Surgery for advanced prostate cancer
About surgery for advanced prostate cancer
You may be offered surgery for advanced prostate cancer. The aim of the surgery is to help with symptoms rather than to treat the cancer.
Before the operation, the surgeon (a urologist) will explain what will happen. They will also talk to you about any possible side effects.
Subcapsular orchidectomy
This is an operation to remove part of the testicles. The aim is to reduce the level of the male hormone testosterone in the body. It is not commonly used because hormonal therapy treatment is usually effective at reducing the testosterone levels.
Transurethral resection of the prostate (TURP)
Your doctor may offer you a transurethral resection of the prostate (TURP) if the cancer is blocking the urethra. This is the tube that drains urine (pee) from the bladder. The aim of the surgery is to remove the blockage, which can help with problems passing urine (peeing) and improve your symptoms.
You may have a TURP before radiotherapy. Radiotherapy can make passing urine more difficult during and after treatment.
Having a TURP for advanced prostate cancer
A TURP can be done under a general anaesthetic. Or you may have a spinal anaesthetic (epidural). An epidural numbs the lower part of your body for a period of time. It is an injection of anaesthetic into the spine. You are awake, but you will not feel anything.
During surgery, the surgeon passes a thin tube through the urethra and into the prostate. This tube contains a cutting instrument and a tiny camera. The cutting instrument is used to shave off the inner area of the prostate and unblock the urethra.
A TURP can also be done using a special laser. This is only done in some specialist treatment centres. Your doctor will advise you if this is suitable for you, and where the treatment is available.
After a TURP
You will be encouraged to start moving around as soon as you can after your operation. This can help lower the risk of complications.
After a TURP, you will usually have a drip (intravenous infusion) into a vein in your arm. This will stay in for a few hours after your operation, until you are eating and drinking again. You can usually go home after 3 or 4 days.
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Catheter
You will have a tube (catheter) to drain urine from the bladder into a bag. After a TURP, your urine will have blood in it for a while. To stop blood clots blocking the catheter, fluid is passed into the bladder and drained out through the catheter. This is called bladder irrigation. The blood will slowly clear from your urine, and then the catheter can be taken out.
You may find it difficult to pass urine without the catheter at first, but this will improve. You may have urinary incontinence after a TURP, but this usually improves within a few weeks.
You may need to keep the catheter in for a while after you go home. This is because swelling caused by the surgery may make it difficult for you to pass urine. The nurse will show you how to look after your catheter before you leave the hospital. They can also organise for a district nurse to visit you at home to help with any problems. When the swelling goes down, the catheter can be removed.
If you go home with a catheter, you may have bladder spasms. These are caused by the catheter irritating your bladder. The spasms can cause urine to bypass your catheter, so you may leak urine at times. These spasms are normal, but if they last a long time and are frequent, tell your doctor or nurse. You may find them uncomfortable.
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Pain
You may have pain and discomfort for a few days after your operation. You will be given painkillers to help with this. If the painkillers are not helping, talk to your doctor or nurse. They can give you another type of painkiller.
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Ejaculating into the bladder
Ejaculating into the bladder is called retrograde ejaculation. It is caused by damage to the nerves or muscles that surround the neck of your bladder. The neck of your bladder is where the urethra joins on to the bladder. It means that during ejaculation, semen goes backwards into the bladder instead of through the urethra in the normal way. After an ejaculation, your urine may look cloudy. This is because there is semen in the bladder, but this is harmless.
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Erection problems
You may have problems getting an erection after the TURP. This is called erectile dysfunction (ED). It might depend on whether you had problems getting an erection before the operation, or if you were on hormone therapy. Your surgeon can tell you more about your risk of erection problems.
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Difficulties passing urine
Sometimes, a TURP can cause some long-term difficulties with passing urine.
Types of surgery for advanced prostate cancer
The tubes that connect the kidneys to the bladder (ureters) may get blocked by the prostate cancer. This will make it difficult to pass urine. If this happens, you may be offered one of the following types of surgery:
- Percutaneous nephrostomy – the doctor puts a tube into the kidney. The tube goes into a bag that sits outside on the skin. Urine can then drain into the bag.
- JJ stent – the doctor puts a fine tube into the ureter. The tube is called a JJ stent. This opens up the ureter, so urine can flow through it.
Your doctor or specialist nurse can give you more information about these types of surgery.
Strengthening a weakened bone
Advanced prostate cancer that has spread to the bones may cause problems that need treating. If there is a risk of a bone breaking, your doctor may advise bone repair surgery to strengthen the bone.
Going home after surgery
If you think you might have difficulties coping at home after your surgery, tell your nurse or social worker when you go into hospital. They can arrange help for when you go home.
Social workers can offer practical advice and valuable support to you and your family. If you would like to talk to a social worker, ask your nurse or doctor to arrange this for you.
Before you leave hospital, you will be given an appointment at an outpatient clinic for your post-surgery check-up. This is a good time to talk about any problems you may have.
Macmillan is also here to support you. If you would like to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat online to our specialists online.
- Visit our prostate cancer forum to talk with people who have been affected by prostate cancer, share your experience, and ask an expert your questions.
About our information
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References
Below is a sample of the sources used in our advanced prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
The National Institute for Health and Care Excellence (NICE) Prostate cancer: diagnosis and management. NICE guidelines. May 2019. Available at www.nice.org.uk/guidance/ng131
Horwich A et al. ESMO Consensus Guidelines: Prostate cancer. Annals of Oncology. 2012.
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.
Date reviewed
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