Surgery

Surgical removal of the prostate, or prostatectomy, has been shown to prolong patients’ life expectancy in the case of medium and high-risk localized prostate cancer. There does not appear to be any equivalent benefit in the case of low-risk prostate cancer.

In the operation, the prostate is remove entirely, including the capsules, meaning that a radical prostatectomy is performed. If the cellular profile of the patient’s cancer is more aggressive (Gleason score ≥ 8) or the PSA level is high (>10 µg/l), the local lymph nodes are surgically removed.

Radical prostatectomy can be performed as robot-assisted surgery, open surgery, or endoscopic surgery. Today, most (300) of the 340 radical prostatectomies performed each year at the HUCH Department of Urology are performed through the abdominal cavity using a robot-assisted laparoscopic method. Endoscopic procedures reduce bleeding during surgery, allow more detailed tissue preparation through the use of 3D images and small instruments, help reduce post-operative pain, and speed up the patient’s recovery to normal after surgery. The cancer treatment outcome is equally successful in open and endoscopic surgery, but the adverse side effects of surgery can be reduced and the hospitalization and recovery period is considerably shorter when using endoscopic surgery. Most patients are discharged from the ward 1–2 days after robot-assisted surgery.

Possible acute side effects of surgery include bleeding, infections, and thrombosis in a small of number patients. Possible long-term side effects of radical prostatectomy include urinary incontinence and sexual impotence. Urinary continence will return to normal for approximately 95% of patients after recovery from surgery. Potency is most likely to be maintained if the patient has a minor localized cancer. Most of the side effects related to surgery are temporary.

A pathologist will examine the surgically removed tissues with a microscope. This provides a precise assessment of the cellular profile and local spread of the prostate cancer, as well as its possible metastasis into the lymphatic vessels or lymph nodes. Surgery is adequate treatment if there is no cancerous tissue at the surgical edge and the PSA value decreases to unmeasurable (< 0.05µg/l). Surgical treatment may be complemented with radiotherapy or medication if the cancer grows through the prostate capsule or into the surgical edges, or if cancer cells are found in the lymph nodes.