What is radical prostatectomy?

A radical prostatectomy is surgery to remove the prostate gland. It is usually done to treat prostate cancer that has not spread out of the prostate.

The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen. The prostate surrounds the urethra. That's the tube that carries urine from the bladder out of the body through the penis.

A radical prostatectomy is done to remove prostate cancer. It is most often used if testing shows that the cancer has not spread outside the prostate.

It is sometimes used to relieve urinary obstruction in people with advanced cancer. But a different surgery, called a transurethral resection of the prostate (TURP), is most often used for that purpose. Surgery usually is not considered a cure for advanced cancer. But it can help relieve symptoms.

There are three main types of this surgery. You and your doctor can choose which type is right for you.

During surgery, the nerves that run along the sides of the prostate may be damaged or removed. These nerves affect whether a person can have an erection. In some cases, the doctor may be able to avoid damage to these nerves. This is called nerve-sparing surgery. It makes it more likely that a person can still have an erection after surgery.

Radical retropubic prostatectomy

The doctor makes a 3- to 4-inch cut (incision) in the skin between the belly button and the pubic bone. This is done to remove the prostate. Nerve-sparing may be possible with this approach.

Radical perineal prostatectomy

The doctor makes a cut between the scrotum and anus. The prostate and other tissue are then removed. This surgery does not take as long as a retropubic surgery. And it may cause less pain. But nerve-sparing is hard to do with this approach. So this surgery is not done as often as a retropubic prostatectomy.

Laparoscopic radical prostatectomy

The doctor puts a lighted tube, or scope, and other tools through a few small cuts in the lower belly. Nerve-sparing may be possible with this approach. This surgery may also be done with the help of a robot (robotic-assisted). Robotic arms translate the surgeon's hand motions into finer and more precise action.

Radical prostatectomy is a surgery that removes the prostate. It often works well to treat prostate cancer that has not spread outside of the prostate (localized prostate cancer). PSA levels drop almost to zero if the surgery successfully removes the cancer and the cancer has not spread. If cancer has spread, advanced cancer may develop even after the prostate has been removed.

For people who have localized prostate cancer, this surgery works about as well as radiation. With either treatment, the chance of the cancer spreading is low. One study looked at men with localized prostate cancer and found that the risk of early death was very low and about the same, no matter what option men chose.

For people with advanced prostate cancer, other treatments may work better than surgery. Radiation, hormone therapy, and other medicines are often used to help control cancer that has spread beyond the prostate.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the method of surgery, including robotic surgery.