Introduction
If you have prostate cancer, you need to learn about your treatment choices. Open prostatectomy is a traditional surgery to remove the prostate gland.
Newer methods exist. But this surgery is still vital for many men. It’s often used in complex cases.
This guide explains open prostatectomy. We cover the surgery, recovery, and long-term results.
Are you weighing options? Or getting ready for surgery? This guide offers key facts from trusted doctors.
What Is Open Prostatectomy Surgery?
Open prostatectomy removes the whole prostate gland. It also removes nearby tissues to treat prostate cancer.
It’s different from newer methods. It uses one larger cut. This lets the surgeon reach the prostate directly.
“Open prostatectomy remains one of the best treatments for prostate cancer that hasn’t spread far,” says Dr. James Wilson. He is Chief of Urologic Oncology at Northeast Medical Center.
Dr. Wilson adds, “Other methods are popular now. But the open technique still gives excellent results.”
There are two main types:
- Retropubic: The surgeon cuts from your belly button down to your pubic bone. This is the most common type for cancer.
- Perineal: The surgeon makes the cut between your scrotum and rectum. This type is less common for cancer.
A Look Back: History of the Surgery
Open prostatectomy started in the early 1900s. Dr. Hugh Hampton Young did the first major surgery of this type in 1904.
Terence Millin developed the retropubic method later, in 1945.
Dr. Patrick Walsh made a big improvement in the 1980s. He developed a nerve-sparing method.
“Walsh’s work changed prostate cancer treatment,” notes Dr. Elizabeth Chen from Western University Medical School. “His technique greatly lowered the risk of side effects. These included urine leakage and erection problems.”
Newer methods became popular after 2000. But open prostatectomy is still used often. It remains a key skill for surgeons, especially for difficult cases.
When Do Doctors Recommend Open Prostatectomy?
Doctors often suggest open surgery for men with cancer. This applies if the cancer is only in the prostate or has just spread beyond it.
Several things affect this choice:
Patient Factors
- Cancer features: Open surgery allows a direct view. This can be better for larger or high-risk tumors.
- Past surgeries: Open surgery might be a better choice if you’ve had belly surgery before.
- Body size: Open surgery can be a good option for very large patients.
- Your choice: Some men prefer open surgery. They trust its long history of success.
Surgeon Factors
- Surgeon skill: Some surgeons are more experienced with open surgery.
- Hospital tools: Not all hospitals have robotic surgery tools.
Dr. Raoul Fernandez explains: “Choosing between open, laparoscopic, or robotic surgery should be personal.” He is Director of Urologic Oncology at Central University Hospital.
“All methods work well against cancer if the surgeon is skilled,” he says. “So, the surgeon’s skill is often the key point.”
Getting Ready for Surgery
Getting ready for open prostatectomy takes several steps:
Medical Tests
- A full physical exam.
- Blood tests (including PSA).
- Scans like MRI, bone scan, or CT scan.
- Tests for heart and lung health (often for older men).
Medicine Check
You might need to stop blood thinners before surgery. Dr. Michelle Thompson, a surgeon, stresses this point: “Tell your doctor about all drugs, vitamins, and herbs you use.”
She adds, “Some can raise bleeding risks. Others react badly with sleep medicine (anesthesia).”
Lifestyle Changes
- Quit smoking 4-6 weeks before your surgery.
- Eat healthy foods and drink plenty of fluids.
- Keep active to stay strong.
Bowel Prep
You might need to clean out your bowels the day before. This helps lower the risk of infection.
Mental Prep
“Getting mentally ready is key,” says Dr. Robert Kim, a cancer specialist. “Ask questions. Share your worries. Find support from family or friends.”
“Knowing what to expect can ease worry,” he explains. “It also helps your recovery.”
The Surgical Procedure
The surgery takes 2-4 hours. You will be fully asleep (general anesthesia). The most common method is retropubic:
- You get medicine to sleep deeply. You lie on your back.
- The surgeon makes a 3-4 inch cut. It runs from below your belly button down to your pubic bone.
- The surgeon carefully works through layers of tissue. They reach the prostate gland.
- Nearby lymph nodes might be removed. This happens if cancer may have spread there.
- The surgeon tries to save the nerves that control erections. This is done whenever possible.
- The prostate is carefully cut away from nearby parts.
- The surgeon reconnects your bladder to your urethra. (The urethra is the tube urine flows through).
- A small tube (catheter) is placed in your bladder. It drains urine while you heal.
- The cut is closed with stitches or staples.
“Open surgery gives us a great view. We can also feel the tissues directly,” explains Dr. David Nguyen, Director of Urologic Surgery.
“This sense of touch helps the surgeon,” he says. “It’s useful if cancer is close to the edge of the prostate.”
Potential Risks
Like any major surgery, this one has risks. Serious problems occur in about 5-10% of surgeries:
Short-Term Risks
- Bleeding: You usually lose more blood than with other methods.
- Infection: You might get an infection in the cut or your urinary tract.
- Blood clots: Clots can form in leg veins (DVT). They could also travel to the lungs (PE).
- Anesthesia problems: Bad reactions to the sleep medicine are rare.
Long-Term Risks
- Urine leakage: Leaking urine is common right after the catheter is removed. Most men regain control in a few months. Lasting leakage affects about 5-10% of men.
- Erection problems (ED): Erections might be affected, even if nerves were saved. Recovery depends on your age and pre-surgery function. The surgeon’s technique also matters.
- Bladder neck scarring: Scars can form where the bladder and urethra join. This can block urine flow.
- Hernia: The cut in your belly raises the risk of a hernia later.
Dr. Sophia Martinez, a cancer specialist, advises: “Be realistic about recovery. Most men do well after surgery. But getting back urine control and erections takes time.”
She adds, “Doctors have gotten better at managing these side effects.”
Recovery Process
Here’s what recovery usually looks like:
In the Hospital (1-3 days)
- You’ll get medicine for pain.
- The urine tube (catheter) stays in.
- You’ll be encouraged to walk soon.
- Any drains are checked. They are removed when ready.
Recovering at Home (First Few Weeks)
- Don’t lift heavy things (over 10 lbs) for 4-6 weeks.
- The catheter usually stays in for 1-2 weeks.
- Use pain medicine if you need it.
- Keep the cut clean and dry.
“Recovery takes time,” says Dr. William Jackson, Chief of Urology. “The first weeks are for basic healing. You’ll also get used to the catheter.”
“After it’s out, you’ll focus on urine control,” he continues. “You will slowly get more active.”
Longer Recovery (Months 1-12)
- Special exercises (Kegels) help improve urine control.
- Getting erections back can take 6-24 months.
- You can often return to a desk job in 3-6 weeks.
- You might return to full activity in 6-12 weeks.
Results and Effectiveness
Studies show open surgery works well for prostate cancer. More than 90% of men are alive 10 years later. This applies if the cancer was only in the prostate.
Cancer Control
“The main goal is controlling cancer. Open surgery has a great track record here,” states Dr. Jonathan Miller, Professor of Urologic Oncology.
“Your PSA blood level should drop to zero after surgery,” he explains. “If PSA rises later, it might mean some cancer cells remain. You may need more treatment.”
Things affecting cancer control include:
- The cancer’s stage and grade at the start.
- Surgical margins (if cancer cells are at the tissue’s edge).
- Your PSA level before surgery.
- The surgeon’s skill and method.
Quality of Life After Surgery
Life quality has improved thanks to better surgery methods:
- Urine control: Most men (80-95%) regain good control within a year.
- Sexual function: Recovery varies a lot. It depends on age, prior function, and nerve-sparing.
- Emotional health: Coping with body changes can be hard. Support groups and counseling can help.
Dr. Patricia Lee, Director of Survivorship Programs, points out: “Recovery involves your body, mind, and social life.”
“Patients often do better if they actively take part in recovery,” she says. “This means doing pelvic exercises. It also includes staying active and getting mental health support.”
Open Prostatectomy vs. Other Treatments
Comparing treatments helps you choose wisely:
Compared to Less Invasive Surgery (Robotic/Laparoscopic)
- Cancer control: Survival rates are similar.
- Blood loss: Open surgery usually means more blood loss.
- Pain/Recovery: Open surgery often means more pain and longer recovery.
- Hospital stay: Usually longer with open surgery.
- Problems: Overall risk is similar. But the specific problems can differ.
- Cost: Open surgery usually costs less than robotic surgery.
Dr. Thomas Wright, Chief of Robotic Surgery, offers this view: “People often debate open versus robotic surgery. But surgeon experience matters most. Skilled surgeons get similar results with either method.”
Compared to Radiation Therapy
- Method: Surgery is one event. Radiation involves many sessions.
- Side effects: The possible side effects are different.
- Cancer control: Both work very well for cancer inside the prostate.
- Future options: Radiation can follow surgery if needed. But surgery after radiation is harder.
Compared to Active Surveillance (Watching Closely)
- Timing: Surgery treats cancer now. Surveillance watches it closely. Treatment only happens if it grows.
- Risks: Surgery removes cancer but has side effects. Surveillance avoids side effects now, but cancer could grow.
- Your choice: Some men want treatment right away. Others want to avoid side effects if possible.
Dr. Sarah Thompson, a Medical Oncologist, advises: “Your choice depends on your cancer risk, age, and health. Think about side effects and life quality too.”
She adds, “A team of experts can help you sort through these complex choices.”
New Ideas and Future Steps
Open surgery is well-known. But doctors keep making it better:
- Better recovery plans: These plans use less pain medicine. They encourage moving early and eating well.
- Better nerve-saving methods: New ways to save nerves help improve erections and urine control.
- Better scans: Improved scans before surgery help surgeons plan better.
- Gene tests: These tests help show which cancers need strong treatment.
- Focused therapy research: Doctors are studying treating only the cancer spot. This might work for some men.
“We are moving toward ‘precision urology’,” explains Dr. Kevin Harris, Director of Urologic Research.
“Better scans and tests help us understand prostate cancer,” he says. “They allow for care tailored to each person. Future treatments may be even more targeted.”
Frequently Asked Questions
How do I choose between open and robotic surgery?
Think about your surgeon’s skill, your cancer, and what you prefer. Cancer results are similar with skilled surgeons. Talk about the pros and cons with your doctor.
How successful is open prostatectomy?
For cancer inside the prostate, cancer control is excellent (over 90% at 10 years). “Success” can also mean good urine control, erections, or life quality.
How long will I need a catheter?
Most men need the urine tube for 1-2 weeks. This lets the area where the bladder and urethra connect heal properly.
Will I leak urine after surgery?
Leaking is common at first. Most men slowly regain control over months. About 85-90% have good control within a year.
Can I get erections after surgery?
Recovery depends on age, prior function, and if nerves were saved. Many men have some ED at first. Function often gets better over 6-24 months. Treatments can help.
When can I go back to work?
Most men return to desk jobs in 3-4 weeks. Physical jobs may need 6-8 weeks off.
What follow-up care is needed?
You’ll need regular check-ups. This includes PSA tests every 3-6 months at first, then yearly. Your doctor will also check for side effects. More tests are done only if needed.
Does insurance cover open prostatectomy?
Yes, most insurance plans cover this surgery for prostate cancer. Details vary by plan. Check with your insurance company.
Conclusion
Open prostatectomy is still a key treatment for prostate cancer. It offers great cancer control. Results like urine control and erections are improving, thanks to better surgery methods.
When thinking about treatments, talk with your doctors. Discuss the good points, risks, and results of each option.
Your choice should depend on your cancer details and surgeon’s skill. Your own wishes and hospital resources also matter.
Research continues to bring improvements. We expect better surgery methods. We also expect better ways to find the best treatment for each man. For many men, open prostatectomy remains a good choice. It offers strong long-term results.