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Having a prostatectomy for early prostate cancer

An operation to remove the whole prostate is called a radical prostatectomy. It is usually only done it the cancer is contained to the prostate.

The aim is to remove all the cancer. The surgeon will explain what the operation involves and explain the advantages and disadvantages. The operation may cure prostate cancer. But it can also cause side effects, such as difficulties getting an erection (erectile dysfunction) and bladder problems.

A prostatectomy can be done with open surgery involving a single large cut to your tummy or a cut between the scrotum and back passage. It can also be done using keyhole (laparoscopic) surgery. You have several smaller cuts to your tummy. The surgeon inserts a thin tube with a camera on its end and uses special instruments to remove the prostate.

In some cases, keyhole surgery is assisted by a machine. The surgeon controls robotic arms which holds the instruments. This is called robotic-assisted laparoscopic radical prostatectomy. It is only available in some hospitals in the UK.

Surgery for prostate cancer

Surgery to remove the prostate is called a radical prostatectomy. Before the operation, the surgeon (a 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 in the prostate and has not spread to the surrounding area.

There are different types of radical prostatectomy (see below).

Open radical prostatectomy

The surgeon makes a cut in your 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. 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 the 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 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.

Back to Surgery for early prostate cancer

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.