Treatment

Surgery: radical prostatectomy

Radical prostatectomy is an operation to remove the prostate and the cancer contained within it. It is an option for men with cancer that is contained within the prostate (localised prostate cancer) and who are otherwise fit and healthy. 

It may also be an option for some men with cancer that has spread to the area just outside the prostate (locally advanced prostate cancer). This will depend on how far the cancer has spread.

What other treatments are available?

Contents

Watch Colin's story for one man's experience of surgery.

Types of surgery

There are several ways of removing the prostate gland.

Open surgery
There are two types of open surgery.

  • A retropubic prostatectomy is done through a long cut in the abdomen above the pubic bone area. This is the most common type of open prostatectomy.
  • A perineal prostatectomy is done through a cut in the area between the testicles and back passage (the perineum). It is less common and not widely available in the UK.

Keyhole (laparoscopic) surgery
The surgeon makes five or six small cuts in your tummy, which they insert a camera and instruments into.

There are two ways of doing this operation:

  • by hand
  • using a robot.

These are similar, but with robot-assisted surgery the surgeon uses robotic arms to move the surgical instruments. Robot-assisted surgery is fairly new and only available in some hospitals in the UK.

All of these methods appear to be equally good at treating prostate cancer.

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What are the advantages and disadvantages?

The advantages and disadvantages of all types of surgery depend on your age, health and the stage of your cancer. Your surgeon should discuss this with you.

Advantages

  • If the cancer is completely contained within the prostate, surgery will remove all of it.
  • The prostate is sent for testing which will give a clearer picture about how aggressive the cancer may be and how far it may have spread.
  • It is easy to measure how successful the surgery was, as your PSA should drop to less than 0.1 ng/ml a few weeks after the operation.
  • If your PSA starts to rise, you may be able to have further treatment with radiotherapy or hormone therapy.

Disadvantages

  • There are risks in having a radical prostatectomy, as with any major operation.
  • You will need to stay in hospital and it will take some time to recover afterwards.
  • If the cancer has broken out of the prostate gland, the surgeon may not be able to remove all of it.
  • There is a risk of side effects such as erection and urinary problems.
  • You will not be able to father children after surgery as the prostate gland, which produces some of the fluid in semen, is removed.

What might be an advantage for one person may not be for someone else.

Some of the success of surgery and risk of side effects will depend on your surgeon's experience and skill. Your surgeon should be able to tell you how many operations they have done and the outcomes of these.

As well as these advantages and disadvantages, there are some specific advantages and disadvantages to the different types of surgery.

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What does treatment involve?

Before the operation
A few days or weeks before your operation you will have several tests to make sure you are fit enough for the surgery. If you are overweight, you may need to lose weight before your operation.

Doing pelvic floor muscle exercises for a few weeks before the operation may help you recover more quickly from problems leaking urine caused by surgery.

The operation
The operation will take two to four hours. You will have a general anaesthetic so you will be asleep and won't feel anything.

If possible, your surgeon will try to save the nerves around the prostate which control erections. This is called nerve-sparing surgery. However, if the cancer has spread too close to the nerves, the surgeon may need to remove them. This may mean you will have problems getting an erection.

After the operation
When you wake up you will have a tube in your arm or hand, to give you fluid. You will also have a tube in your abdomen to drain away any fluid from the wound. These will be removed before you go home.

You will have a catheter (a tube to drain urine out of the body). Most men go home with the catheter and it is removed one to three weeks after the operation. You nurse will show you how to look after it.

You will be able to go home one to seven days after the operation. Men who have had keyhole surgery may be able to go home sooner than men who have had open surgery.

You will see your doctor around six weeks after your operation. You will have regular appointments every three to six months to monitor your PSA level and any side effects. If your PSA rises, this may be a sign that there is still cancer present, and you will be offered further treatment with radiotherapy or hormone therapy.

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What are the side effects?

The most common side effects of surgery are difficulty getting and keeping an erection (erectile dysfunction) and leaking urine (urinary incontinence).

The risk of getting side effects depends on your overall health, the stage and grade of your cancer and your surgeon's skill and experience.

The side effects from all types of prostate surgery are similar.

Some men have problems passing urine after surgery because of scar tissue around the neck of the bladder. Let your doctor or nurse know if you have any problems. If you have a sudden and painful inability to pass urine (acute urinary retention), you should get treatment straight away. Contact your doctor or nurse or go to the hospital accident and emergency (A&E) department.

Watch Paul's story for one man's experience of managing urinary problems after surgery:

Some men find that their penis gets shorter following surgery. Using a vacuum pump, or taking a PDE5 inhibitor such as sildenafil (Viagra®), may also help to prevent shortening and improve erections.

The prostate gland produces some of the fluid in semen. As this is removed, you will not be able to ejaculate any semen. This means you will be infertile. If you wish, you may be able to store your sperm before the operation for use in IVF (in vitro fertilisation).

Watch Kevin's story for one man's experience managing side effects of surgery:

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When to call your doctor or nurse

You should contact your doctor or nurse as soon as possible if you experience any of the following symptoms.

  • Urine stops draining out of the catheter and your bladder feels full.
  • Your urine contains blood clots or turns red.
  • You have strong smelling, dark or cloudy urine, or it burns when you pass urine. This could be a sign of an infection.
  • Your catheter falls out.
  • Your wound edges become red, swollen or painful. This can be a sign of infection.
  • You get pain or swelling in your legs.
  • You have a temperature of more than 38ºC or 101ºF. This could be a sign of an infection.
  • You feel sick (nauseous) or vomit.
  • You get cramps in your stomach that will not go away.

Your doctor or nurse may ask you to come into the hospital or they may advise you to visit the accident & emergency (A&E) department at your local hospital.

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Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

  • What type of surgery do you recommend for me and why?
  • How many of these operations have you done and how many do you do a year?
  • Will you try to do nerve-sparing surgery if possible?
  • How long should I expect to be in hospital?
  • What pain relief will I get after the operation?
  • If I have problems with the catheter or wound, who should I contact?
  • How soon will we know whether the operation has been successful?
  • How often will my PSA level be checked?
  • What is the risk of side effects, such as urinary or erection problems?
  • What treatment will I have to help me get erections and when will I start it?
  • What is the chance of needing further treatment for cancer after surgery?

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References

"All of these methods appear to be equally good at treating prostate cancer" from: Heidenreich A, Bolla M, Joniau S et al. 2010. Guidelines on prostate cancer. European Association of Urology.

"The side effects from all types of prostate surgery are similar" from:

  • Ball AJ, Gambill B, Fabrizio MD et al. Fourth Prize: Prospective Longitudinal Comparative Study of Early Health-Related Quality-of-Life Outcomes in Patients Undergoing Surgical Treatment for Localized Prostate Cancer: A Short-Term Evaluation of Five Approaches from a Single Institution. Journal of Endourology. 2006; 20(10): 723-731.
  • National Institute for Health and Clinical Excellence. 2006. Laparoscopic radical prostatectomy. London: National Institute for Health and Clinical Excellence.
  • Coelho RF, Rocco B, Patel MB et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy: A critical review of outcomes reported by high-volume centres. Journal of Endourology. 2010;24(12):2003-2015

You can find a list of all the references used to produce this page in our online fact sheet.