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The most common surgery for prostate cancer is a radical prostatectomy. This surgery involves taking out the entire prostate gland, some lymph nodes and other nearby tissue, like the seminal vesicles (glands that make most of the fluid in semen).
If you are receiving care through Fred Hutch Cancer Center, your surgeon will try to save the tiny bundles of nerves, one on each side of your prostate, that control your ability to have an erection (nerve-sparing surgery). If your cancer is growing into or very close to the nerve bundles, you may need to have these nerves removed.
Prostate Cancer Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
How Surgery Can Treat Prostate Cancer
Prostatectomy treats prostate cancer by removing the prostate gland, where the cancer began. Our surgeons are experienced with several approaches:
- Open surgery through an incision in your lower abdomen (retropubic prostatectomy)
- Open surgery through an incision between your anus and scrotum (perineal prostatectomy)
- Surgery through several small incisions using special instruments and cameras (laparoscopic prostatectomy)
Laparoscopic surgery has some potential advantages. Compared to open surgery, it can mean faster recovery, less pain, less blood loss and lower risk of infection. Your surgeon may use a robotic surgery system with hand and foot controls to move robotic arms that hold a camera (laparoscope) and surgical tools. The system allows your surgeon to perform very precise, complex motions and helps prevent fatigue.
Other Ablative Techniques to Treat Prostate Cancer
In traditional operations, surgeons cut out the tissue that needs to be removed. For prostate cancer, they sometimes use other methods to remove or destroy the cancer. These are called ablative techniques. They include:
- Cryosurgery: Making a small incision to insert probes that freeze and kill prostate tissue. Your surgeon may use ultrasound imaging and carefully check the temperature of nearby tissues to target your prostate and reduce the risk of damage to healthy tissue.
- NanoKnife irreversible electroporation (IRE): Putting electrodes through the skin into the prostate to kill cancer cells with an electrical current. IRE causes a precise zone of cell death around the electrodes without creating heat.
- High-intensity focal ultrasound (HIFU): Using a high-intensity beam of sound energy to heat and destroy a small area of tissue. Learn more about HIFU for prostate cancer.
Why Choose Fred Hutch for Prostate Cancer Surgery
Surgery and other ablative methods for Fred Hutch patients are done at UW Medical Center – Montlake by experienced UW Medicine surgeons who are leaders in prostate cancer surgery.
The experience level of your surgeon can affect your results. Along with doing your procedure, they should have enough experience to make informed clinical judgments during the operation, like if the nerve bundles can be spared.
You can expect your Fred Hutch surgery team to:
- Talk with you about the approach they recommend for you and why
- Explain in detail what to expect.
- Carefully consider the risk of side effects from surgery
- Plan ways to reduce any risks you may face
- Provide advice and care to support your recovery
- Answer all your questions about your options
A prostatectomy is major surgery from which your body needs time to recover. Your Fred Hutch care team will talk with you about the risks and side effects you can expect.
In the short term, you can expect some pain and swelling. You may have some constipation after surgery from having anesthesia, being less active and taking pain medicine. We have ways to help with effects like these.
In the longer term, potential side effects of prostatectomy may include:
- Loss of fertility (ability to father a child)
- Leakage of urine or loss of bladder control (urinary incontinence)
- Trouble getting or keeping an erection (impotence or erectile dysfunction)
- Changes in orgasm (a different feeling and little to no ejaculate)
At Fred Hutch, we’ve helped many patients through prostate cancer surgery, and we offer extensive support. We’ll do everything possible to prevent or reduce unwanted effects, and we’ll help you manage any side effects you do have.
Surgery may affect your bladder control and sexual function, but it’s different for different people. Your Fred Hutch care team talks with patients like you about these issues every day, and we have ways to help. After prostatectomy, some men have concerns like these:
Sudden need to urinate, trouble getting their bladder fully empty or leaks when force is applied to the bladder, like when you cough or sneeze
Lower ability to get an erection and a change in orgasms (sometimes less intense than before)
Your care team will talk with you before surgery about the ways the surgery might affect you. Let your care team know any effects you experience. There may be medicines or other measures that can make a difference.
Your physicians and nurses can connect you with other helpful services, too. For example, if you have psychological concerns or concerns about sexuality and cancer, learn about Fred Hutch’s psychosocial and sexuality resources. The Men’s Health Center at UW Medical Center – Roosevelt also has expertise you may find helpful.
To prepare for a prostatectomy, ask your care team about meeting with a registered dietitian. A dietitian can help you plan the best diet to support your healing and speed your recovery. For example, getting enough protein is important to help keep up your strength and rebuild your body.
Another key step is to start doing Kegel exercises before surgery and then return to them afterward. Kegel exercises strengthen your pelvic floor and can improve incontinence. Contract the muscles of your pelvic floor as if you want to stop your urine stream. You can do this while lying down or sitting in a chair, based on your comfort. Contract for 10 seconds, then rest for 10 seconds. Repeat this five times. Do this exercise three times a day until your surgery. After you have surgery and after your catheter is removed, talk with your nurse or physician about when and how to resume doing Kegel exercises.
Your care team at Fred Hutch is here to help you prevent or prepare for side effects and to relieve any side effects you have. The most important step you can take is to let your team know what you’re feeling. We’ve helped many patients and families through this process and know ways to ease your experience.
If you are a candidate for radical prostatectomy, it offers a very good chance for a cure. It also gives your physicians detailed information about your cancer, like how aggressive it is, which can help guide other treatment decisions.