In the early 1990s, roughly 30 percent of prostate cancer patients in the United States were treated by surgery, 30 percent by radiation, and 20 percent by watchful waiting. (Most of the rest were treated with a combination of therapies.) In Europe, by contrast, watchful waiting constitutes the standard treatment for asymptomatic prostate cancer.
The popularity of surgery in this country has grown tremendously in recent years. A study of Medicare patients’ records found that the number of men nationwide receiving radical prostatectomy by 1990 was six times greater than the number recorded for 1984, and the increase was seen in all age groups, from the youngest (that is, age 65) to men in their eighties. Recent statistics, however, indicate that since 1993, the rate of prostatectomies has been dropping.
What is a radical prostatectomy?
A radical prostatectomy is surgery to remove the entire prostate gland and regional lymph nodes after a diagnosis of prostate cancer is made. Radical prostatectomy is one of many options for the treatment of prostate cancer. You should discuss all options with your physician.
Radical prostatectomy can be done via an incision made in the abdomen (radical retropubic prostatectomy) or in the perineum, the area between the scrotum and the anus (radical perineal prostatectomy). Alternatively, it may be done with laparoscopy (laparoscopic radical prostatectomy). Laparoscopy is a technique is which surgery is performed by making small incisions and passing specially designed telescopes and instruments into the body.
Laparoscopic radical prostatectomy is a new technique, which may result in less discomfort and earlier return to work. Whether or not it results in the same level of cancer cure and preservation of urinary continence and sexual function is unknown at this time.
In addition to removing the prostate gland, the lymph nodes in the area of the prostate may be removed either before or during the same operation. This is done in order to determine if there has been spread of the prostate cancer to the lymph nodes. This procedure is called pelvic lymph node dissection.. The risk of having cancer in the lymph nodes can be estimated and only men with a moderate or high risk of pelvic lymph node metastases need to undergo pelvic lymph node dissection. This includ