Surgery is an option for men with early (Stage I or II) prostate cancer. It's sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

• Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
  • Through the abdomen: The surgeon removes the entire prostate through a incision in the abdomen. This is called a radical retropubic prostatectomy.
  • Between the scrotum and anus: The surgeon removes the entire prostate through a incision between the scrotum and the anus. This is called a radical perineal prostatectomy.
• Laparoscopic prostatectomy: The surgeon removes the entire prostate through small incisions, rather than a single long incision in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
• Robotic laparoscopic surgery: The surgeon removes the entire prostate through small incisions. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.

Minimally invasive surgeries to remove the prostate in men with prostate cancer, including procedures performed with a surgical robot, are superior to standard "open" prostate removal surgeries by some measures but fall short on several other important outcomes, including risk of incontinence and erectile dysfunction. The study was published October 14, 2009 in the Journal of the American Medical Association.

From 2003 to 2007, the number of minimally invasive radical prostatectomy (MIRP) procedures increased from 1 percent to more than 40 percent of all prostatectomies, an increase that the researchers believe has been largely driven by the rapid growth of robotic surgery. Currently, robotic prostatectomy accounts for 70 percent of all MIRP procedures, said the study's lead author Dr. Jim C. Hu of Brigham and Women's Hospital in Boston.

The study was not a randomized clinical trial. Rather, the researchers used billing and diagnostic data from NCI's SEER-Medicare database, identifying 1,938 men who underwent MIRP and 6,899 men who underwent open surgery. After accounting for differences in physician and patient characteristics in men receiving MIRP versus open procedures, the researchers found that men who underwent MIRP had shorter hospital stays (2 days versus 3 days), far fewer blood transfusions, and a lower risk of respiratory and other surgical complications. But they also had more than twice the risk of genitourinary complications, a 30 percent increased risk of incontinence, and a 40 percent increased risk of erectile dysfunction 18 months after the procedure.

The need for additional cancer therapies was roughly equivalent between the groups, Dr. Hu explained, suggesting that neither procedure is superior in terms of cancer control. The study also revealed several disparities related to MIRP, including less frequent use by African American and Hispanic men.

Laparoscopic surgery is the newest type of surgery to remove the prostate. It is done with smaller incisions using a slender tube with a camera on the end (laparoscope), which may be robotically controlled. The scope is inserted through the navel, and the surgeon can see a highly enlarged image of the prostate. Compared with other types of prostatectomy, this technique may lead to shorter hospital stays, faster recovery, and less blood loss and pain. However, it is fairly new and not widely used. Some surgeons have limited experience with this type of surgery.

TURP. A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

You may be uncomfortable for the first few days or weeks after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

The time it takes to heal after surgery is different for each man and depends on the type of surgery. You may be in the hospital for one to three days.

After surgery, the urethra needs time to heal. You'll have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You'll have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.

After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain at least some bladder control after a few weeks.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that's very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You'll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.

Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumors or tumors that are very close to the nerves may not be able to have this surgery.

The penis may be 1 to 2 centimeters shorter after a radical prostatectomy.