Treatment

Radical Prostatectomy

Radical prostatectomy is surgery to remove the entire prostate gland, the attached seminal vesicles (a pair of glands that produce part of semen) and the vas deferens (the muscular cord that pumps sperm from the testicles to the urethra). Radical prostatectomy is an option when prostate cancer is localized to the prostate gland. The goal is to remove the cancer completely before it has a chance to spread from the prostate to other parts of the body.

Radical prostatectomy is a particularly effective treatment for men with Gleason scores below 7 and whose cancers are confined to the prostate or have penetrated the capsule but not spread to the seminal vesicles. A recent study of over 1300 men undergoing radical prostatectomy was conducted to determine their status five years after surgery. Based on PSA readings, over 90 percent with organ-confined cancer remained cancer-free. Over 70 percent whose cancer extended outside the prostatic capsule remained cancer-free, if it had not invaded the seminal vesicles¹.

Other studies have also reported high rates of metastasis-free survival after 10 years when radical prostatectomy is performed by a skilled, experienced surgeon and the cancer is organ-confined and not aggressive.


Appropriate candidates for radical prostatectomy

• Men whose cancer is believed confined to the prostate.
• Men who can safely undergo an operation requiring general anesthesia.
• Men with at least a 7- to 10-year life expectancy, long enough to recover from and reap the benefits of surgery.

Those who should consider other treatments

• Men whose cancer is known to have spread outside the prostate gland.
• Men whose health or age puts them at increased risk for surgical and post-surgical complications.

The prostate gland is located deep inside the pelvis and surrounded by delicate organs, nerves and tissues. These include the rectum, the bladder, the sphincter (muscles controlling the flow of urine), blood vessels and the nerves that control erections.

Surgical procedures to remove the prostate include:

• Radical retropubic prostatectomy. The prostate is removed retropubically (from behind the pubic bone) through an incision in the lower abdomen.
  
  
• Nerve-sparing radical prostatectomy is a modified version of the radical retropubic prostatectomy, in which the nerves controlling erections are not removed with the prostate.
  
  
• Radical perineal prostatectomy. The prostate is removed through an incision in the perineum, the area between the scrotum and anus.
  
  
• Laparoscopic radical prostatectomy. In this relatively new procedure, the prostate is removed through a "keyhole" incision using a laparoscope (a thin, lighted tube with a camera) for visualization and specialized surgical instruments.

¹Eastham JA, Scardino PT. Radical prostatectomy for clinical stage T1 and T2 prostate cancer. In NJ Vogelzang, PT Scardino, WU Shipley, DS Coffey (Eds.), Comprehensive Textbook of Genitourinary Oncology (2nd ed.). Philadelphia: Lippincott Williams & Wilkins; 2000.

The Prostate Cancer pages of this Web site are part of the Comprehensive Prostate Cancer Awareness Program (CPCAP), a major regional effort to reduce the rates of death and illness caused by prostate cancer in southwestern Pennsylvania. Funding for CPCAP is provided by a grant from the Commonwealth of Pennsylvania.

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