Prostatectomy or HoLEP? Understanding the Surgical Options for Prostate Cancer

When it comes to treating prostate conditions, few decisions are as complex and personal as choosing the right surgical approach. For men diagnosed with prostate cancer or experiencing severe urinary symptoms from an enlarged prostate, the two terms that often surface are prostatectomy and HoLEP. But while they may sound similar, these procedures are fundamentally different in purpose, technique, and outcomes.

Understanding how prostatectomy and HoLEP (Holmium Laser Enucleation of the Prostate) compare can empower patients to take control of their health journey and choose a treatment that aligns with their specific diagnosis, age, lifestyle, and long-term goals.

This article unpacks both procedures, who they’re for, how they work, their risks and benefits and helps answer the question: Which is right for you?

Different Goals, Different Diagnoses

Before diving into surgical details, it’s crucial to clarify one key distinction:

• Prostatectomy is primarily used to treat prostate cancer.
  
• HoLEP is designed to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH) , a non-cancerous enlargement of the prostate.
  

That said, there are cases where HoLEP may be performed in men who also have low-risk prostate cancer or for whom traditional surgery isn’t an option. But generally, the first step in the decision-making process is understanding your diagnosis.

What Is Prostatectomy?

Radical prostatectomy refers to the complete surgical removal of the prostate gland, and in many cases, nearby tissues like the seminal vesicles and surrounding lymph nodes.

Indications:

• Localized or locally advanced prostate cancer
  
• Patients in good overall health
  
• Candidates seeking curative treatment 

Surgical Techniques:

• Open prostatectomy (retropubic or perineal incision)
  
• Laparoscopic prostatectomy
  
• Robotic-assisted laparoscopic prostatectomy (RALP) 

Procedure Summary:

• Performed under general anesthesia
  
• Prostate is removed entirely
  
• Nerves may be spared if possible (to preserve erectile function)
  
• The bladder is reconnected to the urethra 

Typical Outcomes:

• Potential cure for prostate cancer
  
• Long-term monitoring with PSA blood tests
  
• Requires catheterization for 1–2 weeks post-op 

What Is HoLEP?

Holmium Laser Enucleation of the Prostate is a minimally invasive surgical treatment that removes obstructive prostate tissue using a high-powered laser. Unlike prostatectomy, it does not remove the entire gland, but rather the parts compressing the urethra.

Indications:

• Moderate to severe BPH symptoms 
• Very large prostates (often >100g)
  
• Urinary retention or frequent infections
  
• Patients unresponsive to medication 

Procedure Summary:

• Performed under general or spinal anesthesia
  
• A laser is inserted via the urethra no external incisions
  
• Excess tissue is “enucleated” (cut away) and pushed into the bladder
  
• A morcellator removes the tissue through a small tube 

Typical Outcomes:

• Dramatic improvement in urinary flow
  
• Reduced risk of future interventions
  
• Short catheter time (often removed within 24–48 hours) 

Comparing Key Factors

Let’s examine how prostatectomy and HoLEP differ across the dimensions that matter most to patients:

1. Purpose of Surgery

• Prostatectomy: Treats prostate cancer by removing the entire gland
  
• HoLEP: Treats BPH by removing only the obstructive tissue 

2. Surgical Invasiveness

• Prostatectomy: Major surgery with abdominal incisions (open/laparoscopic)
  
• HoLEP: Endoscopic, no cuts on the skin, faster recovery 

3. Hospital Stay

• Prostatectomy: Typically 1–3 nights
  
• HoLEP: Often a same-day or 1-night procedure 

4. Recovery Time

• Prostatectomy: Full recovery may take 6–8 weeks or more
  
• HoLEP: Light activity in a few days; full recovery in 2–3 weeks 

5. Urinary Function

• Prostatectomy: Temporary incontinence is common but usually improves
  
• HoLEP: Strong improvement in flow; mild urgency may occur initially 

6. Sexual Function

• Prostatectomy: Risk of erectile dysfunction and dry ejaculation
  
• HoLEP: Lower risk of ED; dry ejaculation (retrograde) is common 

7. Cancer Control

• Prostatectomy: Offers potential cure for prostate cancer
  
• HoLEP: Not intended to treat cancer (though incidental cancer may be discovered) 

When HoLEP Might Be Chosen Over Prostatectomy

While HoLEP is not a cancer treatment, it may be considered in specific scenarios:

• Men with both BPH and very low-risk prostate cancer, where immediate cancer treatment is not urgent
  
• Older patients or those with comorbidities who are not candidates for major surgery
  
• As a temporary solution to relieve severe urinary symptoms until more definitive treatment is chosen
  

In these cases, HoLEP can drastically improve quality of life and urinary health while allowing time to assess long-term options.

Risks and Considerations

Prostatectomy Risks:

• Erectile dysfunction (especially in non–nerve-sparing surgeries)
  
• Urinary incontinence
  
• Bleeding, infection, or blood clots
  
• Potential need for radiation if margins are unclear 

HoLEP Risks:

• Temporary burning with urination
  
• Retrograde ejaculation
  
• Bleeding or urinary tract infections
  
• Urethral stricture (rare but possible)
  

In both surgeries, surgeon experience is key. Outcomes can vary based on technique and post-op care, so selecting the right medical team is just as important as choosing the procedure itself.

Patient Experience at a Glance

Making the Right Decision

Choosing between prostatectomy and HoLEP isn’t just a medical decision, it’s a deeply personal one. It requires honest conversations with your urologist, careful review of your diagnosis, and a clear understanding of your goals.

Ask yourself:

• Is my condition cancerous or benign?
  
• What matters more curing disease or relieving symptoms?
  
• Am I ready for a major operation, or do I prefer a faster recovery?
  
• What are my concerns about sexual and urinary function?
  

Ultimately, a multidisciplinary approach including urologists, oncologists, and primary care providers will provide the clearest guidance.

Expert Care with Modern Options

At Erdem Hospital in Istanbul, patients are offered both prostatectomy and HoLEP, depending on their diagnosis and treatment needs. Surgeries are performed by top specialists like Prof. Dr. Necmettin Atsü, with a focus on minimizing side effects and improving long-term outcomes.

For men traveling internationally, Erdem Hospital provides personalized care from consultation to post-op recovery, ensuring medical excellence and emotional support at every stage.

One Diagnosis, Two Different Paths

While both prostatectomy and HoLEP involve the prostate, their roles in treatment couldn’t be more distinct. One aims to cure cancer; the other restores comfort and quality of life. Knowing the difference and how each fits into your unique health journey is the first step toward making a confident, informed decision.

Face your options with clarity. Consult your medical team. Choose what’s right for your future.