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Also known as
Radical retropubic prostatectomy (RRP), Radical perineal prostatectomy, Robot-assisted radical prostatectomy (RARP), Robotic prostatectomy, Laparoscopic radical prostatectomy (LRP), Nerve-sparing radical prostatectomy, Total prostatectomy
Definition
Radical prostatectomy is a surgical procedure that involves the complete removal of the prostate gland, seminal vesicles, and some surrounding tissue to treat prostate cancer.1 This procedure is primarily performed when cancer is believed to be confined to the prostate gland (localized prostate cancer).2 The surgery aims to remove all cancerous tissue while attempting to preserve urinary continence and erectile function when possible through nerve-sparing techniques.3 There are several surgical approaches to radical prostatectomy, including open retropubic, open perineal, laparoscopic, and robot-assisted laparoscopic techniques, each with specific advantages and considerations.4
Clinical Context
Radical prostatectomy is primarily indicated for the treatment of localized prostate cancer that has not spread beyond the prostate gland.1 Patient selection criteria include those with clinically localized disease (typically stage T1 or T2), a life expectancy of at least 10 years, and good overall health status.2 The procedure may be used alone or in combination with radiation therapy or hormone therapy depending on cancer stage and risk factors.3
The surgical procedure varies by approach:
- Retropubic approach: The surgeon makes an incision in the lower abdomen from below the navel to the pubic bone. This approach allows direct visualization of the prostate and surrounding structures, including the ability to perform pelvic lymph node dissection if necessary.4
- Perineal approach: The incision is made between the scrotum and rectum. This approach may result in less blood loss but makes lymph node removal more difficult and carries a higher risk of rectal injury.5
- Laparoscopic approach: Several small incisions are made in the abdomen through which specialized instruments and a camera are inserted. This minimally invasive technique typically results in less blood loss and faster recovery.6
- Robot-assisted laparoscopic approach: Similar to standard laparoscopy but with the surgeon controlling robotic arms from a console. This provides enhanced visualization (3D magnified view) and greater precision in dissection and suturing.7
Recovery typically involves 1-4 days of hospitalization, with a urinary catheter in place for 1-2 weeks.8 Common post-operative complications include urinary incontinence (affecting 5-30% of patients) and erectile dysfunction (affecting 30-70% of patients).9 Studies show that nerve-sparing techniques can improve post-operative erectile function recovery, though results vary based on pre-operative function, age, and surgical technique.10