Radical prostatectomy surgery is often carried out for patients with prostate cancer. It’s an extremely effective procedure which like most surgeries has some risks involved.
We recently spoke with a leading urologist, Mr Neil Haldar, to find out some of the indications for radical prostatectomy surgery and what the differences between a prostatectomy and a radical prostatectomy are.
What is a radical prostatectomy?
Radical prostatectomy is surgery to remove the entire prostate gland for men with localised prostate cancer. It is a standard treatment option for men whose cancer has not spread.
What is the difference between prostatectomy and radical prostatectomy?
Simple prostatectomy is a treatment for men with severe urinary symptoms and enlarged benign prostate glands, rather than prostate cancer. Unlike radical prostatectomy in a simple prostatectomy, the surgeon doesn't remove the entire prostate only the obstructing part of the prostate that's blocking the flow of urine.
Most urologists use advanced endoscopic techniques to address enlarged prostate without the need for open, laparoscopic, or robotic surgery in most cases. The most conventional method used is called the Trans-Urethral Resection of the Prostate (TURP).
What are the types of radical prostatectomy?
Surgeons can perform a radical prostatectomy using different techniques. The three primary methods used today to remove the prostate are open, laparoscopic and robotic.
- Open radical prostatectomy:
Open radical prostatectomy surgery is the traditional way of surgically removing prostate cancer. The surgeon makes a single incision below the belly button in the lower abdomen to excise the prostate.
- Laparoscopic radical prostatectomy:
In laparoscopic radical prostatectomy, also known as “keyhole surgery”, the surgeon makes several small incisions in the lower abdomen. Individual ports are placed in these incisions through which the surgeon inserts a camera and specialised instruments to remove the prostate.
- Robotic radical prostatectomy:
In the last ten years or so, robotically-assisted radical prostatectomy has become popular. Similar to laparoscopic radical prostatectomy, this method requires small incisions made in the abdomen through which the robot's arms are inserted. With a robotic interface, the surgeon controls the robot's arms, which in turn controls the camera and surgical instruments.
Radical prostatectomy indications
Urologists offer radical prostatectomy to men whose cancer has not spread beyond the prostate gland, often termed localised prostate cancer. Studies are currently ongoing to assess the role of surgery in men whose disease is no longer confined to the prostate but have a small amount of prostate cancer that has spread to other parts.
Usually, no further treatment is necessary after radical prostatectomy, but occasionally radiation is used in conjunction with radical prostatectomy in patients with locally advanced prostate cancer, termed adjuvant radiotherapy. Some centres also offer “salvage” radical prostatectomy to men who have recurrent prostate cancer after previous radical prostate radiotherapy.
When choosing the most appropriate type of treatment for prostate cancer, the urologist will look at the patient's age, other medical problems, as well as the grade and extent of prostate cancer. Radical prostatectomy is usually only offered to healthy men with a life expectancy of ten or more years after the procedure. Other treatment options such as radical prostatectomy may be more suitable for men with localised prostate cancer with a lower life expectancy or simple monitoring for those with low-grade prostate cancer.