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Medical Services

Prostate Cancer Surgery

The Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine has an international reputation for its nerve-sparing surgical approach to prostate cancer.

Our urologists are renowned for performing nerve-sparing (potency-preserving) radical prostatectomies, in which tumors can be removed with fewer long-term side effects. We perform all types of prostatectomy, including open, laparoscopic and robot-assisted. Rates of sexual potency and urinary continence are generally higher in patients treated at Siteman.

Minimally Invasive Prostate Cancer Surgery

Laparoscopic Radical Prostatectomy

More than 200,000 men in the United States will be diagnosed with prostate cancer this year. Many urologists recommend and perform a radical prostatectomy – a complete removal of the prostate gland when the prostate cancer is confined to the prostate gland. However, Barnes-Jewish Hospital is the only center in the region to offer a state-of-the-art, minimally invasive procedure – laparoscopic radical prostatectomy with or without robotic assistance.

Laparoscopic radical prostatectomy involves inserting a lighted viewing instrument, a laparoscope, into the pelvic region through one tiny incision. Unlike an open prostatectomy, where surgeons use a large abdominal incision to access the prostate, the laparoscopic radical prostatectomy allows the surgeon to examine and remove the prostate through one small incision, about one inch long, and three puncture sites.

There are a number of advantages to the patient with laparoscopic radical prostatectomy versus an open prostatectomy. These include:

  • less time in the operating room, which equals a shorter time under anesthesia
  • reduced blood less, which equals less risk of needing a blood transfusion
  • smaller incision, which equal less pain and shorter recovery time
  • less pain, which equals less pain medication needed
  • shorter hospital stay, which equals a faster return to everyday living
  • anatomic nerve-sparing procedure, which preserves urinary and sexual function.
Almost every man who is eligible for an open prostatectomy is eligible for a laparoscopic radical prostatectomy. Because the surgery is technically quite difficult, patients should look for surgeons experienced in laparoscopic radical prostatectomies. The skilled Washington University urologists at Barnes-Jewish Hospital typically complete the surgery in two to four hours.

Prostate Cryoablation

Prostate cryoablation is a minimally invasive method to treat prostate cancer without removing the prostate. With this procedure, the prostate gland and cancer are frozen to lethal temperatures with no incisions. The surgery offers a quick recovery time and may be done on an outpatient basis. Washington University urologists have the greatest expertise in the region with this procedure. It may be offered under three general circumstances:

Primary Prostate Cancer: For patients with a new diagnosis of prostate cancer, prostate cryoablation is offered as an alternative to radical prostatectomy, brachytherapy (seeds) or external beam radiation therapy. The entire prostate gland is treated and, after the procedure, prostate-specific antigen (PSA) values are checked regularly. Washington University urologists at Barnes-Jewish Hospital also offer laparoscopic lymph node removal at the time of the ablation to remove any potentially cancerous lymph nodes.

Focal Prostate Cancer Ablation: In this procedure, the entire prostate is not treated. Instead, only the portion of the gland that has the cancer is treated. This allows the patient to retain most of his prostate and functions related to it. A biopsy of the prostate may be needed at a follow-up visit to make sure that the gland does not develop any more cancers. Laparoscopic lymph node removal also may be performed at the time of the ablation.

Rising PSA after Radiation Treatment or Brachytherapy: If the PSA starts to rise after the patient has undergone radiation or brachytherapy, this may indicate cancer recurrence in the prostate gland. Salvage cryoablation can be performed to treat any cancer remaining in the prostate. Laparoscopic lymph node removal and/or prostate biopsies may be needed.

Gerald Andriole, MD

Chief of urology, Barnes-Jewish Hospital and Washington University School of Medicine

 
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