely consider for initial treatment of prostate cancer.

1: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page4
2: http://www.mayoclinic.com/health/turp/MY00633

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