Browser does not support script.
Skip to main content
search here
Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
Find out how we produce our information|
Surgery to remove the prostate gland may be a treatment option for you. This operation is known as a radical prostatectomy.
Before any operation, make sure that you’ve discussed it fully with your doctor. It’s important that you understand what it involves, including the chances of success, the likely side effects and whether there are other treatment options that may be more appropriate to your particular circumstances.
Benefits: Removing the whole prostate gland may stop an early cancer from spreading and may result in a cure. Radical prostatectomy appears to prolong life for some men with more fast-growing cancer, but for men with small, slow-growing cancers the benefits are unclear, and probably only apply to younger men. In two out of five men the cancer cells aren’t fully removed, and therefore the operation may not result in a cure.
Risks: One in 200 men over 65, and one in 1,000 men under 65 may die from problems caused by surgery. For every 100 men who have a radical prostatectomy, up to 20 will develop slight leaking of urine. Around five men will have incontinence of urine; and about 50 will have problems getting an erection.
A radical prostatectomy is carried out by specialist surgeons. The whole prostate gland is surgically removed either through a cut made in the abdomen or through a cut made between the scrotum and the back passage. These operations are sometimes known as an open prostatectomy. The aim is to get rid of all of the cancer cells. It is done only when the cancer is thought not to have spread beyond the prostate and usually in men under 70.
The operation often causes impotence (the inability to have and maintain an erection) and infertility (the inability to father children). It can also cause problems with control of passing urine (urinary incontinence). Sometimes it’s possible to do a special type of operation, called a nerve-sparing prostatectomy, which reduces the risk of erection problems.
As doctors can’t predict which men will be affected by these side effects it is important that you’re fully aware of the risks beforehand. Your doctor will discuss the operation, its possible side effects and other treatment options with you.
Although prostatectomy can get rid of the cancer cells completely for many men, in about 1 in 3 men (33%) the cancer cells may come back in the area of the prostate some time after the operation. If this happens, external radiotherapy may be given to the prostate area. The radiotherapy is given over a larger area and can cause more side effects.
With a laparoscopic prostatectomy your surgeon doesn’t need to make a large opening but can take out your prostate gland using only 4 or 5 small cuts (about 1cm each) in your tummy area (abdomen). The surgeon uses specially designed instruments that can be put through these small cuts. This type of surgery is also known as keyhole surgery.
After making the small cuts the surgeon uses carbon dioxide gas to fill the abdomen. A tiny video camera gives a magnified view of the prostate gland onto a video screen. The prostate gland is then cut away from surrounding tissues and removed through one of the cuts in the abdomen.
Sometimes, laparoscopic prostatectomy can be carried out using a machine. This approach is called a robotic-assisted laparoscopic prostatectomy. Instead of the surgeon and assistant moving the camera and instruments, they are attached to robotic arms. The robotic arms can move very delicately, steadily and precisely.
The machine used in robotic laparoscopic prostatectomy is called a da Vinci® machine – so this type of surgery is sometimes called the da Vinci prostatectomy. Only a few surgeons in the UK are trained in this technique and there are only a few robot-assisted systems such as da Vinci, so this treatment is not yet widely available. Your specialist can tell you if it might be appropriate for you and whether it may be available to you.
Most studies have shown that laparoscopic surgery and robotic-assisted laporoscopic surgery are as successful at treating prostate cancer as open surgery. Your surgeon can discuss with you the potential risks and benefits.
After prostatectomy you will have a drip (intravenous infusion) into a vein in your arm and a tube (catheter) to drain urine from the bladder.
If you’ve had an open prostatectomy you’ll have either an abdominal wound or a wound between your scrotum and your anus. You may have a small tube in the wound to drain any excess fluid that is produced.
After your operation you may have some pain| or discomfort, which might continue for a few weeks, particularly when you walk. Regular painkillers should help to ease this, so let the staff on the ward know if you’re still in pain.
You will probably be ready to go home from a week to 10 days after your operation.
Men who’ve had a laparoscopic prostatectomy will have several small cuts in the abdomen and are usually ready to go home earlier than men who’ve had an open prostatectomy. Your catheter will probably stay in for 1–3 weeks to allow the urethra to heal. Arrangements can be made for a district nurse to visit you at home to make sure your catheter is working well. If you have any problems, contact your doctor as soon as possible.
Surgery to the prostate can cause problems getting an erection (sexual impotence) and controlling the bladder (incontinence). Erection problems are caused by reduced blood flow to the penis due to damage to the arteries or nerves.
Often, the need to remove all of the cancer cells makes it impossible to avoid nerve damage. In men aged under 60 who have had nerve-sparing prostatectomy, the risk of erection problems after total prostatectomy may be 5 in 10 (50%) or higher. The risk increases to about 8 in 10 (80%) or more in men over the age of 70 and may be higher if nerve-sparing techniques are not used. We have information about ways of coping with erection problems|.
One of the prostate gland’s functions is to produce semen, which is normally mixed with sperm from the testicles. Removing the prostate gland makes it impossible for men to ejaculate, and although there is still sperm it can’t get out of the body. This causes infertility. If you want children after your treatment, it may be possible to store sperm|. It’s still possible for men who have had their prostate gland removed to have an orgasm, but there will be no ejaculation. This is known as a dry ejaculation.
Problems controlling the bladder as a result of radical prostatectomy are less common. Most men have some incontinence when the catheter is first removed, but this usually improves with time. About one year after the operation up to 20% of men will leak an occasional drop of urine.
Some men may need to wear an incontinence pad, but it’s very rare to be completely incontinent and need a permanent catheter. Another less-common effect of surgery is scarring of the bladder, which can make it difficult to pass urine. This is fairly easily treated with minor surgery (known as a bladder neck dilation).
Some men may find that they have diarrhoea| or constipation| for a few months after a prostatectomy.
If you think that you might have any difficulties coping at home after your surgery, let your nurse or social worker know when you’re admitted to hospital so that help can be arranged.
As well as offering practical advice, some social workers are also trained counsellors who can offer valuable support to you and your family, both in hospital and at home. If you’d like to talk to a social worker, ask your nurse or doctor to arrange it.
Before you leave hospital you’ll be given an outpatient appointment for your post-operative check-up. This is a good time to discuss any problems you may have.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.