A prostatectomy is the surgical removal of part or all of the prostate gland. There are two main types of prostatectomy – simple prostatectomy and radical prostatectomy. The type of prostatectomy depends on the reason for surgery. A simple prostatectomy is done to relieve symptoms of an enlarged prostate. A radical prostatectomy is done to remove prostate cancer.
What is a prostatectomy?
A simple prostatectomy is surgery to remove part of the prostate gland. It is done to treat benign prostatic hyperplasia (BPH). BPH causes symptoms like:
- Frequent or urgent need to urinate
- Trouble starting a urine stream
- A weak stream when urinating
- Dribbling after urination ends
- More frequent urination at night
BPH is a noncancerous enlargement of the prostate that occurs as a man ages. Removing part of the enlarged prostate can relieve these urinary symptoms.
A simple prostatectomy may be done in two ways:
- Transurethral resection of the prostate (TURP) – This is the most common type of simple prostatectomy. The surgeon inserts a thin viewing instrument (a resectoscope) through the tip of the penis. A cutting loop is used to shave away excess prostate tissue that is blocking urine flow. This tissue is flushed out at the end of surgery.
- Open prostatectomy – This surgery removes prostate tissue through an incision in the lower abdomen. It is used less often today due to improvements in TURP surgery.
Both methods can effectively relieve BPH symptoms and allow normal urination. Talk to your urologist about which option may be right for your case.
What is a radical prostatectomy?
A radical prostatectomy is the surgical removal of the entire prostate gland. It is done to eliminate prostate cancer. If the cancer is still inside the prostate and has not spread, removing the whole prostate can cure the cancer.
There are different techniques to remove the prostate during a radical prostatectomy:
- Open radical retropubic prostatectomy – The prostate is accessed through an incision in the lower abdomen. The surgeon removes the prostate and squeezes tissue around the urethra to keep it in place.
- Laparoscopic radical prostatectomy – The prostate is removed with the aid of a laparoscope. This is a thin tube with a camera that is inserted through small abdominal incisions. Long instruments are used to remove the prostate through the incisions.
- Robotic-assisted laparoscopic radical prostatectomy – This uses a robotic interface to help the surgeon operate the laparoscope and instruments through tiny incisions.
In skilled hands, all these methods can effectively remove the prostate and spare nerves/muscles that allow normal urinary and sexual function after surgery.
Key differences between simple and radical prostatectomy
| Simple Prostatectomy | Radical Prostatectomy |
|---|---|
| Removes part of the prostate | Removes the entire prostate |
| Treats enlarged prostate (BPH) | Treats prostate cancer |
| Relieves urinary symptoms | Cures cancer if it is confined to the prostate |
| Low risk of erectile dysfunction after surgery | Higher risk of erectile dysfunction after surgery |
| Does not require hospital stay | Requires 1-2 day hospital stay |
| Faster recovery time | Longer recovery time |
Indications
A simple prostatectomy is recommended for men with:
- Moderate to severe lower urinary tract symptoms (LUTS) from BPH
- Greatly reduced urine flow and repeated urinary retention
- Recurrent urinary tract infections due to BPH
- Significant complications from BPH like bladder stones or damage
- BPH unresponsive to medications or less invasive procedures
A radical prostatectomy is recommended for men with:
- Localized prostate cancer confined to the prostate
- 10+ years life expectancy
- Low to intermediate risk prostate cancer
- No evidence cancer has spread outside the prostate
- Willingness to accept side effects like ED and incontinence
Goals of surgery
- Simple prostatectomy: Improve urine flow and relieve LUTS caused by BPH
- Radical prostatectomy: Remove all prostate tissue to eliminate prostate cancer
How surgery is performed
- Simple prostatectomy:
- TURP: Prostate tissue removed through urethra using resectoscope
- Open prostatectomy: Prostate tissue removed through lower abdominal incision
- Radical prostatectomy:
- Open: Incision in lower abdomen to access prostate
- Laparoscopic: Prostate removed through small incisions using laparoscope
- Robotic laparoscopic: Similar to laparoscopic but uses robotic interface
Side effects and risks
Simple prostatectomy risks:
- Bleeding: Usually stops on its own
- Infection: Treatable with antibiotics
- Retrograde ejaculation: Semen flows to bladder instead of out the urethra
- Erectile dysfunction: Less common than with radical prostatectomy
- Urinary incontinence: Temporary loss of bladder control
- Need for repeat surgery: If too little or too much prostate removed
Radical prostatectomy risks:
- Erectile dysfunction: 50-75% risk after surgery
- Urinary incontinence: 25-50% risk, often improves over time
- Loss of fertility: Radical prostatectomy removes seminal vesicles needed for ejaculation
- Narrowing of urethra: May require additional surgery
- Lymphocele: Fluid collection that causes swelling
- Bowel injury: Rare complication
Recovery after prostatectomy
Simple prostatectomy recovery
- TURP:
- No hospital stay or 1 night stay
- Catheter for 1-2 days to allow urethra to heal
- Resume normal activities in 1 week
- Notice symptom improvement in 4-6 weeks
- Open simple prostatectomy:
- 1-3 day hospital stay
- Catheter for 5-7 days
- 4-6 week recovery at home
- Gradual return to normal activities over 2-3 months
Radical prostatectomy recovery
- Hospital stay: 1-2 days
- Catheter: 5-14 days to allow bladder neck to heal
- No strenuous activity: 4-6 weeks
- Kegel exercises: Start early to improve continence
- Erectile function: Takes 6-24 months to return, if at all
- Follow-up: Lifelong PSA monitoring to check for recurrence
Outcomes after surgery
Simple prostatectomy outcomes
A simple prostatectomy can provide significant relief of urinary symptoms in around 80-90% of patients. Benefits include:
- Greatly improved urine flow rate
- Reduced urgency and frequency of urination
- Decreased need to get up at night to urinate
- Improved emptying of the bladder
- Reduced risk of urinary tract infections
- Improved quality of life and sleep
Symptom relief starts in the first few weeks and continues to improve over 2-3 months. The enlarged prostate and related urinary problems are unlikely to return unless BPH progresses. About 10-15% of patients require a repeat prostatectomy at some point due to regrowth of prostate tissue.
Radical prostatectomy outcomes
For men with localized prostate cancer, radical prostatectomy offers excellent long-term survival if performed by an experienced surgeon. About 90% of men are cancer-free 10 years after surgery. Other outcomes include:
- Continence rates around 90% after 1 year, up to 95% after 2 years
- Erectile function returns in 20-75% of patients depending on age and nerve sparing
- Normal orgasms possible but no ejaculation after surgery
- PSA should drop to undetectable levels; rising PSA may indicate recurrence
- Further treatment needed if cancer recurs or spreads after surgery
Talk to your doctor about all potential outcomes after prostatectomy surgery. Certain side effects can often be managed with treatment.
Conclusion
In summary, the main differences between a simple prostatectomy and a radical prostatectomy include:
- A simple prostatectomy removes part of the enlarged prostate to relieve urinary symptoms from BPH. A radical prostatectomy removes the entire prostate gland to cure prostate cancer.
- Recovering after a simple prostatectomy is quicker with a shorter hospital stay, catheter time, and return to normal activities. Radical prostatectomy has a longer recovery period.
- The risks of urinary and erectile dysfunction are higher after a radical prostatectomy compared to a simple prostatectomy.
- A simple prostatectomy improves urination in 80-90% of patients with BPH. A radical prostatectomy successfully eliminates cancer in 90% of men with localized prostate cancer.
The best prostatectomy option depends on your diagnosis, prostate anatomy, health status, and priorities regarding side effects. Talk to an experienced urologic surgeon to determine if you are a candidate for prostatectomy surgery.