Surgery to remove a cancerous prostate gland, like the operation on Secretary of State Colin Powell, is typically performed when the disease is detected early and doctors believe they may cure it before the cancer spreads.
The operation, called a radical prostatectomy, involves removing the entire prostate gland plus nearby pelvic lymph nodes.
If cancer is discovered in these lymph nodes, the disease has probably progressed to other parts of the body. If no cancer is found, it means the cancer may be confined to the gland. In such cases, men typically have a better than 90 percent chance of living at least another 10 years.
During the operation, which typically involves a six-inch-long incision below the navel, doctors try to spare nerves that control urination and sexual function. Bladder control is often a problem for a few weeks after the surgery, but 95 percent of men regain full control.
Sexual function varies, depending on the patient’s age. For those under 50, more than two-thirds getting nerve-sparing surgery are able to resume erections. But after age 70, this figure falls to one-quarter or less.
Prostate cancer is the most common cancer in American men and their second leading cause of cancer death after lung cancer. The average age of diagnosis is 72. However, by age 50, one-quarter of all men have some cancerous cells in their prostates, and by 80, half do.
African-American men have the highest rates of prostate cancer in the world for a variety of reasons ranging from genetics to poorer health care. While death rates for the disease have been declining for both whites and blacks for a decade, the death rate is still twice as high for black Americans as for whites.
The first sign of prostate cancer is often an elevated PSA — prostate-specific antigen — during a routine physical exam. The disease is also detected with a digital rectal exam.
Early stage prostate cancer does not cause symptoms. When symptoms do occur, they may be similar to those of non-cancerous prostate enlargement, such as difficult or frequent urination.
Generally, prostate surgery is reserved for otherwise healthy younger men who have a longer life expectancy. Other treatment options include:
- External beam radiation. X-rays are used to kill the cancer. One-minute treatments are typically given five days a week for seven or eight weeks. Like surgery, the treatment can damage nerves that control erections and urinary control and also cause rectal problems.
- Hormone therapy. The treatment blocks the production of male sex hormones, which stimulate growth of cancer cells. It may be used before surgery or radiation in early stage cancer to shrink the tumor.
- Radioactive seed implants. In a one-time treatment, the radioactive material is injected into the prostate to kill the tumor. Urinary symptoms may be more severe than with other treatments.
- Watchful waiting. This may be suggested for men with early stage cancer that appears to be slow-growing, especially if they are older or have other medical problems.
Powell underwent surgery Monday to remove his cancerous prostate gland. “Everything went fine,” his spokesman said. Powell's doctors said he had a "localized" prostate cancer and a full recovery is expected.