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Prostate Removal

When Should Prostate Removal Be Performed?

Last modified: 
23/04/2012 - 16:39

Contributing Author: Guy Slowik FRCS

Prostate removal generally is performed for one of two reasons:

For Prostate Enlargement

There are a variety of treatments for prostate enlargement (benign prostatic hyperplasia, or BPH). These treatments include medication and the use of lasers guided through the urethra to destroy excess prostate tissue.

Prostate removal is considered when:

  • The prostate gland is greatly enlarged.
  • There are significant complicating factors, such as obesity.
  • The wall of the bladder has been significantly damaged and requires repair.

For Prostate Cancer

Prostatectomy is effective in treating prostate cancer in men whose cancer has not spread beyond the prostate gland. Physicians use a TNM grading system to determine the best candidates for surgery.

Need To Know:

Understanding TNM Staging

To determine TNM staging, a doctor looks at:

  • The tumor size (T staging)
  • The lymph node involvement (N staging)
  • The presence of cancer in other parts of the body, or its metastasis (M staging)

T staging goes from T1 to T4, with some sub-stages:

  • T1 means the cancer cannot be seen or felt, but a biopsy has confirmed its presence.
    • T1a means cancer is present in five percent or less of the prostate tissue that has been examined.
    • T1b means cancer is present in more than five percent of the prostate tissue.
  • T2 means the cancer is confined to the prostate.
    • T2a means that cancer is on one side of the prostate.
    • T2b means that cancer is on both sides.
  • T3 means the cancer has spread beyond the prostate to nearby tissues and organs.
  • T4 tumors have spread to other organs, such as the bladder or rectum.
    • T3a means cancer is not found in the seminal glands (which contribute toward the production of semen).
    • T3b means that it has spread to the seminal glands.

N staging goes from N0 to N1:

  • N0 means that cancer has not spread to the lymph nodes.
  • N1 means that cancer has been found in the lymph nodes.

M staging goes from M0 to M1, with some sub-stages:

  • M0 means that cancer has not spread to distant tissues.
  • M1 means that cancer has been found in distant tissues.
    • M1a means it has been found in lymph nodes beyond the pelvic area.
    • M1b means it has been found in the bone.
    • M1c means it has been found in other sites.

Based on TNM staging, men whose prostate cancer is in the following stages will most likely benefit from prostatectomy:

  • Stage T1b disease, in which the pelvic lymph nodes show no evidence of the spread of cancer cells beyond the prostate gland.
  • Stage T2 (a,b,c) disease, in which the cancer is larger but still is confined to the prostate gland.

How-To Information:

What To Consider When Selecting A Surgeon

The effectiveness of the surgery is related to the surgeon's education, training, and experience. Constant practice is required to maintain effective surgical skill levels.

The patients of surgeons who perform only a handful of prostatectomies each year generally have more complications than patients of surgeons who perform more than 100 prostatectomies each year.

For this reason, it's a good idea to ask your potential surgeon about the number of prostatectomies he or she performs.

This article continues: 

Prostate Removal (Prostatectomy)

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.