The Purpose of Prostate Surgery

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Prostate surgery, also known as prostatectomy, refers to a procedure done for partial or complete removal of the prostate. It is usually done to correct problems with the prostate, such as an enlarged prostate or prostate cancer. There are several types of prostate surgery.

The prostate is a walnut-sized gland that lies between the bladder and penis. It wraps around the urethra, a thin tube that urine and semen pass through to leave the body. An enlarged prostate can cause serious health issues, such as kidney damage. It also may be linked with prostate cancer.

This article looks at how the prostate works and why it may become enlarged. It explains why prostate surgery may be needed, and the tests and other factors a healthcare provider uses to make that decision.

Prostate Symptoms

The prostate gland is a part of the reproductive system, and it helps to produce semen. The prostate tends to grow larger with increasing age. A small amount of prostate enlargement is present in many men over 40 and more than 90% of men over 80.

That's because hormonal changes and cell growth in the aging process sometimes cause it to swell. The swelling puts pressure on the urethra, making it harder to empty the bladder during urination.

An enlarged prostate is also known as benign prostatic hyperplasia (BPH).This is not cancer and does not raise a person's risk for prostate cancer. Still, the prostate may swell to the point of causing a problem. Symptoms of many prostate issues include:

  • dribbling urine
  • trouble urinating
  • blood in the urine

Many of these problems can be managed with medicine or lifestyle changes. In some cases, radiation may be used to treat prostate cancer. In others, surgery is needed to correct the problem.

BPH is so common that it has been said all men will have an enlarged prostate if they live long enough.

Common Prostate Problems

There are common conditions that an enlarged prostate gland may indicate. They include prostatitis and prostate cancer.

Prostatitis

Prostatitis is an inflammation of the prostate or the areas around it. There are four different types of prostatitis:

  • chronic prostatitis (CP/CPPS)
  • acute bacterial prostatitis
  • chronic bacterial prostatitis
  • asymptomatic inflammatory prostatitis

With the exception of chronic prostatitis, sometimes called chronic pelvic pain syndrome (CP/CPPS), these conditions are caused by bacteria. They can usually be treated with antibiotics and anti-inflammatory medications.

Two procedures may be recommended if prostatitis is not caused by bacteria, as with CP/CPPS. The surgery may be needed because these drugs won't work on this type. The surgeries are called transurethral resection of the prostate (TURP) or transurethral vaporization of the prostate (TUVP).

Prostate Cancer

Prostate cancer begins when cells in the prostate gland start to grow out of control. Unlike some other cancers, prostate cancer tends to be slower and less invasive as it grows. "Watchful waiting" may be used in some people who seem to be at lower risk of spread. This means a person with prostate cancer is carefully monitored for signs of spread, or to treat new symptoms as they arise.

People who have prostate cancer will have their prostate-specific antigen (PSA) level regularly checked to monitor their progress. Radiation and/or surgery may prove necessary. Open or laparoscopic radical prostatectomy, which removes the entire gland, may help those with prostate cancer that has not spread to other organs and tissues.

Prostate Surgery

Any growth or inflammation of the prostate gland can cause the urethra to become constricted. When other therapies cannot fix the problem, surgery may be the best option.

Removal of the prostate gland may be recommended for those with prostate cancer that has not spread beyond the gland. People with CP/CPPS may benefit from TURP in particular. Note that this is not done on younger men, usually because there is a risk of fertility issues.

People who plan on getting prostate surgery should consider that:

  • Some prostate surgeries may result in a loss of sensation. That may lead to sexual difficulty, including orgasm, infertility and erectile dysfunction.
  • Urinary incontinence (loss of bladder control) in the form of leaking or dribbling may occur.
  • Prostate surgery can cause lymphedema, a fluid buildup in lymph nodes near the genitals.
  • The risk of inguinal hernias is greater in men who have had prostate surgery.
  • Surgery can shorten the length of the urethra, therefore reducing the size of the penis.

There are some cases where your healthcare provider may view prostate surgery as necessary, including:

  • The inability to completely empty the bladder
  • Recurring bleeding
  • Bladder stones along with an enlarged prostate
  • Extremely slow urination
  • Hydronephrosis, or increased pressure on the ureters as a result of urinary retention

Recap

A swollen prostate is common as men age, but it does not always mean a prostate cancer diagnosis. Other conditions, like prostatitis, also may be at work. Surgeries may be used to treat some prostate issues. Total removal of the gland may help if cancer is the diagnosis and it has not yet spread. These surgeries may have lasting health or quality of life impacts, so be sure to talk through all your options with your healthcare provider.

Tests and Labs

A healthcare provider may order tests to assess prostate health before surgery, both to see if it is necessary and if the person is a good match for a procedure. Below are some common tests and exams that help a healthcare provider to make a decision about prostate surgery:

  • Prostate-specific antigen (PSA) blood test: PSA is a protein made by the prostate gland. It is present in both semen and blood. As PSA levels increase, so does the chance of having prostate cancer. The PSA level may be used to monitor cancer risk, and suggest if someone needs more tests for prostate cancer.
  • Digital rectal exam: A digital rectal exam often is done to directly feel the prostate gland. The practitioner will insert a gloved, lubricated finger into the rectum and feel for any unusual lumps or bumps. The test can be uncomfortable, but should not be painful. It usually only takes a few minutes.
  • Cystoscopy: This is used to check the urinary tract for narrowing, blockage, or stones. A urologist threads the cystoscope into the opening at the tip of the penis and into the lower urinary tract. Local anesthesia is usually provided.
  • Urine test: This test checks for prostate cancer by checking for the PCA3 gene in the urine. If there are too many copies of this gene, there is a higher risk of prostate cancer.
  • Imaging tests: This can be done with magnetic resonance imaging (MRI). It is used to monitor the spread of prostate cancer. A transrectal ultrasound may be used to measure the size of the prostate.
  • Biopsy: A healthcare provider may suggest a biopsy if other tests and exams indicate a more serious issue. The biopsy device—a thin, hollow needle—will take a small tissue sample from the prostate. Your practitioner may numb the area first, so the biopsy should be quick and relatively painless. The tissue sample will be analyzed for cancer cells. It helps the medical professionals with diagnosis and treatment.

Prostate cancer is the second most common form of cancer among men in the United States. One in eight men will be diagnosed with the condition during their lifetime.

Summary

Most men are likely to have an enlarged prostate later in life, and that doesn't mean it is cause for alarm. But the swelling, and symptoms that come with it, also may point to more serious prostate issues, including cancer. Surgery may be the best option, but it is not always the first option. Your healthcare provider will base a decision on tests and exams that help to explain the swelling, and then discuss the next steps with you.

A Word From Verywell

The prostate is a rather small gland, but due to its location, any changes in its size or function can cause big problems. If you have trouble with urination or ejaculation, you should ask your healthcare provider about prostate screening. There are risks and potential complications, but surgery is necessary and life-saving in some cases.

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9 Sources
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