Choosing Between Procedures

• Radical prostatectomy is the removal of the prostate and nearby tissue, including seminal vesicles and the pelvic lymph nodes. It can be done through a retropubic prostatectomy, which involves an incision in the lower abdomen, or a perineal prostatectomy, which requires cuts in the perineum, the space between the scrotum and the rectum. In both cases, patients are given general anesthesia.
  
  A surgeon may also perform a laparoscopic surgery, with special instruments and a tiny camera. The optical system is inserted into the body through a tiny incision, and the instruments are inserted through other incisions. Some doctors now do this surgery with robotic arms, which is called robot-assisted prostatectomy.
  
  Surgeons may or may not decide to remove the lymph nodes. Because prostate cancer can likely spread to the lymph nodes in the pelvis, it is fairly common to perform surgery on them as well. It depends on the outcome of biopsies and PSA tests, as well as the tumor's size. There are two types of lymphadenectomy--laparoscopic and open.
  
  Similar to prostate surgery, an incision is made in the lower part of the abdomen during an open lymphadenectomy. During a laparoscopic lymphadenectomy, a miniature telescopic device is inserted through a small incision. The surgeon then inserts instruments through other incisions. The camera is connected to a monitor. Laparoscopic lymphadenectomies have a faster recovery time.
  
  The final kind of prostate cancer surgery is called nerve-sparing surgery. It helps keep the nerves alongside the prostate intact. These nerves are necessary to achieve an erection. Doctors only do this procedure if there is minimal chance of leaving cancer cells behind.
  
  

Things to Consider

• It's important to keep in mind several factors when going over options for prostate cancer surgery. Removing the prostate can lead to bladder and erection issues. For most men, however, these problems improve over time. When deciding to go ahead with surgery, find a doctor who performs at least 40 similar surgeries per year.
  
  Another important consideration is that there's no way of knowing before surgery whether the cancer has spread beyond the prostate. Thus, surgery alone may not be enough to cure the cancer.
  
  

Another Option

• For people who can't handle radiation or surgery, who are elderly, have prostate-confined tumors, or those who don't respond to radiation, cryosurgery (or cryoablation) is another option. It is much less invasive and is handled as an outpatient procedure. It kills cancer cells by rapidly freezing and thawing the tissue containing cancer--twice.
  
  Prior to the surgery, the patient is subjected to a prostate biopsy and a transrectal ultrasound to figure out how big the tumors are and where they are located. The doctor will use general or regional anesthesia.
  
  While the patient lies on his back, the surgeon will put a warming catheter into the urethra. This protects it from the freezing temperatures. He then inserts an ultrasound transducer into the man's rectum to enable him to see the prostate and surrounding tissue. The next step is to make several needle punctures in the perineum, monitoring the progress through the transducer. The needles are inserted into several parts of the prostate tumor. Argon gas or liquid nitrogen goes through the probes and freezes the cancer cells. Once the tissue around the cryoprobes are iced over, the solution is stopped, allowing the area to thaw. The cycle is then repeated.
  
  Recovery is usually pretty fast. Patients can go home the same day or a day after the procedure. However, they usually have to wear a catheter for about three weeks. According to urologychannel.com, studies show that 97 percent of cryosurgery patients are free of cancer one year after surgery.