Classic operation
Retropubic Walsh prostatectomy has been the standard for decades and remains important in difficult cases: direct control allows removal of the tumor with adjacent tissue at T3, wide lymph node dissection, and management of bleeding from a large dorsal venous complex. Nerve sparing is possible on the unaffected side. The anastomosis is performed with interrupted sutures on a catheter. Blood loss is higher than laparoscopic, recovery is 6–8 weeks, but oncological and functional results are comparable in experienced hands.
Who is indicated for radical prostatectomy?
Surgery is the main treatment for localized and locally advanced prostate cancer in men with a life expectancy of more than 10 years. Indications: intermediate and high-risk cancer (Gleason 7 or higher, PSA greater than 10, stage T2-T3) and low-risk cancer if desired by the patient instead of active surveillance. An alternative is radiation therapy; the choice is discussed at the oncology consultation.
Laparoscopy and nerve sparing
Laparoscopic prostatectomy provides an enlarged image, minimal blood loss, precise anastomosis and quick recovery - hospital stay is 5-6 days versus 7-8 with open surgery. In low- and intermediate-risk cancers, the neurovascular bundles are preserved—erection is restored in 50–70% of men within 1–2 years with rehabilitation. Extended lymph node dissection is performed in intermediate and high-risk patients for staging.
Functional results
Urinary continence is restored in 90–95% of patients within 3–12 months with the help of pelvic floor muscle exercises; In the first weeks, pads are used. Erectile function depends on nerve sparing, age and initial potency. PSA after surgery should become undetectable (less than 0.1 ng/ml) - its monitoring every 3-6 months reveals a relapse, in which case radiation or hormonal therapy is prescribed.
