Men have better options for surgical treatment today than they used to. Radical prostatectomy, the gold standard for the surgical treatment of prostate cancer, is now safer and has fewer side effects than ever before. During this procedure, the surgeon removes the patient’s prostate and seminal vesicles, the saclike glands that release fluid that becomes part of semen. In some cases, the surgeon also removes pelvic lymph nodes. Not surprisingly, almost everyone undergoing a radical prostatectomy wants a nerve-sparing procedure. If the nerves on either side of the prostate can be spared, the patient has a higher chance of preserving erectile function. Whether a nerve-sparing operation is possible depends on the location and extent of the cancer.
To perform a radical prostatectomy, the surgeon may use any of several techniques. In the open retropubic technique, the surgeon operates through an incision in the abdomen. In the laparoscopic method, the surgeon operates through several “keyhole” incisions in the abdomen. An increasingly common variation on the laparoscopic technique is robot-assisted prostatectomy; this operation is still done by a person, but instead of holding the instruments in his hands, the surgeon sits at a control panel and manipulates a machine that performs the surgery using special instruments and techniques. Another option is the perineal technique, in which the surgeon works through an incision in the perineum, the area between the scrotum and the anus. The method used generally reflects your surgeon’s preference and skills.
Regardless of which technique he or she performs, it’s important to choose an experienced surgeon.