/ Published Aug 11, 2025

When Is Surgery Used For Advanced Prostate Cancer? What Patients Should Know

Creator: Kavontae Smalls
Published: 2025-08-11T10:51:08-04:00

: Dr. John Fruehauf Medical Source: Dr. Randall Lee
Fox Chase Cancer Center Written by: Kavontae Smalls

Details
Save This Video

Is Surgery Right for You? Navigating Advanced Prostate Cancer Care

Surgery is not always an option for patients with advanced prostate cancer. However, those with oligometastatic disease (cancer that has spread to only a few spots) may benefit.
Dr. Randall Lee, a urologic oncologist at Fox Chase Cancer Center, tells SurvivorNet that patients who “have obstructive urinary symptoms or a locally advanced prostate cancer that hasn’t involved any of the lymph node disease” may benefit from surgical options.
Prostate cancer surgery can be performed using two primary approaches: open radical prostatectomy or minimally invasive (robot-assisted laparoscopic) prostatectomy.
Risks and side effects matter — surgery can impact quality of life, with potential issues like erectile dysfunction and urinary incontinence.
Patients should talk openly with their doctors about all treatment options, and make sure personal concerns and goals are part of the decision-making process.

If you’re dealing with advanced prostate cancer, the thought of surgery might feel like a lot to take in — and that’s completely understandable. For many men facing an advanced diagnosis, surgery will not be part of the treatment plan — however, there are certain situations where it can be beneficial.

“Surgery in the advanced prostate cancer setting is a very nuanced discussion,” Dr. Randall Lee, a urologic oncologist at Fox Chase Cancer Center, tells SurvivorNet. “It depends on the patient, and it requires a lot of discussion and counseling.”

That’s why it’s so important to have open, honest conversations with your care team to weigh the risks, benefits, and what makes the most sense for you personally.

If your prostate cancer has only spread to a few spots — or what doctors call oligometastatic disease — hormone therapy, also known as androgen deprivation therapy (ADT), along with local radiation therapy, is typically the first choice for control. However, Dr. Lee points out that surgery could be an option for some of these patients.

That’s especially true if you’re dealing with urinary blockage or if the cancer is locally advanced but hasn’t spread to the lymph nodes or caused a big jump in your prostate-specific antigen (PSA) levels. PSA is a protein made by the prostate gland; when elevated, it could signal prostate cancer or an enlarged prostate.

Weighing Risks & Benefits

Surgery in advanced prostate cancer isn’t always straightforward. There can be side effects and risks from anesthesia, and it’s important to weigh how the procedure might affect your quality of life while still keeping the cancer in check. That’s why doctors take extra care in deciding who’s a good fit for surgery.

“In the appropriately selected patient that is counseled on the risks and benefits of surgery… it is possible and it’s definitely something that is offered,” Dr. Lee explains.

When it comes to prostate cancer surgery, there’s no one-size-fits-all approach. One option is a prostatectomy, where the surgeon removes the entire prostate along with some surrounding tissue, including the seminal vesicles (they help produce semen). This procedure is usually considered for patients whose cancer hasn’t spread beyond the prostate.

It’s important to know that a prostatectomy can come with side effects, like erectile dysfunction or urinary incontinence, which is why doctors weigh the pros and cons carefully before recommending it.

It can be performed using two primary approaches: open radical prostatectomy or minimally invasive (robot-assisted laparoscopic) prostatectomy. While both robotic and open prostatectomy can offer excellent cancer control, robotic-assisted surgery has emerged as the preferred method for its potential advantages in recovery time, pain, and preservation of urinary and sexual function.

Surgery also doesn’t always mean removing the whole prostate. In some cases, especially for patients dealing with urinary issues or going through radiation, doctors might suggest procedures similar to those used for BPH (benign prostatic hyperplasia) — that’s when the prostate is enlarged. These surgeries help open up the urinary tract.

“There are surgeries in which we are able to open up the urinary tract to allow patients to have a better quality of life so they don’t run into issues after radiation or during radiation,” Dr. Lee explained.

If you’re facing advanced prostate cancer, the most important thing is to talk openly with your care team. Don’t hesitate to ask about all your options—including whether surgery makes sense for you. And make sure your personal concerns, like how treatment might affect your urinary symptoms, sex life, or your long-term quality of life, are part of that conversation.