A nerve sparing technique, open surgery involves a 10 to 15 cm incision in the abdomen. Side effects at the time of operation are now very infrequent, with less than 2% major complications and the urinary incontinence rate at one year post surgery is 1.5%.
A final decision on whether or not to spare nerves is made at the time of surgery. When the layers surrounding and attached to the prostate become thickened and if after removal of the prostate there is concern that not all the cancer has been removed then the nerves are sacrificed. In my hands, more than 85% of all nerves are preserved.
In young men, 50% achieve normal sexual function after two years, whilst 80 to 90% achieve reasonable sexual function with or without Viagra after the same period.
Advantages of open surgery
The advantage of an open radical prostatectomy includes more detailed knowledge about the nature or pathology of the cancer and its extent. If the pathology findings indicate that the cancer has been completely removed, it offers peace of mind.
The cure, however, is a difficult concept in prostate cancer management because any residual cancer can take years to progress. There is still a risk of recurrence, even if the entire cancer appears to have been removed.