Surgery for Prostate Cancer
At NYU Langone, surgery to remove the prostate, known as radical prostatectomy, may be recommended for men with cancer that hasn’t spread to the lymph nodes, the bones, or other organs. Factors considered may also include a man’s age, life expectancy, or other health conditions, and whether the cancer is fast- or slow-growing. The goal of surgery is to eliminate the cancer by removing the prostate.
When removing the prostate, NYU Langone surgeons in most cases carefully preserve the bundle of nerves close to the prostate, provided that doing so doesn’t interfere with the doctor’s ability to control the cancer. These nerves control erectile function, and doctors at NYU Langone first identified them in the 1980s.
In a radical prostatectomy, the prostate gland is surgically removed along with the adjacent seminal vesicles, the small structures connected to the prostate that assist in making semen. A surgeon may also remove the pelvic lymph nodes at the same time as the prostate—a procedure known as a pelvic lymphadenectomy—to determine if the cancer has spread beyond the prostate. The decision to perform a pelvic lymphadenectomy is based on the risk that the cancer has spread to the lymph nodes. Lymph nodes are located throughout the body and are part of the lymphatic system that helps rid the body of toxins and waste.
The types of prostatectomy performed at NYU Langone include open prostatectomy and robotic prostatectomy. There is no evidence that either method of surgery is superior to the other, and our surgeons use the technique with which they are most experienced.
Surgeons at NYU Langone’s Smilow Comprehensive Prostate Cancer Center work closely with NYU Langone urologists, who are internationally recognized experts in urinary and erectile function.
Open Radical Prostatectomy
In open radical prostatectomy, an NYU Langone surgeon makes a small incision between the belly button and the pubic bone. Our surgeons pioneered the development of this technique, called a nerve-sparing radical retropubic prostatectomy.
The cavernous nerves, which control erectile function, are located very close to the prostate en route to the penis. These very delicate nerves may become damaged if meticulous care is not taken to preserve them. In cases where the cancer is growing through the prostate capsule, a membrane that surrounds the prostate gland, the nerves may need to be removed in order to ensure cancer control is not compromised.
Prostatectomy may also be performed using a laparoscopic approach. In this method, our doctors at the Robotic Surgery Center perform a prostatectomy using surgical instruments that are inserted into the body through small incisions and attached at the other end to robotic arms, which are controlled by NYU Langone surgeons.
Our doctors use a robotic surgery device called the da Vinci® surgical system to perform this type of prostatectomy. The surgeon inserts a small video camera into the body, which transmits the image of the organs to an external video monitor. This gives doctors a detailed, magnified view.
Recovery from Surgery
At NYU Langone, about 90 percent of men who undergo open or robotic radical prostatectomy can return home after one day of hospitalization. You can typically return to work that doesn’t require heavy lifting in 7 to 10 days, and after 3 weeks for more physically strenuous jobs. Most men can make a full return to their everyday activities within three weeks after open or robotic prostatectomy.
Almost all men early in their recovery have erectile dysfunction. Over time, the majority of men regain their erectile function. The Smilow Comprehensive Prostate Cancer Center team works closely with our male sexual health team to design penile rehabilitation programs to facilitate the return of erectile function.
For those who do not regain their erectile function, our urologists can treat this condition with medications, devices, or surgery.