Surgery (Radical Prostatectomy) for Prostate Cancer

Surgical removal of the prostate, also called a radical prostatectomy, is most often used for cancer that is in its early stages and hasn't spread beyond the prostate. This is one of the most common treatments for prostate cancer. 

Chesapeake Urology surgeons are highly skilled in all approaches to prostatectomy, which includes open prostatectomy and an innovative and more precise technique, the robotic radical prostatectomy. Our surgeons have expert training, years of experience, and use the most refined techniques, including nerve-sparing methods, to provide the best chance of saving the nerves that control erections.

Open radical prostatectomy

This traditional approach can be used for patients whose cancer is contained to the prostate or those who have too much scar tissue to be candidates for robotic surgery. Traditional open prostatectomy uses an incision to remove the prostate and any margin of nearby tissue to which the cancer has spread. Patients usually recover in the hospital for one to two days, and have a six to eight week recovery period before resuming everyday activities.  

Meet our physicians who perform open radical prostatectomy -

Sankar J. Kausik, MD

Geoffrey N. Sklar, MD

Ronald F. Tutrone, MD

 

Robotic-assisted laparoscopic radical prostatectomy (da Vinci surgery)

This approach is a state-of-the-art, minimally invasive surgery for cancer that is contained to the prostate. Chesapeake Urology surgeons are leaders in robotic surgery, having performed more of these surgeries - well over 1,000 -  than all other urologists in a community hospital setting in Maryland. 

Robotic surgery uses advanced optics with 10x magnification and high-definition 3-D images. The surgeon operates from a console where his hand motions translate into precise movements executed by the robot's arms, manipulating micro-instruments to perform the minimally invasive surgery. The operating instruments are positioned through five or six small incisions in the abdomen. This surgery has been shown to result in less blood loss, lower risk of transfusion and a shorter hospital stay and recovery period. 

Oftentimes, in order to remove the prostate cancer, the surgeons must cut through the nerves that control a man's ability to have an erection. In some cases though, prostate cancer can be removed using a nerve-sparing technique, where the surgeon attempts to cut around these nerves. The surgeons at Chesapeake Urology have experience performing the nerve-sparing radical prostatectomy, and use the technique whenever possible.

Learn more about Chesapeake Urology's advanced robotic surgery program here.

 

RADICAL PERINEAL PROSTATECTOMY

Radical Perineal Prostatectomy is the surgical removal of the prostate and seminal vesicles through a small incision in the perineum, the area between the anus and the scrotum. The perineum is the most direct route to the prostate gland. Radical perineal prostatectomy is for patients with localized prostate cancer (prostate cancer that has not spread beyond the gland).

Learn more about radical perineal prostatectomy here.

 

What can I expect after prostate cancer surgery?

After your prostatectomy, your surgeon will provide you with specific care instructions and details of what to expect in the coming weeks and months. In general, you'll need to be aware of the following:

  • Foley catheter - For 1 to 3 weeks following your surgery, you'll have a tube called a Foley catheter in your urethra. This tube, which comes out the tip of your penis, drains urine as your bladder recovers. You will be advised on how to care for the tube and what to do if it falls out.
     
  • Incision - Depending on whether you had open or minimally invasive robotic surgery, you'll have either one large incision or several small incisions on your abdomen. You will receive specific instructions on when you can shower or swim, and how to care for the incision site and change the dressing, if necessary.
     
  • Medications - If you need pain medication, your doctor will write a prescription or talk to you about your over-the-counter options. You may also be prescribed antibiotics and a stool softener to alleviate additional strain on the surgical site. Talk to your doctor about when you can resume taking any other medications.
     
  • Diet - Most men can resume their normal diet after surgery, but your doctor will provide you with specific requirements. It's advisable to eat plenty of fresh fruits and vegetables and increase fluid intake to make bowel movements more comfortable.
     
  • General activities - You'll be able to get back to most normal activities, including driving, about a week after surgery. More strenuous and jarring exercises, like heavy lifting, cycling, motorcycle and horseback riding, should be avoided for at least 6 weeks. Depending on your line of work, you should be able to return within 2 to 3 weeks after surgery. You may be advised to refrain from sexual activity for anywhere from a few days to a month after the catheter is removed. Light activity, like walking and climbing stairs is encouraged, and you shouldn't sit in one position longer than 45 minutes. You may shower 48 hours after the procedure, but baths and swimming must be avoided until the incision has healed, around 4 weeks.
     
  • Incontinence - Prostate cancer surgery may weaken the pelvic floor muscles and the urinary sphincter that control urine flow. After catheter removal, you may experience light urine leakage or even an inability to control urination. Your doctor will advise you on exercises to help strengthen the pelvic floor muscles-which may also lead to improved sexual function. Urinary leakage usually goes away within a few weeks or months, but some men do experience long-term problems. Visit the Chesapeake Urology Continence Center to learn about available treatments.
     
  • Erectile dysfunction (ED) - Many men regain the ability to have an erection between 6 and 12 months following surgery. Some men continue to have difficulty. Fortunately, Chesapeake Urology Associates offers short-term and long-term solutions that can help almost every man regain a satisfying sex life. Visit Chesapeake Urology's website on Erectile Dysfunction  to learn about available treatments.