The radical prostatectomy is the name given to surgery used to remove the prostate in patients with cancer. It involves the removal of the entire prostate gland, together with the seminal vesicles, and the bladder is the reconnected with the urethra, the channel through which the urine flows from the bladder through the penis to the exterior. In special cases, the surgeon might also remove the regional lymph nodes to evaluate them and determine if the cancer has spread beyond the prostate.
An important consideration is that after surgery, the patient will no longer ejaculate due to the removal of the prostate and the seminal vesicles, which store the seminal fluid; although this happens, the patient will conserve exactly the same sensation of pleasure during orgasm. In the case where the patient wishes to have children after the procedure, some assisted reproductive techniques to achieve fatherhood will be needed, such as those that involve the extraction of sperm from the testicles with subsequent injection into the female reproductive cells (as such is the case with in vitro fertilization).
In general, a radical prostatectomy is recommended only for men who have clinical, biochemical, and /0r radiological evidence of the cancerous disease located only in the prostate, as well as being in good health in general, with a life expectancy of 10 years or more. An exception to this are young men with suspicion of a localized advanced disease, who could benefit more from a combined treatment including radical prostatectomy, radiotherapy and hormonal blocking (as opposed to just receiving radiotherapy and hormonal blocking). The urologist cam make, to estimate the risk of extraprostatic disease and evaluate the pros and cons of surgery.
Diagnostic studies currently available do not make it possible to precisely evaluate whether the prostate tumor has extended beyond the prostate. This can only be known after surgery, once the pathological examination has been completed. Furthermore, on rare occasions (less than 3% of patients), it happens that the disease was limited to the prostate, the prostate-specific antigen begins to rise after surgery, revealing that possibly cancerous cells still remain at the prostate bed or has entered the bloodstream and disseminated in the body. For this reason, patients who have undergone this operation, even when according to the biopsy the disease was contained, must continue annual control during at least 10 years after surgery.
Extract from Prostate Cancer: A Patient’s Guide.