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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 have discussed it fully with your doctor. It is 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. Your doctor may suggest that you have hormonal therapy| before or after your surgery.
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. This aims to get rid of all of the cancer cells. This operation 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. It can also cause problems with control of passing urine (urinary incontinence). Sometimes it is possible to do a special type of operation, called a nerve-sparing prostatectomy, which reduces the risk of erection problems.
As doctors cannot predict which men will be affected by these side effects it is important that you are fully aware of these risks beforehand. Your doctor will discuss the operation, its possible side effects and other possible 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 a while after the operation. If this happens, external radiotherapy| may be given to the prostate area. The treatment is given over a larger area, which 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 (inflate) 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 (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 these techniques and there are only a few robot-assisted systems such as da Vinci®, so this treatment is not yet widely available. Your specialist will be able to 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. These types of surgery are only carried out by surgeons with specialised training and experience in the techniques involved.
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 the operation is done through the abdomen you will also have an abdominal wound. 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 may 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 are still in pain.
You will probably be ready to go home from a week to ten days after your operation. 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, and if you have any problems you should contact your doctor as soon as possible.
Surgery to the prostate can cause problems in getting an erection (sexual impotence) and in controlling the bladder (incontinence). Erection problems are caused by a reduction in the 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 1 in 2 (50%) or higher. The risk increases to about 4 in 5 (80%) or more in men over the age of 70 and may be higher if nerve-sparing techniques are not used. Our section on side effects| discuss ways of coping with erection problems.
Problems with 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 is very rare to be completely incontinent and need to have 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 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 are admitted to hospital so that help can be arranged.
As well as being able to offer practical advice, many social workers are also trained counsellors who can offer valuable support to you and your family, both in hospital and at home. If you would like to talk to a social worker, ask your nurse or doctor to arrange it for you.
Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check-up. This is a good time to discuss any problems you may have.
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