If your prostate cancer profile is overwhelmingly positive and you have an expected healthy lifespan of 7–10 years, the following procedures will typically be recommended.
- Radical Robotic Prostatectomy
- Radical Open Retropubic Prostatectomy
- Radical Perineal Prostatectomy
- Laparoscopic Prostatectomy
Radical Robotic Prostatectomy
With the advent of the da Vinci™ robot, Tulane Urology was among the first in the United States to acquire this advanced surgical option for prostate cancer management. This technology offers the surgeon 3-D high-definition visualization, enhancing precision while prioritizing quality-of-life issues that matter most to patients.
In addition to drastically reducing pain and blood loss, robotic prostatectomy provides up to 10x magnification, which greatly facilitates nerve-sparing surgery—a preferred approach for most patients diagnosed early with prostate cancer.Tulane’s robotic urology team not only offers this state-of-the-art procedure but also trains surgeons nationwide.
Brief Description of the Procedure
After thorough preoperative discussion and consent, general anesthesia is administered. Laparoscopic ports (trocars) are inserted into the abdomen to introduce the 3-D camera and robotic instruments. Additional ports allow a bedside surgeon to assist by inserting instruments, sutures, and drains. The enhanced visualization allows for a more precise surgery compared to traditional open radical prostatectomy.
The procedure typically takes slightly longer than open surgery, mostly due to robot setup and instrument changes. Most patients stay overnight in the hospital and go home the next day after a regular breakfast. Postoperative pain is usually managed with over-the-counter anti-inflammatory medications.
Experience Matters
Robotic surgery involves a significant learning curve, and surgeon experience is critical. The nerve-sparing technique is essential for preserving quality of life and ensuring negative surgical margins. Patients should ask their urologist about their experience with the da Vinci™ robot for radical prostatectomy.
Advantages of Robotic Surgery
- Superior 3-D visualization
- Less invasive
- Reduced pain
- Faster recovery
- Quicker return to normal activities
Radical Perineal Prostatectomy
Tulane Urology is among the most experienced centers in the country performing radical perineal prostatectomy. This approach involves an incision in the perineum (the area between the scrotum and anus) and is offered by specially trained urologists. Recovery is generally quicker and return to normal activities is often easier with this approach.
Who is Eligible for Radical Perineal Prostatectomy?
This option is suitable for patients with multiple abdominal surgeries or bowel conditions, including those with J-pouches who are not candidates for robotic prostatectomy. However, lymph node evaluation will be performed using advanced imaging techniques.
Laparoscopic Prostatectomy
Before the availability of robotic surgery, Tulane Urology performed laparoscopic prostatectomies to treat prostate cancer. This technique is still used at several centers worldwide. Talk with your urologist to determine the surgical option best suited for you.
If your PSA and Gleason scores are low, pelvic lymph node dissection may not be necessary. The advantage of surgery is that removal of the prostate allows for effective cancer monitoring through serial PSA tests. Radical prostatectomy offers some of the best long-term outcomes for controlling prostate cancer.
Potential Side Effects of Radical Prostatectomy
- Bleeding: Blood transfusions are needed in only a small percentage of patients.
- Urinary tract infection: A catheter will drain your bladder for about two weeks post-surgery.
- Urinary incontinence: Some degree of leakage can occur but often improves over time.
- Impotence: The likelihood of preserving erectile function depends on several factors:
- Younger patients have a higher chance of potency preservation.
- Older patients have a lower chance.
- Potency-sparing nerve preservation is possible in some cases, depending on your cancer profile.
- Erectile function: About 30-50% of patients regain erections sufficient for intercourse, often with assistance from medications, devices, or penile implants.
Tulane Urology’s expert team will guide you through this journey of recovery.