Prostate cancer surgery: options, how it works, prognosis

A prostate cancer diagnosis is scary, and so is having surgery. There’s no easy way around those feelings. 

However, having prostate cancer surgery is one of the most effective ways to treat this illness.  For some men with very early disease, it can even cure their prostate cancer.

There are several different types of surgery available for prostate cancer, and they each have their own risks and benefits. Knowing your options can help alleviate some of your fears and give you the tools you need to have open discussions with your healthcare provider about your unique situation.

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Prostate cancer is the most commonly diagnosed cancer in men throughout the world. This amounts to over 1.2 million new diagnoses each year. Fortunately, most prostate cancers grow very slowly, giving healthcare providers time to treat them (Leslie, 2021).

If your cancer is limited to just your prostate, it’s called “localized prostate cancer,” and it’s potentially curable. Cancer that has spread outside your prostate (called metastatic prostate cancer) is a little more challenging to treat, but there are still many options to discuss with your healthcare provider (Leslie, 2021).

The first decision about managing prostate cancer is whether to treat it at all. Since prostate cancer is usually so slow-growing, people who are elderly or in poor health might choose to only monitor their cancer with active surveillance. You and your provider might decide that the risks of treatment aren’t worth the potential benefits (Leslie, 2021).

If you do decide that prostate cancer treatment is the right choice for you, the most common options are surgery, hormone therapy, radiation therapy, or a combination of these (Leslie, 2021).

Within those categories, there are a number of different prostate cancer surgery options.

Your options for prostate cancer surgery depend on your age, activity level, other health issues, and how far your cancer has spread. Your healthcare provider can help you decide what type of surgery is right for you (Leslie, 2021).

Prostatectomy

The complete removal of your entire prostate gland and possibly some of the surrounding lymph nodes is called radical prostatectomy (RP). An RP usually offers your best chance at curing prostate cancer if it’s only localized by preventing it from spreading to surrounding tissues. This surgery has less benefit if you have advanced prostate cancer that has already spread to distant areas of your body, but it can still help (Leslie, 2021).

There are multiple ways for a surgeon to perform a radical prostatectomy. No one approach has been proven to be more effective than another. These methods include (Brawley, 2018):

• Open radical prostatectomy

• Laparoscopic radical prostatectomy

• Robotic prostatectomy

Open surgery is the traditional method for prostate cancer surgery, but most are now done as robotic surgery or laparoscopic surgery. Studies don’t show that this improves outcomes or side effects, but it can result in shorter hospital stays and less chance of needing a blood transfusion (Rosario, 2021; Leslie, 2021).

Compared to monitoring, people who undergo RP are less likely to have their prostate cancer spread to other areas of the body, but it hasn’t been shown to change how long you can live with prostate cancer (Brawley, 2018).

Transurethral resection of the prostate (TURP)

Unlike other surgeries on this list, transurethral resection of the prostate doesn’t actually treat prostate cancer. Instead, it’s used to relieve urinary problems caused by an enlarged prostate, such as those that can also happen with benign prostatic hypertrophy (BPH). In this case, problems can occur when a prostate cancer tumor presses on the tube that drains urine from your bladder, making it hard for you to empty your bladder. A TURP removes this blockage (Stormont, 2021).

During a TURP, a surgeon inserts a scope into your urethra and up through your penis to the level of the prostate. This scope lets your surgeon see and remove any tissue that’s blocking the flow of urine. This surgery has minimal side effects, which usually get better with time (Stormont, 2021).

High-intensity focal ultrasound (HIFU)

Another popular type of ablation therapy used to treat prostate cancer is high-intensity focal ultrasound. This treatment uses focused ultrasound waves to heat and destroy cancer tissue in the prostate. Compared to radical prostatectomy, HIFU can destroy the tumor within the prostate with fewer side effects or damage to nearby tissue. Still, there are questions about how effective HIFU is (Rosario, 2021; Ahdoot, 2019)

Clinical trials have shown that HIFU is safe and has fewer side effects than other types of prostate cancer surgery. Other benefits of HIFU include that it is relatively inexpensive, avoids radiation, and can be repeated if needed (Lodeizen, 2019; Leslie, 2021).

Laser ablation

While HIFU is a more popular treatment, laser ablation therapy might have some advantages for treating prostate cancer. In laser ablation, special fibers are inserted into the prostate, and energy is directed down the fibers to heat the cancer tissue and destroy it. Laser ablation can be used to treat larger areas of the prostate than HIFU, and it only requires local anesthesia, unlike HIFU. This means that there is a slightly shorter recovery time (Ahdoot, 2019).

The most common side effects from laser ablation for prostate cancer are blood in the urine and trouble urinating. Recent studies reported no significant changes in erectile function. However, long-term studies are still needed to know how effective laser ablation treatment is (Ahdoot, 2019).

Focal cryotherapy

Cryotherapy involves using extreme cold to freeze the prostate, causing the cells to rupture and die off. The procedure was initially used to ablate the whole prostate gland, but it is more often used now to target specific spots with cancer. Only partially destroying the prostate seems to result in fewer side effects than freezing the whole prostate (Ahdoot, 2019; Lodeizen, 2019).

Cryotherapy is a safe option for treating prostate cancer, but studies don’t always agree on its effectiveness. As many as 30% of people who have prostate cryotherapy experience trouble with sexual function in the year after the procedure. Some studies have shown that these problems might go away with time (Ahdoot, 2019; Lodeizen, 2019).

Any type of surgical procedure has a risk of some complications. These could include:

• Pain

• Bleeding

• Risk of infection

• Risk of anesthesia complications

Other possible side effects from prostate surgery have to do with the specific procedure you choose. These can include (Brawley, 2018; Lodeizen, 2019):

• Scarring of the urethra

• Trouble getting or keeping an erection (erectile dysfunction)

• Urinary incontinence or leakage

• Hernia

Your surgeon and other healthcare providers can work together with you to minimize these side effects and the impact they can have on your life.

Your prostate produces some of the fluid needed to keep sperm alive in your semen when you ejaculate. Any treatments that remove or destroy prostate tissue can result in infertility. If you’re considering prostate cancer surgery and might want to have children in the future, your healthcare provider can discuss semen banking before surgery (Brawley, 2018).

There are a lot of factors that go into predicting how well prostate cancer surgery will help your condition. Your healthcare provider can give you a more detailed prognosis. In general, this will depend on (Mullangi, 2021):

• Your age

• Your health before you were diagnosed

• How far the cancer cells have spread in your body

• How well you tolerate treatment

The earlier that your cancer is discovered, the more likely providers can successfully treat it. However, even if your prostate cancer is advanced when it is found, there are still treatment options that can help you live longer and control your symptoms.

There are also several promising new technologies becoming available that can help improve outcomes from prostate cancer surgery. Researchers aren’t sure yet how much they will affect outcomes, but they are optimistic (Ahdoot, 2019).

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

November 10, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.