Prostate Surgery: Purpose of Prostate Surgery

Prostate surgery, also known as prostatectomy, refers to a variety of procedures done for partial or complete removal of the prostate. It is usually performed to correct problems with the prostate, such as an enlarged prostate and prostate cancer. The different types of prostate surgery include transurethral resection of the prostate (TURP) and radical prostatectomy. 

The prostate is a walnut-sized gland that lies between the bladder and penis. It wraps around the urethra, and, for this reason, it can cause major issues if it becomes enlarged, such as urinary tract infections and bladder or kidney damage. Whether the enlargement is caused by cancer or less malignant problems, the treatment is largely the same.

doctor holding a model of the prostate gland


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Diagnosis Related to Prostate Surgery

The prostate gland is a part of the reproductive system, and it helps 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 the prostate to swell, resulting in compression of the urethra (the duct that urine passes through to leave the body) and difficulty for the bladder to empty completely.

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is not cancerous and does not raise a person's risk for prostate cancer. Sometimes the prostate could grow to the point of causing a problem, however, including dribbling urine, difficulty urinating, or blood in the urine. Some of these problems can be managed with medications or lifestyle changes. In other cases, prostatectomy 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.

Some common conditions that an enlarged prostate gland could indicate:

  • Prostatitis: Inflammation of the prostate or the areas around the prostate. It is caused by bacteria and can usually be treated with antibiotics and anti-inflammatory medications. There are four different types of prostatitis: chronic prostatitis, acute bacterial prostatitis, chronic bacterial prostatitis, and asymptomatic inflammatory prostatitis. Transurethral resection of the prostate (TURP) or transurethral vaporization of the prostate (TUVP) may be recommended for those with nonbacterial prostatitis if medications don't help, while prostatitis caused by bacterial infection is treated with antibiotics
  • Prostate Cancer: Cells in the prostate gland start to grow out of control. Unlike some other cancers, prostate cancer tends to be more slow-growing and less invasive. Watchful waiting is a common practice, and involves monitoring a man with a cancer diagnosis for signs of spread and treating new symptoms as they arise. People who have prostate cancer will have their prostate-specific antigen (PSA) level regularly checked to monitor the progress of prostate cancer. Open or laparoscopic radical prostatectomy, which involves removing the entire prostate gland, is reserved for those with localized prostate cancer (cancer that has not spread to other organs and tissues)

Criteria

Given the way the prostate wraps around the urethra in general, any growth or inflammation of the prostate gland can cause the urethra to become constricted. This constriction can block the flow of urine, causing issues for the bladder and kidneys. With obstructions that cannot be resolved with other therapies, surgery may be the best option.

Radical prostatectomy is recommended for those with prostate cancer when a cancerous tumor is only limited to the prostate and has not spread. Those who have nonbacterial prostatitis that does not respond to medical treatment will also benefit from prostate surgery, specifically TURP. It is not done on younger men for the most part because of its potential to cause fertility issues.

Those who are planning on getting prostate surgery should consider the following:

  • Surgeries like radical prostatectomy and TURP may result in loss of sensation and difficulty reaching orgasm, infertility, and erectile dysfunction. Patients who don’t want these processes disrupted may want to avoid surgery if possible
  • Urinary incontinence (involuntary loss of control over the bladder) in the form of leaking or dribbling may occur after prostate surgery
  • Prostate surgery can cause lymphedema, a collection of fluid in the lymph nodes located in the genital area
  • The risk of inguinal hernias, an unexplained bulge in the groin area, is greater in men who have had prostate surgery
  • There is a chance that prostate surgery can shorten the length of the urethra, therefore reducing the size of the penis

There are some cases where your doctor 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

Tests and Labs

A health care provider will want to assess the health of the prostate before surgery to determine whether surgery is necessary and if someone is a suitable candidate for the procedure. Below are some of the common tests and examinations that can give a doctor information about the prostate to make a decision about surgery:

  • Prostate-specific antigen (PSA) blood test: PSA is a protein made by the prostate gland that is present in both the semen and blood. The chance of having prostate cancer goes up along with increasing PSA level, so the PSA level may be used to monitor prostate cancer risk and determine when someone may need more testing for prostate cancer
  • Digital rectal exam: A digital rectal exam may be done to perform a direct assessment of the prostate gland. The doctor will insert a gloved, lubricated finger into the rectum and feel for any abnormal lumps or bumps. The test can be uncomfortable, but should not be painful. It usually only takes a few minutes
  • Cystoscopy: It is used to check for the narrowing, blockage, or stones in the urinary tract. A urologist inserts the cystoscope through 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 the presence of prostate cancer by assessing the gene PCA3 in the urine. PCA3 is a prostate-specific gene that’s only in the prostate, and if the gene is overexpressed (there are too many copies of it), there’s a higher risk of prostate cancer
  • Imaging tests: This could be done with magnetic resonance imaging (MRI), which is used to monitor the spread of prostate cancer, or a transrectal ultrasound, which measures the size of the prostate
  • Biopsy: If a doctor finds anything in your blood test, imaging studies, or physical exam that suggest a more serious problem, they may suggest a biopsy to be done. The doctor will insert a special biopsy instrument into the prostate through either the wall of the scrotum or through the skin between the scrotum and anus (perineum). The biopsy device—a thin, hollow needle—will take a small tissue sample from the prostate. Your doctor may numb the area first, so the biopsy should be quick and relatively painless. The tissue sample collected will be analyzed for the presence of things like cancer cells, and the doctor will use this information to make a treatment plan

Prostate cancer is the second most common form of cancer among American men, and one in nine men will be diagnosed with the condition during their lifetime.

A Word From Verywell

The prostate is a rather small gland, but due to its location, changes in the size or function of this gland can cause big problems.

If you experience problems with urination or ejaculation, you should discuss screening for prostate problems with your doctor. Though prostate surgery comes with potential complications, it is necessary and life-saving in some cases. If you have any concerns about undergoing prostate surgery, bring them up with your health care provider and find out ways that can help manage these complications.

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Article Sources
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