Surgery to remove the prostate is called a radical prostatectomy. The aim of the surgery is to remove all the cancer cells. It is usually only done when the cancer is contained in the prostate and has not spread to the surrounding area (early prostate cancer).
Prostatectomy is only suitable for a small number of men with locally advanced prostate cancer. This is because it may not be possible to remove all the cancer cells that have spread outside the prostate. You can talk to your specialist doctor about whether a prostatectomy would be suitable for you.
Before the operation, the surgeon 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.
We have more information about surgery if you have advanced prostate cancer.
There are different types of radical prostatectomy.
Open radical prostatectomy
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 of a prostatectomy
- If the cancer has not spread outside the prostate, removing it may cure the cancer and you will not need any more treatment.
- If you have locally advanced cancer, having a prostatectomy may increase the chance of curing the cancer.
- 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 of a prostatectomy
- 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.
- If you have locally advanced cancer you will usually need further treatment after surgery such as radiotherapy or hormonal therapy.
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.
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.
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.
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.
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.
Follow-up after a prostatectomy
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.
If you have locally advanced prostate cancer, you may have other types of surgery:
- Transurethral resection of the prostate (TURP) – this operation does not treat the cancer, but may help with symptoms such as difficulty passing urine (peeing). It is sometimes done before other treatments such as radiotherapy.
- Subcapsular orchidectomy – this operation may be done to remove part of the testicles. This reduces hormone levels and can help to control the cancer and symptoms.