Prostatectomy

Surgical treatment for prostate cancer involves removing the entire prostate and seminal vesicles. When the cancer is confined within the tissues, surgery alone can usually cure localized prostate cancer. The PSA level in the blood should fall to undetectable levels after prostatectomy.

There are three main types of prostatectomy:

  • Retropubic Prostatectomy (RP)
  • Nerve-Sparing Prostatectomy
  • Robotic Assisted Laparoscopic Prostatectomy (RALP)

Retropubic Prostatectomy (RP) is a prcedure where the surgeon makes a skin incision in the lower abdomen (four finger breadths below the umbilicus to just above the pubic area). If indicated, a pelvic lymph node dissection (PLND) is performed prior to removal of the prostate.  The lymph node dissection is a staging procedure performed to more accurately determine if prostate cancer is present in the lymph nodes.

Following the PLND, the prostate is removed from between the bladder and the urethra.  When it is possible, the surgeon carefully spares the small bundles of nerves located on either side of the prostate gland that are needed for erections (‘nerve sparing surgery’). With the prostate removed, the bladder opening is sewn to the urethra.  A catheter is placed through the penis and remains in place while the tissues heal. Patients undergoing surgery can expect a hospital stay of 1 to 2 days. The catheter and staples are removed in the clinic approximately 7 to 10 days later.  

Nerve-Sparing Prostatectomy is performed if there is no indication of tumor extension close to the nerves surrounding the prostate, called the neurovascular bundle. A unilateral nerve-sparing procedure will save the nerves on one side of the prostate. A bilateral nerve-sparing procedure saves the entire neurovascular bundle or the nerves on both sides of the prostate. Patients with locally advanced tumors are not offered nerve-sparing surgery because of concerns about leaving cancer at the margins of the prostate capsule. Occasionally there are technical issues (eg. scarring, unusual blood vessel anatomy, large prostates) that make nerve sparing difficult or impossible. The surgeon cannot predict these factors prior to operating. Men who are younger than age 60, and those who have the highest levels of pre-operative sexual function usually have the best outcomes in terms of potency.

Robotic Assisted Laparoscopic Prostatectomy (RALP) is a minimally invasive technique used to remove the prostate in patients with prostate cancer.  The surgeon performs the procedure through six small incisions spread in a fan shape across the upper abdomen. Surgical fields are viewed with the use of a laparoscope (a camera inserted through one of the incisions). Surgeons performing LRP at Vancouver General Hospital use a robotic surgical assist device called the “da Vinci® Surgical Robot”.

There are two main components to the robotic system. A surgeon’s console, where the operating surgeon sits and controls the instruments and the robotic arms, which are at the patient’s side and hold the camera and instruments used during the operation. The da Vinci® robot allows surgeons to perform surgical procedures with greater ease and precision.

Patients considering surgical treatment for their prostate cancer have common concerns: cure, recovery, urinary continence, and sexual function.

Please see our 2014 study comparing the outcomes of robotic surgery vs. open prostatectomy here (PDF, opens in new window).

Return of urinary continence and sexual function following both the open and LRP are similar.

A World Class Centre

The Vancouver Prostate Centre (VPC) has a track record of success that has earned it a reputation as one of the world’s most respected cancer facilities. It is a National Centre of Excellence and a designated Centre of Excellence for Commercialization and Research.

Events

Movember Foundation 2018

Movember 2018

The Movember Foundation's fundraiser runs from November 1 to 30.  The Vancouver Prostate Centre team will join teams across Canada to raise funds for men's health research in the areas of prostate cancer, testicular cancer, mental health and suicide prevention.

Employment

Work at the Vancouver Prostate Centre

Thursday, July 26, 2018

Dr. Gleave awarded the 2018 Dr. Chew Wei Memorial Prize in Cancer Research

Dr. Gleave
Tuesday, May 29, 2018

Three VPC trainees receive 2018 VCHRI Rising Star Awards

2018 Rising Star Awardees
DNA

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