Other Surgery Options

Treatment Options
Observation
da Vinci Prostatectomy
Other Surgery Options
Hormonal Therapy
Radiation Therapy

In the early 1990s, roughly 30 percent of prostate cancer patients in the United States were treated by surgery, 30 percent by radiation, and 20 percent by watchful waiting. (Most of the rest were treated with a combination of therapies). In Europe, by contrast, watchful waiting constitutes the standard treatment for asymptomatic prostate cancer.

The popularity of surgery in this country has grown tremendously in recent years. A study of Medicare patients' records found that the number of men nationwide receiving radical prostatectomy by 1990 was six times greater than the number recorded for 1984, and the increase was seen in all age groups, from the youngest (that is, age 65) to men in their eighties.

The growth of the popularity of surgery has corresponded with the advent of minimally invasive surgical options that reduce side effects and promote faster recovery times. Two surgical options touched on in this section are radical prostatectomy and cryosurgery.

Radical Prostatectomy

An operation called radical prostatectomy completely removes the prostate and nearby tissues. A radical prostatectomy is further described in terms of the incisions used by the surgeon to reach the gland. In a retropubic prostatectomy, the prostate is reached through an incision in the lower abdomen; in a perineal prostatectomy, the approach is through the perineum, the space between the scrotum and the anus.

In radical prostatectomy, the surgeon excises the entire prostate gland, along with both seminal vesicles, both ampullae (the enlarged lower sections of the vas deferens), and other surrounding tissues. The section of urethra that runs through the prostate is cut away (and with it some of the sphincter muscle that controls the flow of urine). Pelvic lymph node dissection is done routinely as part of a retropubic prostatectomy; with a perineal prostatectomy, lymph node dissection requires a separate incision.

Cryosurgery

Cryosurgery uses liquid nitrogen to freeze and kill prostate cancer cells. Guided by TRUS, the doctor places needles in preselected locations in the prostate gland. The needle tracks are dilated for the thin metal cryo probes to be inserted through the skin of the perineum into the prostate. Liquid nitrogen in the cryo probes forms an ice ball that freezes the prostate cancer cells; as the cells thaw, they rupture. The procedure takes about 2 hours, requires anesthesia (either general or spinal), and requires 1 or 2 days in the hospital.

During cryosurgery, a warming catheter inserted through the penis protects the urethra, and incontinence is seldom a problem. However, the overlying nerve bundles usually freeze, so most men become impotent.

The appearance of prostate tissue in ultrasound images changes when it is frozen. To be sure enough prostate tissue is destroyed without too much damage to nearby tissues, the surgeon carefully watches these images during the procedure. A suprapubic catheter is placed through a skin incision on the abdomen into the bladder so that if the prostate swells after the procedure (which usually occurs), it won't block the passage of urine. The catheter is removed 1 to 2 weeks later.

After the procedure, there will be some bruising and soreness of the area where the probe was inserted. You will likely stay in the hospital for 1 or 2 days. Cryosurgery is less invasive than radical prostatectomy, so there is less blood loss, a shorter hospital stay, shorter recovery period, and less pain than radical surgery. But compared with surgery or radiation therapy, doctors know much less about the long-term effectiveness of cryosurgery.

Current techniques using ultrasound guidance and precise temperature monitoring have only been available for a few years. Outcomes of long-term (10- to 15-year) follow-up must still be collected and analyzed. For this reason, most doctors do not include cryotherapy among the options they routinely consider for initial treatment of prostate cancer.

Related Content

Obtaining Copies of Your Medic...
Interactive Health Tools
Outpatient Rehabilitation Serv...
The Wound Healing and Hyperbar...
Oncology Services
Sign Up For a Blood Drive
Helpful Links
Walk-In Centers
Awards & Recognition
Admitting Information
History
The von Arx Diabetes Center of...
Orthopaedic Services
Concierge Medicine Helpful Lin...
Advance Directives
Guidelines for Donating Blood
Regional Emergency Center
Our Procedures
Hospital Pricing & Performance...
Patient Rights and & Responsib...
Bonita Community Health Center
The Future Continues (1990's )
Concierge Physicians Naples
Treatment Centers
The Millennium and Beyond (200...
Privacy Notice
Diagnostic Services
About the Community Blood Cent...
Your Accommodations
Health E-Newsletters
Arts in Healing
da Vinci Surgical System at NC...
Common Smoking Cessation Metho...
Request Information about Dona...
NCH Foundation Home
da Vinci Surgeons at NCH
Ostomy Clinic
Diabetes Education
Maternity Services
Preventing Medical Errors
General Surgery
The NCH Healthcare System Foun...
Concierge Medicine Enrollment
Palliative Care
General Surgery
Public Safety
Recipient Stories
Interested in Hosting a Blood ...
Disaster Relief
Donor Stories
Prepaid OB Delivery Package Pr...
Our Surgeons
Spirit of Women
Physician of the Year 2011 Hon...
Outpatient Infusion Services (...
Rehab
Laboratory
Diagnostic Imaging Services
Open Heart Surgery
NCH Orthopaedic Medical Team
Clinical Pastoral Education
Kidcare/Pediatric Emergency Se...
Cardiac Rehab Phase II
Radiology
Naples Day Surgery
NCH Breast Health Navigator Pr...
Blood Work
Adenosine/Persantine
Stent Placement
Request an Estimate
Breast Health Navigator
Diagnostic Tests
Green Tree Outpatient Rehabili...
Code Save-A-Heart
Radiation Therapy
Video Content
Concierge Medicine Program FAQ...
Joint Replacement Procedures
Prostate Cancer
Women's Diagnostic and Breast ...
Patients & Family Tools
Regular Exercise Stress Test
Cardiac Catheterization
Contact Surgery
Diagnostic Services
Stress Test
Naples Orthopaedic Surgery
NCH Cares Terms of Use
Treatments for Heart Disease
More About Heart Disease
Derechos y Responsabilidades d...
Echocardiogram
About da Vinci
Outpatient Rehab
Uterine Conditions
Magnetic Resonance Imaging (MR...
Robotic Hysterectomy
Digital Mammography
Briggs Outpatient Rehabilitati...
Treatment Options
Contact Outpatient Rehabilitat...
Ultrasound Imaging
Observation - "Watchful Waitin...
The Brookdale Center for Healt...
Factors for Medical Management
Epidural Anesthesia and Consul...
Patient Experiences
Diagnostic Radiology (X-Ray)
da Vinci Prostatectomy Video
Platelets/double red cell dona...
Nuclear
Angioplasty
Oncology
Specialty Care
Here's Why - Stroke Treatment
Hormonal Therapy
Valve Disease
da Vinci Prostatectomy
Computed Tomography (CT) Scan
Magnolia Ball Home
Locations
Marco Island Outpatient Rehabi...
Rechte und Pflichten des Patie...
Dobutamine
Outpatient Rehabilitation
Quitting Resources
Programs You Made Possible
Here's Why - Orthopedic Servic...
In the News
Bonita Outpatient Rehabilitati...
Concierge Patient Benefits
Pediatric Therapy
Rehabilitation
Immokalee Outpatient Rehabilit...
Here's Why - Oncology Services
Make an Outpatient Rehabilitat...
Droits et Responsibilities du ...
Frequently Asked Questions
News
Speech Therapy Programs
Bone Density Test - DEXA
Tea and Fashion
Orthopedic & Sports Injuries
Varicose Veins
Photo Gallery
Wellness & Nutrition Package
Events
Hand & Wrist Conditions
Aquatic Therapy
Pre & Post Joint Replacement
Services
Helpful Forms
Lymphedema Therapy
Vestibular & Balance Program
Parkinson’s Disease
Classes
Vascular Ultrasound
Educational Resources
Testimonials
Lectures & Speaker’s Bureau
Post-Stroke Rehab.
Osteoporosis Program
Support Groups
Your Visit
Golf & Tennis Injuries
Other Neurological Conditions
Day of Dance Registration
Your Appointment
What is Palliative Care?
Education & Outreach
Neck Pain
NCH Diagnostic Imaging Service...
Contact NCH Concierge Medicine
Palliative Care Related Servic...
Jesse Haven, MD
Magnolia Ball News
FAQs
Our Locations
Robert Hanson, MD
Girls Night Out
Purpose, Mission, & Vision
Piper Building
Day of Dance
Concierge Medicine
Oncology
Girls Night Out
General Surgery
Contact General Surgery
Home
Forms
Breast Health Navigator
General Surgery
Wellness Program
National Cancer Survivors Day ...
Education & Outreach
Home
Patients & Family Tools 2
Concierge Home
Concierge Medicine
Family Medicine
Gastroenterology and Hepatolog...
Home
Infectious Disease
Internal Medicine
Palliative Care
Pay Your Bill
Pediatric Medicine
Physical Medicine
Physician Group Locations
Primary Care
Volunteer Services
Women's Health
Related Videos