Radical prostatectomy surgery

Some men have an operation called a radical prostatectomy. This is where the whole prostate gland is removed.

You may have open surgery – which involves a single larger cut to your tummy – or keyhole (laparoscopic) surgery. With keyhole surgery you have several smaller cuts to your tummy and a video camera is inserted so the surgeon can see the prostate gland. The surgeon uses special instruments are used to cut away the prostate gland.

In some cases, laparoscopic prostatectomy may be assisted by a machine. This is called robotic-assisted laparoscopic radical prostatectomy. The surgeon operates a robot which holds the instruments. This operation is not widely available in the UK.

A radical prostatectomy can cause difficulty getting and maintaining an erection (erectile dysfunction or ED). You will also be infertile and may have problems controlling your bladder. Your specialist will talk to you about these possible side effects and what can help before you have your operation.

Surgery for prostate cancer

Surgery to remove the prostate gland is called a radical prostatectomy. Your doctor will discuss the surgery with you before you have it. They will tell you what it involves, how successful it might be in treating your cancer and the possible side effects. Your doctor should also tell you about other treatments, such as radiotherapy, that may be suitable for you and as effective.

Open radical prostatectomy

The surgery is carried out by a urologist. In an open radical prostatectomy the urologist will remove the whole prostate gland usually through a cut made in the tummy (abdomen). Very occasionally the surgeon will remove the prostate gland through a cut made between the scrotum and the back passage (perineal prostatectomy). The nearby lymph nodes and the glands that help make semen (seminal vesicles) are also removed.

The aim of the surgery is to get rid of all of the cancer cells. It’s only done when the cancer is thought not to have spread beyond the prostate.

After this operation you may be unable to have and maintain an erection; this is called erectile dysfunction – ED. The operation will also affect your fertility. You’ll be unable to father children naturally. The operation can also cause problems with controlling your bladder (urinary incontinence). You can read more about these side effects.

Sometimes it’s possible to do a type of operation called a nerve-sparing prostatectomy, which reduces the risk of some of these problems. As doctors can’t predict which men will be affected by these side effects, it’s important that you know about them before you have surgery.

Advantages of open prostatectomy

  • It may cure the cancer.
  • It may mean that you avoid the need for further treatments such as radiotherapy and hormonal therapy.
  • It may prolong the life of men with fast-growing cancers.
  • If you had urinary symptoms before surgery, these may improve after surgery.
  • Doctors can assess the success of the surgery by measuring your PSA level. This should drop to less than 0.1ng/ml a few weeks after surgery.

Disadvantages of open 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.

Robotic-assisted laparoscopic radical prostatectomy

Sometimes, laparoscopic prostatectomy can be assisted by a machine. This is called a robotic-assisted laparoscopic prostatectomy. Instead of the surgeon holding the tube with the camera and instruments, they are attached to robotic arms. The surgeon controls the robotic arms, which can move very delicately, steadily and precisely.

This type of surgery is only carried out in some hospitals in the UK. Your specialist will tell you if this type of surgery is suitable for you and where the treatment is available.

Advantages of laparoscopic or robotic surgery

  • Laparoscopic surgery is as successful at treating prostate cancer as open surgery.
  • Most men who have laparoscopic surgery spend less time in hospital and recover more quickly from their operation compared to men having an open prostatectomy.

Disadvantages of laparoscopic or robotic surgery

  • Because laparoscopic surgery, particularly robotic surgery, hasn’t been used for as long as open prostatectomy, we don’t know if it’s better at reducing long-term side effects (ED and incontinence) compared to open prostatectomy.
  • Laparoscopic and robotic surgery are more complicated to carry out than open surgery. This may mean that they don’t have as good long-term outcomes.

The consultant explained it was an intricate operation. As I lay on a table the doctors were on a computer, operating a machine next to me.


Back to Surgery explained

Who might I meet?

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

What happens after surgery?

The hospital staff and sometimes a district nurse will help you and provide support as you recover from your operation.