What is a prostatectomy?

A prostatectomy is the surgical removal of part or all of the prostate. The prostate is a walnut-sized gland in men that produces a portion of the fluid that makes up semen. It lies in front of the rectum, under the bladder, and surrounds the urethra. The urethra is the tube that carries urine from the bladder through the penis and out of the body.

Your doctor may recommend a prostatectomy for prostate cancer or enlarged prostate (benign prostatic hyperplasia, or BPH). BPH is the enlargement of the prostate with age. It is a common condition that causes problems with urination. These include incontinence and the inability to begin urinating or to fully empty the bladder. 

A prostatectomy is a major surgery with serious risks and potential complications. You may have less invasive treatment options. These include procedures that use heat, such as with a laser or electrical current, to destroy prostate tissue. Consider getting a second opinion about all of your treatment choices before having a prostatectomy. 

Types of prostatectomy

The major types of prostatectomy include:

  • Simple prostatectomy is the removal of just the inside portion of the prostate gland to treat benign prostatic hyperplasia (BPH). A simple prostatectomy involves making a cut from your belly button to your pubic bone to access and remove the inside of the prostate gland.
  • Radical prostatectomy is the removal of the entire prostate and some of the lymph nodes near it to help treat prostate cancer. A radical prostatectomy involves making a cut or series of smaller cuts under your testicles or above your pubic bone to access and remove the prostate and other tissues. This may include nearby lymph nodes.
  • Transurethral resection of the prostate (TURP) is the removal of all or part of the prostate to treat benign prostatic hyperplasia (BPH). Sometimes, a surgeon may choose TURP for treating prostate cancer in older or ill men who cannot tolerate a radical prostatectomy.

The surgeon accesses the prostate through your urethra using a tube-shaped tool called a cystoscope. The surgeon then removes part or all of your prostate in pieces using electric current. 

Why is a prostatectomy performed? 

Your doctor may recommend a prostatectomy to treat prostate cancer. Prostate cancer causes frequent urination, painful urination, painful ejaculation, and other symptoms. It can spread (metastasize) to other organs and body systems, such as the bones, liver and lungs. 

Prostatectomy may also alleviate the symptoms of an enlarged prostate, or benign prostatic hyperplasia (BPH). BPH is a noncancerous condition in which the prostate enlarges as a man ages. When the prostrate grows, it can press against the urethra and bladder. This can cause sudden urination, incontinence, painful urination, and incomplete emptying of the bladder.

Your doctor may only consider a prostatectomy for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a prostatectomy.

Who performs a prostatectomy?

A urologist performs a prostatectomy. A urologist is a doctor and surgeon who specializes in diseases and conditions of the urinary tract and the male reproductive organs. 

How is a prostatectomy performed?

Your prostatectomy will be performed in a hospital, a surgeon’s private office, or an outpatient surgery clinic. It involves making incisions in the lower abdomen or behind the genitals, or inserting a small tube (cystoscope) through the urethra. 

The surgeon then cuts away part or all of the prostate from the tissues around it. The surgeon may also remove nearby lymph nodes if the surgery is for prostate cancer. The surgeon will tie off the remaining blood vessels and reattach the urethra to the bladder if the entire prostate is removed. 

Surgical approaches to prostatectomy

Your doctor will perform a prostatectomy using one of the following approaches: