Surgery for Prostate Cancer

At NYU Langone’s Perlmutter Cancer Center, doctors may suggest active surveillance for prostate cancer when tumors are low risk. But surgery to remove the prostate, known as radical prostatectomy, may be recommended for men with cancer that hasn’t spread to the lymph nodes, the bones, or other organs. Doctors also consider age, life expectancy, or other health conditions, and whether the cancer is fast- or slow-growing. The goal of surgery is to eliminate the cancer by removing the prostate.

When removing the prostate, our surgeons can in most cases preserve the bundle of nerves close to the prostate, as long as doing so doesn’t interfere with the doctor’s ability to control the cancer. These nerves control erectile function, and doctors at NYU Langone first identified them in the 1980s.

In a radical prostatectomy, the prostate gland is surgically removed along with the adjacent seminal vesicles, the small structures connected to the prostate that assist in making semen. A surgeon may also remove the pelvic lymph nodes at the same time as the prostate—a procedure known as a pelvic lymphadenectomy—to determine whether the cancer has spread beyond the prostate. The decision to perform a pelvic lymphadenectomy is based on the risk that the cancer has spread to the lymph nodes. Lymph nodes are located throughout the body and are part of the lymphatic system that helps rid the body of toxins and waste.

Approaches to this procedure include open prostatectomy and robotic prostatectomy. There is no evidence that either method of surgery is superior to the other, and our surgeons use the technique with which they are most experienced.

Open Radical Prostatectomy

In open radical prostatectomy, a surgeon makes a small incision between the belly button and the pubic bone. Our surgeons pioneered the development of this technique, called a nerve-sparing radical retropubic prostatectomy.

Our surgeons developed nerve-sparing radical retropubic prostatectomy to protect nerves that control erectile function.

The cavernous nerves, which control erectile function, are located very close to the prostate. These delicate nerves may become damaged if meticulous care is not taken to preserve them. In cases where the cancer is growing through the prostate capsule, a membrane that surrounds the prostate gland, the nerves may need to be removed in order to ensure that the cancer can be fully controlled.

Our results after open radical retropubic prostatectomy, in terms of removing cancer while preserving erectile function, are among the best in the world.

Robotic-Assisted Prostatectomy

Prostatectomy may also be performed using a laparoscopic approach. In this method, our doctors at the Robotic Surgery Center perform a prostatectomy using surgical instruments that are mounted on several robotic arms. These are inserted into the body through small incisions and controlled by surgeons.

Robotic Prostatectomy

Surgeons at the Robotic Surgery Center are experts in the use of the da Vinci robotic surgical system to perform prostatectomy.

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Our doctors use a robotic surgery device called the da Vinci surgical system to perform this type of prostatectomy. The surgeon inserts a small video camera into the body, which transmits the image of the organs to an external video monitor. This gives doctors a detailed, magnified view.

Recovery from Surgery

At NYU Langone, about 90 percent of men who have open or robotic radical prostatectomy can return home after 1 day in the hospital. You can typically return to work that doesn’t require heavy lifting in 7 to 10 days, and after 3 weeks for more physically strenuous jobs. Most men can make a full return to their everyday activities within three weeks after open or robotic prostatectomy. Learn more about our recovery and support services.

NYU Langone was the site of the first randomized study to demonstrate that prescribing medications such as Viagra and Cialis immediately after radical prostatectomy improves erectile function.

Early in their recovery, almost all men experience erectile dysfunction and some urinary incontinence. Over time, the majority of men regain both erectile and urinary function. The Smilow Comprehensive Prostate Cancer Center team works closely with our male sexual health team to design penile rehabilitation programs to facilitate the return of erectile function.

For those who do not regain their erectile function or who continue to experience incontinence, our urologists can treat these conditions with medications, devices, or surgery.