radical prostatectomy
Meaning of radical prostatectomy: Removal of the whole prostate rather than part of it, performed to cure cancer that still appears confined to the gland.
Definition of radical prostatectomy
A radical prostatectomy is an operation that removes the entire prostate gland along with the seminal vesicles, and often nearby lymph nodes as well. It is performed to cure prostate cancer that appears to be contained within the gland. The urethra is then rejoined directly to the bladder. Surgeons reach the prostate through the lower abdomen, through the perineum, or with keyhole and robot assisted instruments.
What does radical mean here?
Radical describes how much is taken, not how dangerous the operation is. A simple prostatectomy removes only the inner part of the gland to relieve blocked urine flow and leaves the outer shell behind. A radical operation removes the whole prostate with its capsule intact, because cancer cells sit throughout the gland and any remnant could still harbor them. The seminal vesicles come out with it since tumor spreads into them early. Deciding which version of prostatectomy is appropriate depends entirely on whether the problem is cancer or obstruction.
How is the prostate reached?
| Route | How it is done |
|---|---|
| Retropubic | An open cut in the lower abdomen, the classic approach, described under radical retropubic prostatectomy |
| Perineal | A cut between the scrotum and the anus, which cannot reach the lymph nodes |
| Laparoscopic | Several small cuts and a camera, with less blood loss |
| Robot assisted | Laparoscopic instruments controlled from a console, now the commonest route in many countries |
What follows the operation?
Two nerve bundles run along the outside of the prostate and carry the signals for erection. Sparing them is possible when the tumor sits away from them, and is abandoned when it does not, so erectile function afterward varies widely. Leakage of urine is usual at first and improves over months as the remaining valve mechanism strengthens. Semen is no longer produced, since the glands that make it have been removed, and fertility ends. The pathologist examines the whole specimen, and finding tumor at the cut edge raises the chance that some was left behind.
Also known as
Used in a sentence
A radical prostatectomy was performed after imaging suggested the tumor was confined to the gland.
Good to know
Once the whole gland has been removed, PSA in the blood should fall to an undetectable level, so a measurable and rising PSA afterward is usually the first sign that cancer remains.
Word origin
Where “radical prostatectomy” comes from
Prostatectomy joins the Greek prostates, meaning one standing before, with ektome, a cutting out. Radical is from the Latin radix, a root.