Prostate Cancer Surgery

Prostate cancer surgery may need to be performed with an open radical prostatectomy when cancer has advanced to other organs of the genitourinary system. An open surgery is the traditional manual surgery; the surgeon holds the surgical instruments in their hands and operates. When the surgeon cuts the initial incision, whether it is in the peritoneal area or the abdomen, the incision needs to be big enough to fit the fingers and hands, and large enough to peer into the surgical site with a clear view to operate. The complications with a large surgical incision may include excess blood loss during surgery, a long healing time, and the possibility of infection in the surgical site.  This being said, prostate cancer surgery, even open prostate cancer surgery does have a great chance of stopping the cancer.

Prostate cancer surgery for prostate removal made a major advancement with laparoscopic surgery. Laparoscopic surgery involves performing the surgery through small holes into the body with the surgical instruments placed at the end of thin poles that have a controlling mechanism on the other end that is held by the surgeon. A small video camera is also inserted into the body cavity so the prostate surgery can be viewed up on a monitor by the urology specialists performing the urologic surgery. This method of performing surgery with the body “closed” minimizes bleeding, healing time, smaller scars, and less infection. Laparoscopic surgery brought the term “minimally invasive surgery” to medicine. The tradeoff was that many surgeons that performed open radical prostatectomy never made the transition to laparoscopic surgery for various reasons.

Enter da Vinci surgery, known as robotic surgery or da Vinci prostatectomy which is simply laparoscopic surgery with laparoscopic poles and surgical tools being manipulated with a robotic controller. The advantages this brings are 1) the removal of shaking that manually holding laparoscopic instruments brings with it over long periods of surgery 2) the ability to rotate the surgical instruments 360 degrees 3) software that gives the surgeon a 3D view of the surgical site and 4) a magnified high definition (HD) view of the surgical site.

Prostate cryosurgery has been used and refined during the last 25 years. Cryosurgery is used to freeze tissue to destroy cancer cells on many organs of the body. Originally prostate cryosurgery had many side effects such as stress incontinence, urinary retention, and other urinary symptoms. Erectile dysfunction causes (impotence causes) were created from nerve damage created by the prostate turning into an ice ball. Just as prostate removal surgery advanced through the years so did cryosurgery.

Prostate cancer surgery known as prostate radiation seeding has also gone through a metamorphosis. For decades radioactive “seeds” have been implanted into the prostate with the strategy of destroying the cancer cells in the prostate. Urologists, radiation oncologists, physicists, and dosimetrists have improved on the way the seeds are implanted, the type and size of the seeds used, and the distribution of the seeds in the prostate. These changes improved outcomes in stopping the prostate cancer, and minimizing radiation burn and urinary frequency.

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