What is a radical prostatectomy?

Surgery to remove the prostate is called a radical prostatectomy. Before the operation, the surgeon (urologist) will explain what will happen and tell you about the possible side effects. They may also tell you about other treatments that may help in your situation, such as radiotherapy.

The aim of the surgery is to remove all of the cancer cells. It is usually only done when the cancer is contained within the prostate and has not spread to the surrounding area.

Open radical prostatectomy

The surgeon makes a cut in the lower tummy (abdomen), so they can remove the whole prostate. Or sometimes they remove the prostate through a cut they make in the area between the scrotum and the back passage, called the perineum.

Laparoscopic radical prostatectomy

In this type of operation, your surgeon does not need to make a large cut. Instead, they remove the prostate using 4 or 5 small cuts (about 1cm each in length) in the tummy (abdomen). This type of surgery is also known as keyhole surgery.

The surgeon then puts a small tube with a light and camera on the end (laparoscope) through one of the cuts. This shows an image of the prostate on a video screen. The surgeon then uses smaller, specially designed equipment to cut away the prostate from surrounding tissues. Then they remove the prostate through one of the small cuts.

Robotic-assisted laparoscopic radical prostatectomy

This is when a laparoscopic radical prostatectomy can be assisted by a machine. Instead of the surgeon holding the tube with the camera (laparoscope) and the surgical equipment, they are attached to robotic arms. The surgeon controls the robotic arms, which can move very precisely. This means the surgeon is less likely to damage nerves that control erections and passing urine (urinary continence).

Surgeons need special training before they can do this type of surgery. This means it is only available in some hospitals in the UK. Your surgeon will tell you if robotic surgery is suitable for you and where the treatment is available.

Advantages and disadvantages of a prostatectomy

Advantages

  • If the cancer has not spread outside the prostate, removing it may cure the cancer and you will not need any more treatment.
  • If the cancer comes back, you will still be able to have further treatment.
  • If you had urinary symptoms before surgery, these may improve after surgery.

Disadvantages

  • There may be a small risk of problems after the surgery, such as bleeding or infection.
  • Surgery may cause long-term problems with erectile dysfunction and incontinence.
  • Removing the prostate means you will no longer be able to have children.

After surgery

You will be encouraged to start moving around as soon as you can after your operation. This can help reduce the risk of complications.

After a prostatectomy, 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.

Wound

If you have had an open prostatectomy, you will have a wound on your tummy or a wound between your scrotum and your back passage. If you have had a laparoscopic prostatectomy, you will have a few small wounds. You may have a small tube in the wound to drain any fluid coming from it. This is usually removed after a few days.

Pain

You may have some pain or discomfort. This might continue for a few weeks, particularly when you walk. Taking painkillers regularly should help this. Let the staff on the ward know if you are still in pain.

Catheter

You will have a tube (catheter) to drain urine from the bladder into a bag. Your catheter will usually stay in for a short while after you go home. This lets urine to drain while the urethra heals and any swelling goes down. It can be removed at the outpatient clinic 1 to 3 weeks after the operation.

A district nurse can visit you at home if needed to make sure your catheter is working well. If you have any problems, contact your doctor, specialist nurse, or the ward where you had your surgery as soon as possible.

Going home

If you had open surgery, you will probably be ready to go home after 3 to 7 days. If you had laparoscopic surgery, you can usually go home after 1 to 2 days.

Most men return to their normal activities 4 to 12 weeks after an operation for prostate cancer. It will depend on the type of surgery you have had. Men who have had robotic-assisted surgery usually recover faster and can get back to normal activities more quickly than men who have had open surgery.

Try to get plenty of rest and eat well. Do some light exercise, such as walking, to help build up your energy. You can slowly increase the amount you do.

If you think you might have any difficulties coping at home after your surgery, tell your nurse or social worker when you are admitted to hospital. They can arrange help for when you go home.

Sex after surgery to the prostate gland

When your prostate gland is removed, you will still make sperm, but it won’t come out through your penis. It will be absorbed back into the body. You may also have problems with erections or lose interest in sex after prostate surgery. Although you may feel embarrassed, doctors who deal with prostate cancer are very used to talking about these issues and will be able to give you advice. There are treatments that can help with this.

We have more information about your sex life and treatment for prostate cancer.

Follow-up after surgery

After your prostate has been removed, your PSA level should drop to a level so low that it is not possible to detect it in the blood. Your PSA level will be checked about 6 to 8 weeks after surgery. This can help your doctors tell whether they removed all of the cancer.

You will be given a clinic appointment to see the surgeon to check your wound is healing properly. They will also tell you about:

  • the tissue removed during surgery (pathology)
  • the stage of the cancer
  • any further treatment you need.

About our information

  • References

    Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    European Association of Urologists. Guidelines on Prostate Cancer. 2016.

    European Society for Medical Oncology. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2015.

    National Institute for Health and Care Excellence (NICE). Prostate cancer overview. Available from: pathways.nice.org.uk/pathways/prostate-cancer (accessed from March 2017 to November 2017).

    National Institute for Health and Care Excellence (NICE). Surveillance report 2016. Prostate cancer: diagnosis and management (2014). NICE guideline CG175. 2016.



  • 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 Editors, Dr Jim Barber, Consultant Clinical Oncologist and 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.