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.

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.

After this operation you may be unable to have and maintain an erection (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 prolong the life of men with fast-growing cancers.

Disadvantages of open prostatectomy

  • It is only suitable for a small number of men with locally advanced prostate cancer.
  • Some men may require radiotherapy after surgery if there’s a possibility that cancer cells have been left behind.
  • For some men, cancer cells may come back immediately or some time after the operation. If this happens, radiotherapy or hormonal therapy may be given.

Laparoscopic radical prostatectomy

With a laparoscopic prostatectomy your surgeon doesn’t need to make a large cut. Instead they can take out your prostate gland by making four or five small cuts (about 1cm each) in your tummy (abdomen). This type of surgery is also known as keyhole surgery.

To start with, small cuts are made in your tummy, which is then filled with carbon dioxide gas. The surgeon puts a small tube with a light and camera on the end (laparoscope) through one of the cuts. This shows a magnified image of the prostate gland on a video screen. The surgeon uses specially designed instruments to cut away the prostate gland from surrounding tissues. The prostate gland is then removed through one of the cuts.

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.

I had a radical prostatectomy. I was lying on a table and the doctors were on a computer operating a machine next to me.


Back to Types of surgery

TURP surgery

A transurethral resection of the prostate (TURP) is an operation to remove part of the prostate gland and make passing urine easier.