March 16, 2009 -- Question: What are the differences between a radical perineal prostatectomy and a radical retropubic prostatectomy?
Answer: There are two open approaches to radical prostatectomy -- one through an abdominal incision, known as the retropubic approach, and the other through the perineum, which is that small space between the scrotum and the rectum called a radical perineal prostatectomy.
Radical perineal prostatectomy is the oldest form of radical prostatectomy actually developed at this hospital in 1904. It's sort of a keyhole operation. And in that respect when the operation's performed in that way, there is less pain and less bleeding.
The problem however is there is less tissue removed with the prostate and it's impossible to do a lymph node dissection. And so if a patient has cancer that extends outside the prostate, it is more likely that the patient will have a positive surgical margin.
Furthermore, via the perineal technique, it is very hard to save the nerves. Thus radical perineal prostatectomy is best reserved for men who are impotent pre-operatively and who have very small cancers that are most likely confined to the prostate.