Radical Prostatectomy

What is it?
  • Surgery that completely removes the prostate gland, as well as the seminal vesicles and part of the urethra within the prostate.
  • Potentially removes all cancer cells.
  • May be recommended if your cancer has not spread outside the prostate (stage T1 or T2).
  • May be used in combination with other treatments e.g., radiation.
What is done?

There are 3 main types:
  • Open: One cut, 3 to 4 inches long, made from below the belly button to the pubic bone.
  • Laparoscopic: Several small cuts are made in the abdomen and a video camera is inserted to view the prostate. The surgeon operates the instruments by the bedside.
  • Robot-assisted: Similar to laparoscopic surgery except that the video camera and instruments are connected to a robotic system that is controlled by the surgeon.

Nerve-sparing techniques can be used to try to preserve the nerves that control erections, rather than removing them with the prostate. If you have a more advanced or aggressive cancer, this may not be recommended as there is increased risk that cancer cells may remain.

What to expect?

Day of surgery:
  • You will be admitted to hospital.
  • Procedure takes 2–4 hours and is carried out under anaesthetic.
  • A catheter is inserted at the end of surgery.
After surgery:
  • Hospital stay is typically 2–5 days.
  • Most men have minimal pain and discomfort after surgery.
  • Catheter is removed after 1–2 weeks.
  • Recovery process at home takes 4–6 weeks.
Even after the prostate gland is removed, a small amount prostate tissue may remain and produce PSA. After surgery, it is important to have regular PSA tests to monitor your PSA level for any changes.

Side effects and risks
  • Short-term constipation is a common side-effect.
  • Incontinence is temporary in most men, but around 10% will continue to have stress incontinence when sneezing, coughing etc. 2-3% of men may have serious incontinence long-term.
  • Erectile dysfunction is a common side-effect that may be permanent or temporary. Recovery may take up to a couple of years.
  • Radical prostatectomy results in infertility.
  • Blood loss during surgery may require a transfusion (under 10% of cases).
  • Very rarely (in less than 1% of cases) there is injury to the rectum requiring a temporary colostomy.
  • Very small risk of death (as with any major surgery).
 
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