The Purpose of Prostate Surgery

Prostate surgery, also known as prostatectomy, refers to a procedure done to remove part or all of the prostate. It is usually done to correct problems with the prostate, such as an enlarged prostate or prostate cancer. Yet 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 interfere with urine flow and cause serious health issues, such as kidney damage. Most often, an enlarged prostate is benign, but sometimes prostate cancer is the cause.

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

Common Prostate Problems

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.

There are common conditions that an enlarged prostate gland may indicate. They include benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer.

Benign Prostatic Hyperplasia

An enlarged prostate is also known as benign prostatic hyperplasia (BPH). This condition 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.

BPH symptoms are common in older men and include:

• Frequent urination
• Waking up at night to urinate
• A weak urine stream or having to strain to urinate
• Sudden urgency to urinate
  

Some people with BPH may require surgery. Transurethral resection of the prostate (TURP), which uses an electrified wire loop to remove prostate tissue and relieve pressure on the urethra, is a common procedure used to treat people with BPH.

Other surgical options include transurethral electrovaporization of the prostate (TUVP), which relies on electrical energy to remove tissue with heat, and transurethral incision of the prostate (TUIP). With the TUIP, tissue is not removed but the opening for the urethra is surgically widened.

Laser techniques, and newer procedures such as prostatic arterial embolization (PAE), may also be options in treating BPH.

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.

CP/CPPS shares some symptoms with other prostate conditions but is often more painful than other types. The pain can spread across the pelvis and abdomen, and flare up for months and years.

When it's caused by an acute (severe and sudden) infection, prostatitis can also cause fever, chills, body aches, and nausea and vomiting.

Surgical procedures may be recommended if prostatitis is not caused by bacteria, as with CP/CPPS. The surgery may be needed because medications won't work on this type.

Both TURP and TUVP may be used to treat prostatitis. Additionally, treatment that relies on shock waves to treat CP/CPPS is a promising alternative that's under study in both animals and humans, but more research is needed to confirm its benefits.

Prostate Cancer

Prostate cancer begins when cells in the prostate gland start to grow out of control. Compared to some other cancers, prostate cancer tends to be slower and less invasive as it grows.

Prostate cancer often has no symptoms until it has spread. When symptoms are present, they can include:

• Dribbling urine
• Trouble urinating
• Blood in the urine
• Erectile dysfunction
• Incontinence (inability to hold urine)

"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

In the case of prostate surgery, if the tumor is large, fast-growing, or at risk of spreading, prostatectomy will likely be recommended.

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.

There are some other 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

The type of surgery will depend on the prostate condition that needs to be treated. In some cases, that may mean a minimally invasive procedure. In others, such as the full removal of your prostate gland, the surgery is more complex and your recovery time is likely to be longer.

Risks of Prostate Surgery

People who plan on getting prostate surgery should consider that:

• Some prostate surgeries may result in a loss of nerve 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.
  

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 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 looks 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.

Summary

Most men are likely to have an enlarged prostate later in life, and it isn't typically 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 ultimate 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 growth, 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.