Prostatectomy for prostate cancer

There are different ways of doing a radical prostatectomy. Your surgeon will explain the type of surgery you will have. It is usually laparoscopic (keyhole) surgery. This is often robotic-assisted laparoscopic surgery. Occasionally, it may be open surgery.

During a radical prostatectomy, the surgeon frees the prostate gland from the bladder and urethra so that it can be removed. They rejoin the urethra to the bladder using dissolvable stitches. They also remove the seminal vesicle, the part of the body that helps make semen. They may also remove the lymph nodes close to the prostate and check them for cancer cells. This depends on your risk of having cancer in the lymph nodes.

A radical prostatectomy is usually done under a general anaesthetic, which means you are not awake when you have the procedure. But it can also be done under a spinal anaesthetic. If you have a spinal anaesthetic, you will be given a sedative to help you relax and feel sleepy.

You will meet with an anaesthetist to talk about which anaesthetic you will have, and pain control after the surgery.

We have more information about the healthcare professionals you might meet when having surgery, and about types of anaesthetic.

You usually go into hospital on the day of your surgery, or the day before. When you arrive, the nurses on the ward will explain what to expect and give you some information. They will give you an identity bracelet with your details on it. You might find you meet different healthcare professionals and you may be asked the same questions each time. This is just to check everything is correct at each stage of your care.

Ask questions if you are unsure about anything. The nurses would prefer you to ask than be worried.

If you are going into hospital on the day of your surgery, you may be asked not to eat or drink anything for a few hours. This is sometimes called nil-by-mouth. If you have diabetes, make sure the doctors and nurses know about this.

Follow any advice you are given at the pre-operative assessment about taking your usual medicines. You can usually still take these with a sip of water, but you should check with the doctor and nurses.

Your nurse will give you compression stockings to put on before surgery. These are called TED stockings. You will also have to wear these for a period of time afterwards. Compression stockings reduce the risk of getting a blood clot in your legs. This is called deep vein thrombosis or DVT.

Compression socks and stockings need to be the right size with no folds or wrinkles to work effectively. Your nurse will measure you and then check they fit and are on properly.

If you had laparoscopic or robotic surgery, you usually go home after 1 to 2 days. After open surgery, it is usually between 3 and 7 days. Before you leave hospital, your hospital doctor will send a letter called a discharge summary to your GP. The letter is usually sent electronically so that your GP gets it within 24 hours of your discharge. You are usually given a copy to take home with you. It will explain your diagnosis, what type of surgery you had, any medication you are taking and about your follow-up care.

If you need a district or community nurse, the ward nurses will organise this before you go home. You should also be given 24-hour telephone numbers for your hospital team in case you need to contact them.

You can usually get back to normal activities 4 to 12 weeks after surgery, depending on the operation you had. If you had robotic-assisted surgery, you usually recover faster.

It is important to remember that even if you have small wounds, you have still had major surgery. You will feel tired, so try to get plenty of rest and eat well. Do some light exercise, such as walking, to build up your energy. You can slowly increase the amount you do.

Your surgeon, specialist nurse or nurses on the ward can give you advice on when you can start doing things such as driving or returning to work. They can also give you advice on when you can have sex again.

There are side effects after a radical prostatectomy. Some side effects improve over time, but some are permanent.

Surgery to the prostate can cause problems getting or keeping an erection. This is called erectile dysfunction (ED). This is caused by damage to the nerves and blood vessels close to the prostate. These are the nerves and blood supply that help you get an erection.

Surgeons can operate in a way that tries to protect these nerves or blood vessels. This is called a nerve-sparing technique. It is only possible if the cancer has not spread to the edges of the prostate. During surgery, if the surgeon thinks there is cancer in the nerves or surrounding area, they remove some or all the nerves.

Whether you will have problems getting an erection after a nerve-sparing operation depends on different factors. For example, it may depend on your age and whether:

• you had erection problems before surgery
• you have any other medical conditions, such as diabetes
• you are taking medicines for high blood pressure
• you have had surgery called a transurethral resection of the prostate (TURP)
• the surgeon was able to spare some or all of the nerves.

You can ask your surgeon about your risk of ED. Your ability to have an erection may slowly return after surgery. But this may take 1 or 2 years. It is less likely to return if you have further treatment after surgery, such as hormonal therapy or radiotherapy.

You may be offered penile rehabilitation using different ED treatments soon after surgery. This is called an ED recovery package.

When you have your prostate removed, you can still have an orgasm even without an erection, but there will be no ejaculation. This is called a dry ejaculation or dry orgasm. It may cause some discomfort at first, but this usually improves with time. You may pass a small amount of urine when you orgasm. Talk to your urologist or specialist nurse if you are having this problem. They may be able to give you some advice.

Having your prostate removed will affect your fertility. This is your ability to make someone pregnant. The prostate and seminal vesicles produce semen, which is normally mixed with sperm from the testicles. Removing the prostate means you will not be able to ejaculate any more.

It is important to talk to your urologist or specialist nurse about fertility before treatment. It may be possible to store sperm before your surgery.

It is usual to have some leaking from the bladder when the catheter is first removed. This is called urinary incontinence. It usually improves within a few weeks or months after surgery. You will be encouraged to do pelvic floor exercises to strengthen the pelvic floor muscles. You will need to wear a pad to manage the incontinence, but the need for pads should lessen.

Sometimes, you may have some incontinence when you cough, sneeze or exercise. This is called stress incontinence. It is rare to be completely incontinent, but it can happen. If you are having problems, talk to your GP, urologist or specialist nurse. They can refer you to a continence specialist who can give you treatment, information and support to manage your symptoms. If these do not help, you may be able to have surgery to improve your symptoms.

Another less common side effect can be scarring to the urethra or the entrance of the bladder. This is called the bladder neck. Scar tissue can narrow the bladder neck or the urethra and make passing urine difficult. This causes urine to build up in the bladder and overflow, causing you to leak urine. This can usually be treated with a small operation that opens up the bladder neck or the urethra. If you are having problems passing urine after surgery, talk to your GP, urologist or specialist nurse.

If you need to use a toilet urgently, Macmillan has a toilet card that you can use in places such as shops, offices, cafés and pubs. You can use it during or after treatment. We hope it allows you to get access to a toilet without any awkward questions. But we cannot guarantee that it will work everywhere.