Prostate Cancer Surgery

Prostate Cancer Surgery

Surgery

No spread of cancer to bone

Tumor confined to the prostate gland (stage T1 and T2)

Depending on the extent of the disease, there are several surgical options for prostate cancer.

Cryosurgery

This minimally invasive outpatient procedure, also called cryoablation, destroys cancer cells by twice rapidly freezing and thawing cancerous tissue. It is recommended for patients who cannot tolerate surgery or radiation, have prostate-confined tumors (stage T3 or lower),

The procedure is performed under regional (e.g., epidural nerve block) or general anesthesia.

An ultrasound transducer is inserted into the rectum, so the surgeon can see the prostate and surrounding tissue and monitor placement of the cryoprobes. Recent studies show that 97% of cryosurgery patients are cancer free at 1 year and 82% are cancer free at 5 years following surgery. Cryosurgery usually can be repeated safely if cancer returns.

Complications
The urethral warming device causes incontinence or urethral obstruction in about 1% of patients. High Intensity Focused Ultrasound (HIFU)

High intensity focused ultrasound (HIFU) is currently undergoing clinical trials in the United States. Impotence occurs in 1–7% of patients.

Radical Prostatectomy

Radical prostatectomy is the surgical removal of the prostate gland and surrounding tissues, including the seminal vesicles and the pelvic lymph nodes. Surgeons use one of two surgical techniques, retropubic prostatectomy or perineal prostatectomy. General anesthesia is used in both procedures.

This gives the surgeon access to the prostate gland, seminal vesicles, and the pelvic lymph nodes. With perineal prostatectomy, a second procedure is required to remove the pelvic lymph nodes (lymphadenectomy).

The 10-year survival rate after radical prostatectomy ranges from 75% to 97% for patients with well and moderately differentiated cancers (containing normal-appearing and slightly abnormal cells) and 60% to 86% for patients with poorly differentiated cancers (containing very abnormal cells).

Following prostatectomy, an imaging tested called ProstaScint® may be used to locate recurrent prostate cancer (indicated by PSA levels) earlier than CT scans and bone scans. In the ProstaScint® test, antibodies (immune system proteins) are injected into the body and attach to remaining prostate cells. Prostate Px™ is a new diagnostic test that may be appropriately used to help predict the risk for prostate cancer recurrence in high-risk patients who have undergone prostatectomy.

Radiation therapy may be recommended if cancer returns.

Laparoscopic Radical Prostatectomy

Laparoscopic radical prostatectomy is performed through several small incisions. Surgical instruments are inserted through the other incisions. Robotic Laparoscopic Radical Prostatectomy
In some cases, a computer-enhanced robotic surgical system is used to perform laparoscopic radical prostatectomy. In this procedure, a robotic surgical system (e.g., da Vinci® surgical system) is used to perform laparoscopic radical prostatectomy.

Lymphadenectomy

Prostate cancer usually spreads first to the lymph nodes in the pelvis. This procedure allows the patient to recover more quickly than open lymphadenectomy.

When cancer is confined to the prostate gland, the disease is usually curable. A number of patients with locally spread cancer die within 5 years. When identified and treated early, prostate cancer has a high cure rate.