What is a radical prostatectomy?

Marc B. Garnick, MD
Hematology & Oncology
The goal of radical prostatectomy is to cure early prostate cancer that is confined to the prostate by removing the entire gland. Because the prostate is wedged tightly between the bladder and the rectum, the procedure is a delicate task that should be performed by a skilled urologic surgeon. The nerves that are responsible for erections are often damaged during the operation, so impotence is a common complication. A variation on this procedure, the nerve-sparing prostatectomy, attempts to preserve potency by removing the prostate without disrupting the nerves. Surgeons always try to strike a balance between removing all of the cancer and sparing the nerves and the urinary sphincter. Most err on the side of doing as complete an operation as possible to minimize the chance of leaving cancer cells behind.

Not surprisingly, almost everyone undergoing prostatectomy wants the nerve-sparing procedure, and it's available across the country. However, success is not guaranteed. If the tumor is too close to a nerve bundle, the nerves can't be saved -- and saving one nerve bundle is not as likely to preserve erectile function as saving both of them. Even if the procedure is successful, it can take a year or more for the tiny nerve fibers -- which often stop transmitting impulses when they've been traumatized by the surgery -- to heal sufficiently to restore sexual function. Estimates of the number of men undergoing radical prostatectomy who actually regain their ability to have erections range widely, from 25% to 80%.

It's important to choose an experienced surgeon. The likelihood of a successful outcome -- in terms of preserving potency, preventing incontinence, and, most important, curing the cancer -- generally correlates with experience. The number of procedures a surgeon performs does not necessarily make him better than one who does fewer; however, a minimum of 15 to 20 prostatectomies per year is necessary to be sufficiently skilled at the operation.

Recovery of sexual function also depends on the patient's age and the location of the tumor. Medication may be prescribed to help this process.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.