Prostatectomy is surgical removal of the prostate gland. When performed to treat prostate cancer, the procedure usually includes removal of some adjacent tissues and is called a radical prostatectomy. Radical prostatectomy involves open surgery, with the incision made in the lower abdomen (retropubic prostatectomy) or between the scrotum and anus (perineal prostatectomy). A possible alternative to these open prostatectomies is laparoscopic surgery, a minimally invasive procedure that uses several small incisions to remove the prostate.

Partial (or simple) prostatectomy is more often used as a treatment for enlargement of the prostate, which is common after age 50, or to relieve pain and facilitate urination in men with advanced prostate cancer. The surgeon inserts an instrument through the urethra to remove prostate tissue in a transurethral resection of the prostate (TURP). The surgeon also can make cuts in the gland in a transurethral incision of the prostate.

Prostatectomy is not an appropriate treatment for all prostate cancer. Prostate cancer usually grows slowly and may need no initial treatment other than regular monitoring, referred to as “watchful waiting.” Surgery usually cannot help advanced cases that have metastasized (spread outside the gland). According to the U.S. National Cancer Institute (NCI), radical prostatectomy is generally reserved for patients who:

• Are in good health and under age 70 (older men may also have the surgery).
  
  
• Have cancer confined to the prostate gland (bone scans or other test results have shown the cancer has not spread to other areas).
  

The prostate is a walnut-size male reproductive gland located in front of the rectum. It lies below the urinary bladder and surrounds the upper part of the urethra, the tube that at different times carries urine and semen out of the body through the penis. The prostate helps makes seminal fluid, which protects sperm cells in semen. Located behind the prostate are the seminal vesicles, which make most of the seminal fluid. As men age, the prostate tends to enlarge and constrict the urethra, reducing the flow of urine.

Main concerns that many men have about removal of the prostate are related to sexual function and bladder control. Men may avoid impotence if nerve-sparing surgery can be used. Patients usually regain full urinary continence within weeks or months. However, incontinence may last up to 12 months. According to the American Academy of Family Physicians:

• Patients under age 50 are more likely to retain sexual function.
  
  
• Patients over 70 are more likely to become impotent.
  
  
• Impotence is less likely if the tumor is small and nerves do not have to be cut.
  
  
• Patients rarely have severe incontinence. About one-third may have occasional leaking of urine during laughter, coughing, sneezing or heavy lifting.