Prostatectomy is a surgical procedure used to treat prostate cancer or severe benign prostatic hyperplasia. The primary goal is to remove part or all of the prostate tissue to control cancer spread or alleviate urinary obstruction symptoms. This surgery is commonly performed in patients with early-stage prostate cancer or in cases of benign prostatic hyperplasia unresponsive to medication.
The choice of surgical method depends on the patient's age, cancer stage, and overall health, including open surgery, laparoscopic surgery, and robotic-assisted surgery. In recent years, robotic systems have become popular due to their high precision and minimal invasiveness.
Open prostatectomy involves making a large incision in the lower abdomen or perineum to directly remove prostate tissue. This approach has a longer recovery time but is suitable for larger lesions or cases with high risk of metastasis.
The main indications include prostate cancer confirmed by biopsy, elevated PSA levels, or benign prostatic hyperplasia causing severe urinary difficulties or recurrent urinary tract infections. If the cancer has not metastasized and the prognosis is favorable, surgery is often considered curative.
Contraindications include severe cardiopulmonary insufficiency, coagulation disorders, or inability to tolerate general anesthesia. Surgeons will assess surgical risks based on age, tumor stage, and comorbidities.
The procedure is usually performed under general anesthesia and takes approximately 3 to 6 hours. Robotic-assisted surgery involves making 5-6 small incisions (0.5-1 cm) in the lower abdomen to insert robotic arms and a camera.
The concept of "dosage" does not apply to surgery; however, surgeons will adjust the extent of resection based on tumor scope. For example, localized cancers may involve only removing the prostate and surrounding lymph nodes, while high-risk cases may require more extensive removal.
Major benefits include a 5-year survival rate exceeding 90% in early-stage cancer patients and the complete removal of tumor tissue. Robotic systems can precisely preserve neurovascular bundles, reducing risks of incontinence and erectile dysfunction.
Possible short-term risks include bleeding, infection, and injury to the urethra or rectum. Long-term complications may include incontinence (especially if nerve-sparing is difficult), erectile dysfunction, and lymphedema of the lower limbs due to lymphatic fluid retention.
Serious complications include urethral anastomotic leaks requiring secondary surgery, permanent erectile dysfunction, or anesthesia-related cardiopulmonary issues. Postoperative follow-up includes monitoring PSA levels and renal function.
Patients should undergo preoperative anesthesia assessment, rectal examination, imaging, and pathological confirmation of indications. Postoperatively, a urinary catheter is typically maintained for 2-4 weeks, along with bladder training.
Contraindications include uncontrolled diabetes, coagulation disorders, or metastasis beyond the pelvic region. Previous pelvic radiation therapy may increase intraoperative complications.
Surgery is often combined with hormonal therapy, such as androgen deprivation therapy postoperatively to reduce recurrence risk. Compared to radiation, surgery avoids long-term radiation-induced gastrointestinal toxicity.
If patients refuse surgery, options like focused ultrasound ablation or brachytherapy with iodine-125 can be considered. However, these alternatives may not completely eradicate the tumor.
Clinical studies show that patients with localized prostate cancer who undergo radical prostatectomy have a 10-year survival rate of 70-90%. Robotic-assisted surgery generally shortens recovery time by about 50% compared to traditional open surgery.
International guidelines recommend surgery for early cancers with Gleason scores below 7, as it offers the best chance for cure. Elderly patients should weigh surgical risks against potential benefits.
Non-surgical options include:
Choice of alternative depends on tumor malignancy. For example, Gleason scores above 8 may require neoadjuvant chemotherapy before surgery. Benign lesions may be treated with transurethral resection of the prostate (TURP).
What preparations are needed before surgery?
Patients should undergo detailed physical examinations and imaging studies (such as ultrasound or MRI) to assess tumor location and surrounding tissue relationships. They should avoid anticoagulants 3 to 7 days prior to surgery and prepare for bowel cleansing. The medical team will explain surgical risks and obtain informed consent.
How can the risk of erectile dysfunction after surgery be reduced?
Surgeons will try to preserve the nerves responsible for erectile function as much as possible, but risks remain. Preoperative consultation about nerve-sparing options is recommended. Postoperative recovery can be aided by pelvic floor exercises or medical devices, and some patients may require hormone therapy or implants.
How long does it take to resume normal activities after surgery?
Open surgery typically requires 7 to 10 days of hospitalization with a recovery period of about 6 to 8 weeks. Robotic surgery shortens hospital stay to 3 to 5 days and allows faster recovery. During the initial period, lifting heavy objects and prolonged sitting should be avoided. High-intensity activities are generally not recommended within 3 months. Activity levels should be gradually resumed based on recovery progress.
What are the criteria for choosing different surgical methods?
Open surgery is suitable for larger or locally invasive tumors; robotic surgery offers high precision and is preferred for early-stage patients to minimize scarring. Cryoablation allows real-time confirmation of adequate resection margins. The choice depends on tumor stage, overall health, and anatomical considerations.
What long-term follow-up is required after surgery?
Regular PSA testing is essential, typically every 3 to 6 months for the first two years, then annually. Digital rectal exams and imaging may be performed to monitor for recurrence. Any abnormal rise in PSA warrants further investigation.
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