The prostate cancer surgery that Secretary of State Colin L. Powell underwent yesterday is a common, usually highly successful procedure from which most men recover quickly, experts said.
"I would expect that he would do very well after the operation," said J. Brantley Thrasher, a professor of urology at the University of Kansas and a spokesman for the American Urological Association. "We are curing the majority of patients with prostate cancer."
Prostate cancer is the most common cancer in men, and the second leading cause of cancer death after lung cancer. About 220,000 men are diagnosed with prostate cancer each year, and about 29,000 die.
The prostate gland is a walnut-sized structure just below the bladder that surrounds the urethra, the passageway for urine. Its main function is to provide fluids for semen.
Prostate cancer is often first diagnosed by a physical examination and by a blood test called the prostate-specific antigen, or PSA, test, which detects a protein in the blood secreted by prostate cells. Widespread use of the test has raised questions about whether prostate cancer is being over-diagnosed and over-treated.
Prostate cancer often grows very slowly, and studies have indicated that most men will develop it at some point as they get older, but in many cases, it will never cause problems or become life-threatening.
As a result, some men diagnosed with prostate cancer opt for an approach known as "watchful waiting," treating it only if it starts to grow or cause problems.
But "for the most part, watchful waiting would be an option most people consider viable for older gentlemen, over age 75, or for someone who is not in very good health" and wants to avoid the stress of treatment, Thrasher said.
Of those who choose to get treatment, about half get the cancer removed surgically and half undergo radiation.
Radiation is usually done in cases in which the cancer appears to have spread. The radiation is administered externally or by implanting tiny radioactive pellets known as "seeds," in a treatment called brachytherapy. Radiation is often accompanied by drugs that suppress the hormone testosterone, which encourages prostate cancer to grow. In advanced cases, cancer chemotherapy is used.
Although some men opt for radiation treatment for early prostate cancer, surgery remains the usual treatment in cases such as Powell's, in which the cancer appears to have been caught early.
"The new, improved forms of radiation therapy, although effective, have not been in place long enough to know how well they can control the cancer over several decades," said Patrick Walsh of Johns Hopkins Medical Center in Baltimore, who performed prostate cancer surgery on presidential candidate Sen. John F. Kerry (D-Mass.) this year.
In the operation, known as radical prostatectomy, a surgeon makes about a four-inch incision either below the belly button or above the rectum, removes the prostate and reconnects the urethra to the bladder.
Most men are released from the hospital within two days, with many returning to work almost immediately as long as they do not do any strenuous physical activity. A catheter inserted to drain urine is removed after about 10 days, and full recovery usually takes about six weeks.
"For someone like Secretary Powell, he most likely will able to resume all his important activities very, very quickly," Walsh said.
Complications are rare, but about 2 percent to 4 percent of men experience urinary incontinence, and 20 percent to 25 percent experience impotence from nerve damage that occurs during surgery.
"Viagra has really helped with a return to potency," Thrasher said.
Some doctors have also started removing the prostate through other procedures, including a laparoscopic approach through small incisions in the skin.
In another procedure known as transurethral resection of the prostate, or TURP, the doctor removes part of the prostate with an instrument inserted through the urethra. The cancer is cut out by electricity passing through a small wire loop on the end of the instrument. This approach is used mainly to remove tissue that blocks urine flow.