Surgical procedures for prostate cancer treatment

Cancer of the prostate is a significant cause of death in men. In 2014, it accounted for 13% of all deaths due to cancer in men living in Australia. Surgery is the main method of treating prostate cancer and various types of surgical procedures can be adopted depending on the patient's circumstance.

The major considerations that determine the type of surgery to be performed are the size of the cancer, histopathology of the prostate (what the cells look like under a microscope), evidence of cancer spread to other parts of the body, severity of symptoms and the patient's ability to withstand surgery.

Radical prostatectomy is the main type of surgical procedure for prostate cancer treatment if it is thought not to have spread beyond the prostate gland. This involves the removal of the entire prostate gland along with the seminal vesicles and the surrounding tissues. The traditional open method of radical prostatectomy provides the surgeon access to the surrounding lymph nodes and tissues, although this approach is now less popular.

The surgeon can access the organ through the retropubic approach by making a lower abdominal incision from the belly button down to the pubic bone or by a perineal approach in which an incision is made between the anus and the scrotum. Although the perineal approach is a shorter procedure, it is less often used because it does not provide access to surrounding lymph nodes and there is a higher probability of developing erection problems after surgery.

Laparoscopic prostatectomy has now become a more popular surgical procedure for treating prostate cancer as the patient recovers faster and there is less pain and smaller blood loss. The surgeon removes the prostate gland with the aid of special instruments introduced into the abdomen through several small incisions. One of the instruments is equipped with a tiny video camera which enables the surgeon see inside the abdomen.

Modern technology now enables laparoscopic surgery to be performed through a robotic interface. The operating surgeon remotely controls the special laparoscopic instruments from a control panel in the operating room. The robotic-assisted laparoscopic approach allows for more precision and greater ability to manoeuver.

Trans-urethral resection of the prostate may be performed if the cancer is inoperable but causing symptoms. It involves the removal of the inner part of the prostate when it is pressing on the urethra and making it difficult to empty the bladder. This procedure will not cure the cancer but it is a huge relief for the patient.

The male sex hormone, testosterone, produced by the testicles, is thought to promote the growth of prostate cancer.  Orchidectomy, the surgical removal of the testicles is therefore occasionally performed to retard the growth of advanced prostate cancer, especially in men who prefer this type of surgery to regular hormone injections for reducing their level of testosterone.

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