New techniques and tools improve results after prostate cancer surgery

Prostate cancer awareness is on the rise and so is the number of radical prostatectomies — surgery to totally remove the prostate gland. Since 1990 the operation has increased six-fold among Medicare patients. A decade ago, most of these patients would have expected permanent impotence and incontinence. Today, there are established and evolving methods to help men regain both their sex lives and bladder control.

“Both radiation therapy and radical prostatectomy give very good results for localized prostate cancer,” says Dr. Paul Lange, professor and chair of the Department of Urology at the School of Medicine. “The advantage of radical prostatectomy is that you remove all the cancerous prostate, so you know better and sooner where you stand regarding cure and your prospects for survival might be better.”

Nerve-sparing surgery to save potency was developed in the early 1990s, but in the past 18 months the results have been improved with several new surgical techniques and instruments. “Until recently, doctors still felt some insecurity about saving nerves which are very close to the prostate because there was the risk of leaving some cancer behind,” explains Lange, who practices at UW Medical Center.

A new procedure involves cutting from a different angle than in the past. Wearing microscopic loupes, surgeons get a better view of the extremely small nerve bundles so they can put them out of harm’s way before prostate removal begins. This is used in conjunction with a recently developed surgical aid to stimulate the critical cavernosal nerves, which control erection.

Nerve-sparing prostatectomy is limited to those with very early cancer. Also, at the time of surgery, surgeons may still decide against it if it looks like the nerves are too close to the cancer, adds Lange.

Incontinence is another common side effect of prostate surgery that can be more effectively prevented with newer surgical techniques. Generally about 5 percent to 20 percent of prostatectomy patients are temporarily incontinent, but at some centers, including UWMC, this figure has dropped to 2 percent. Temporary incontinence can last several weeks to a few months. Those who remain incontinent may undergo minor procedures such as collagen injections or an implantable cuff.

About 60 percent to 65 percent of patients have regained potency after nerve-sparing surgery, a significant increase over what was achieved previously at UWMC and many other hospitals, says Lange. Many men are able to have erections right away, while others may take up to a year. If potency is not restored in the first three months, alternative means can be used to achieve an erection. These include: