Sometimes, prostate cancer requires surgery to remove the prostate. While this can yield some benefits, prostate cancer surgery can also lead to severe side effects.
There are several treatment options for men with prostate cancer. Which type a person has depends on the size, spread, and location of the tumor, as well as general health and life expectancy of the individual.
In this article, we look at the different types of surgery and their side effects.
A cancer specialist might recommend surgery for men with a prostate cancer diagnosis, depending on various factors. These include their age, overall health, and the stage of the cancer.
Not every man who has prostate cancer will receive surgery. Surgery can lead to a range of side effects, such as erectile dysfunction and problems with urinary control, which can affect a person's quality of life.
Prostate cancer grows slowly, so doctors may recommend watchful waiting or active surveillance if it is not causing any symptoms.
Doctors often recommend watchful waiting for older men and those who are unable to have treatment for health reasons. A doctor will only suggest treatment if it becomes necessary.
Active surveillance involves regular tests to identify any signs of cancer growth and progression in time to receive treatment.
There are three types of prostate surgery: Radical prostatectomy, transurethral resection of the prostate (TURP), and pelvic lymphadenectomy.
A radical prostatectomy may benefit men with prostate cancer whose health is otherwise good. However, if the cancer has spread outside of the prostate, this operation may not be suitable.
During a radical prostatectomy, a surgeon removes the whole prostate gland, including the cancerous cells. They may also remove the seminal vesicles, which are glands that secrete many components of semen.
There are several types of radical prostatectomy:
- Retropubic prostatectomy: A surgeon removes the prostate through an incision in the wall of the abdomen. They may also remove nearby lymph nodes through the same incision to reduce the risk of cancer cells spreading.
- Perineal prostatectomy: A surgeon removes the prostate through an incision in the region between the testicles and anus. They might remove the lymph nodes, although through a separate incision in the abdominal wall.
- Laparoscopic prostatectomy: This involves the surgeon making five or six incisions in the abdomen to remove the prostate. They perform this procedure by hand, using a camera and a lighted tube to guide them.
- Robotic prostatectomy: The surgeon uses a computer to control a robotic machine with four arms. They perform a laparoscopic procedure.
The type will depend on the hospital's resources and the surgeon's expertise.
Risks and side effects
Radical prostatectomy carries risks. These include:
- injury to nearby organs, such as the bowel and nerves
- blood clots
The most common side effects are leaking urine, known as urinary incontinence, and erectile dysfunction. Surgeons will try to save the nerves that control erections, but this is not always possible. Even if the surgeon manages to save the nerves, many men still have difficulty achieving and maintaining erections after a prostatectomy.
After surgery, most men lose control of their bladder. Some may experience stress incontinence, which means leaking a few drops of urine during exercise, coughing, or sneezing. Others may need absorbent pads or pants, though this usually improves with time.
Some men experience difficulties producing urine after the operation, and this might happen gradually or suddenly.
The prostate also plays a role in producing semen. Removing it means that men are unable to ejaculate or father children through sex.
After surgery, men experience "dry orgasms," which is the sensation of orgasm without the ejaculation.
Men planning on having a radical prostatectomy may wish to consider storing sperm for fertility treatment at a later date.
Transurethral resection of the prostate (TURP)
This procedure does not cure the cancer. It helps resolve difficulty passing urine. This happens when the enlarged prostate presses against the urethra, causing it to become narrow.
A man receiving a TURP will be under general anesthesia. The surgeon passes a thin metal tube with a camera attached through the penis to the urethra.
The surgeon then inserts a small wire loop through the tube and applies heat to remove small parts of prostate tissue. During the operation, they will also pass fluid through the bladder to flush away the removed tissue.
Possible side effects of TURP include:
- Retrograde ejaculation: This occurs when semen flows into the bladder instead of out of the penis. It is the most common side effect of TURP, occurring after 90% of procedures. Men who have retrograde ejaculation experience orgasm differently and may not be able to father children through sex. Banking sperm is a treatment option for this side effect.
- Erectile dysfunction: Around 10% of men cannot achieve or maintain an erection following a TURP.
- Urinary incontinence: Many men experience urge incontinence after a TURP. This leads to strong urges to urinate, and a loss of bladder control when urinating is not possible.
- Urethral stricture: This might occur if the urethra incurs damage and scarring during a TURP. This can make the urethra narrow and lead to pain, straining, and a divided stream when passing urine.
This usually takes place before a radical prostatectomy to check whether more intensive surgery is necessary.
A surgeon removes the lymph nodes from the pelvis. They will also send some of the nodes for a biopsy to check for cancerous cells. These would be a sign that prostate cancer is spreading from the prostate into other tissues.
If a biopsy finds cancer in the lymph nodes, a radical prostatectomy might end up causing severe side effects without resolving the spread of cancer. A cancer specialist may recommend different treatments.
The outlook for men diagnosed with prostate cancer is good. According to the American Cancer Society, the 5-year relative survival rate for prostate cancer is almost 100 percent. This is dependent on the cancer not spreading beyond tissue in the region.
If prostate cancer spreads to distant organs, or metastasizes, this reduces to 30%.
However, many men report that prostate cancer changes their quality of life. A diagnosis, symptoms, and surgery can adversely affect a person's life, work, and relationships.
Managing erectile dysfunction
Phosphodiesterase type 5 (PDE5) inhibitors are medications that help men get and keep erections. Viagra is a well-known example.
A range of creams, pumps, and implants may also help. Men may also wish to receive testosterone replacement therapy.
Managing urinary incontinence
Absorbent pads or pants or a urinary sheath, which drains urine from the penis to a bag, can help a man manage symptoms of urinary incontinence.
Healthcare teams also recommend pelvic floor exercises to strengthen the muscles used during urination.
For more severe cases, a doctor might suggest surgical options, such as an artificial urinary sphincter or internal male sling.