What are the different types of surgery for prostate cancer?

The following are some of the different surgical options used to treat prostate cancer:

• radical prostatectomy

  an open-surgery procedure in which the entire prostate gland and some tissue around it are removed. This surgery involves an incision in either the abdomen or the scrotum area.

• transurethral resection of the prostate (TURP)

  surgery to remove part of the prostate gland that surrounds the urethra by using a small tool that is placed inside the prostate through the urethra. There is no incision with this method.

• cryosurgery

  a procedure that involves killing the cancer by freezing the cells with a small, metal tool placed in the tumor.

Possible complications or side effects of prostate cancer surgery

Long-term, serious side effects are somewhat less common now than in the past, as new surgical methods continue to be introduced. New, nerve-sparing surgical procedures may prevent permanent injury to the nerves that control erection, and damage to the opening of the bladder. However, possible complications and side effects of prostate cancer surgery still exist. Be sure to discuss the following with your physician before a surgical procedure:

• Incontinence

  Incontinence is the inability to control urine and may result in leakage or dribbling of urine, especially just after surgery. Normal control returns for many patients within several weeks or months after surgery, although some patients become permanently incontinent.

• Impotence

  Impotence is the inability to have an erection of the penis. For a month, or so, after surgery, most men are not able to get an erection. Eventually, approximately 40 to 60 percent of men will be able to get an erection sufficient for sexual intercourse, but without ejaculation of semen, since removal of the prostate gland prevents that process.

This effect on a man's ability to achieve an erection is related to the stage of the cancer and the patient's age. However, most men who have surgery should expect some decrease in their ability to have an erection. For men who are completely impotent after surgery, several solutions are available.

Non-Surgical Treatment Options

Radiation Therapy

One of the most advanced treatment options available for prostate cancer is a new radiation targeting tool called the Calypso targeting advice. The Nebraska Medical Center was one of five sites in the country that participated in a pivotal clinical trial that led to FDA approval of Calypso which has been incorporated into its standard of care for prostate patients.

Calypso provides several advantages over other targeting systems in use today including quicker localization of the tumor as well as the elimination of subjectivity during targeting. It is the only FDA approved targeting technology that can track the prostate position in real time as the 10- to15-minute radiation treatment is being delivered. Calypso is expected to result in improved cure rates and decreased side effects for men with prostate cancer. It may also represent the most effective available treatment option when there are high risk features or evidence of the prostate cancer extending locally beyond the prostate gland.

How it works

The targeting tool relies on electromagnetic “beacons” to localize the prostate, which provide more exact tracking of the prostate and accounts for slight movements before and during treatment. Working much like a global positioning device, the implanted beacons emit individualized radiofrequency signal which triangulate the position of the prostate during treatment. This allows for correction during treatment due to any prostate movement.

Advantages

Some of the advantages of Calypso targeted IMRT over prostatectomy include a better chance for cure when the cancer has locally extended beyond the prostate, most likely at least an equivalent chance for cure when the cancer is contained within the prostate, a much better chance of avoiding any urinary incontinence, and an excellent chance for potency preservation in men who have normal erectile function at diagnosis. It should also be noted that men treated with radiation have a potentially higher risk of bowel symptoms post- treatment compared to surgery. The incidence of long term bowel side effects is under 5 percent in men treated at the Nebraska Medical Center since 1999.

The effectiveness of IMRT is also dependent on delivering a higher radiation dose. Not all radiation oncology centers deliver the higher prostate radiation doses associated with the best outcome. The Nebraska Medical Center has been using dose escalation for prostate cancer since 1999.

The Nebraska Medical Center also plans to participate in a clinical trial that will evaluate the administration of increasing radiation dosages, while reducing the number of treatments from 40 to 26 and the total treatment interval from eight weeks to five weeks which may further improve the cure rates for prostate cancer.