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Surgery

Surgery is a common treatment for early stage prostate cancer. Your doctor may remove the whole prostate or only part of it. In some cases, your doctor can use a method known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. But if you have a large tumor or a tumor that is very close to the nerves, you may not be able to have this surgery.

Each type of surgery has benefits and risks. Your doctor can further describe these types:

Radical retropubic prostatectomy: The doctor removes the entire prostate and nearby lymph nodes through an incision (cut) in the abdomen.

Radical perineal prostatectomy: The doctor removes the entire prostate through a cut between the scrotum and the anus. Nearby lymph nodes may be removed through a separate cut in the abdomen.

Laparoscopic prostatectomy: The doctor removes the entire prostate and nearby lymph nodes through small incisions, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) is used to help remove the prostate.

Transurethral resection of the prostate (TURP): The doctor removes part of the prostate with a long, thin device that is inserted through the urethra. The cancer is cut from the prostate. TURP may not remove all of the cancer. But it can remove tissue that blocks the flow of urine.

Cryosurgery: This type of surgery for prostate cancer is under study at some medical centers. (More about cryosurgery is in "The Promise of Cancer Research" section.)

Pelvic lymphadenectomy: This is routinely done during prostatectomy. The doctor removes lymph nodes in the pelvis to see if cancer has spread to them. If there are cancer cells in the lymph nodes, the disease may have spread to other parts of the body. In this case, the doctor may suggest other types of treatment.

The time it takes to heal after surgery is different for each man and depends on the type of surgery he has had. You may be uncomfortable for the first few days.

However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

After surgery, the urethra needs time to heal. You will have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You will have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.

Surgery may cause short-term problems, such as incontinence. After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain bladder control after a few weeks.

Some men may become impotent. Nerve-sparing surgery is an attempt to avoid the problem of impotence. If a man can have nerve-sparing surgery and the operation is a success, impotence may not last. In some cases, men become permanently impotent. You can talk with your doctor about medicine and other ways to help manage the sexual effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You will have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure.

You may want to ask your doctor these questions before choosing surgery:

  • What kinds of surgery can I consider? Is nerve-sparing surgery an option for me? Which operation do you recommend for me? Why?
  • How will I feel after the operation?
  • If I have pain, how can we control it?
  • Will I have any lasting side effects?
Is there someone I can talk with who has had the same surgery I'll be having?
  
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