Types of prostate surgery

There are several different approaches to prostate cancer surgery and they can be performed in a variety of ways. 

The type and extent of your surgery will depend on how aggressive your cancer is and whether it has spread beyond your prostate.

Radical prostatectomy is when your surgeon removes the whole prostate gland. If cancer has spread, your surgery may extend beyond your prostate and include the surrounding lymph nodes.

There are several types of surgery available when you need to have your prostate gland cut, partially removed or removed, each with its own benefits.

Open retropubic surgery

Your surgeon makes a 10cm incision in your abdomen, then removes the entire gland. If you have very aggressive prostate cancer, some of the surrounding lymph nodes may also be removed for testing. Your surgeon may not continue the surgery if they discover that your cancer has already spread.

Keyhole (laparoscopic) surgery

Your surgeon accesses your prostate gland by inserting instruments through several small incisions in your abdomen. Keyhole prostate surgery is usually done robotically: miniature robotic arms, controlled by your surgeon, are inserted through the incisions. It has similar benefits to traditional non-robotic surgery, but the procedure tends to cost more because of substantial out-of-pocket costs from your surgeon.

Rarely, keyhole prostate cancer surgery is converted into open abdominal surgery. This might happen during the procedure because your condition means that approach would be more effective.

Nerve-sparing surgery

In certain prostate cancers, the nerves that help retain your sexual function can be preserved. Nerve-sparing surgery can be performed as open or keyhole surgery. Your surgeon will try and preserve the nerves but this may not be possible if the cancer is too advanced. Multiple factors contribute to the success of nerve-sparing surgery. Your surgeon’s skill is one. Even if successful, erectile dysfunction is relatively common with this surgery.

Other surgeries for prostate cancer

Sometimes, if your surgeon can’t remove your entire prostate, a transurethral resection of the prostate (TURP) can relieve urination problems. For a TURP, your surgeon accesses your prostate using an instrument that’s inserted through your urethra. Your surgeon then ‘bores out’ the prostate gland. This can reduce the resistance to your bladder outflow and improve the flow of urine.

Open perineal surgery

Your surgeon accesses your prostate through an incision between your scrotum and anus. It’s usually only done this way when you have other medical conditions that could complicate abdominal or keyhole surgery.

Which is the best type of surgery?

The best type for you will depend on why you’re having the surgery and other factors, such as your general health, previous surgeries and the experience of your surgeon.

The benefit of radical prostatectomy for prostate cancer is that it gives you the possibility of permanently curing your cancer. Also, if your doctor needs to remove lymph nodes for testing, this can be done at the same time. On the downside, there’s a risk of erectile dysfunction and/or urinary incontinence.

For all types of radical prostate surgery, recovery time may be quicker with keyhole or robotic surgery compared to open surgery and there’s usually less blood loss and pain after the surgery. However, robotic surgery doesn’t give better results in the key areas of cancer control, erection preservation or the risk of incontinence.