Radical Prostatectomy

Surgery Overview

A radical prostatectomy is surgery to remove the prostate gland. It is done to remove prostate cancer. It may be done as open surgery. Or it may be done as laparoscopic surgery through small incisions.

Laparoscopic surgery may be done by hand. But many doctors now do it by guiding robotic arms that hold the surgery tools. This is called robot-assisted prostatectomy.

Open surgery

In open surgery, the surgeon makes an incision to reach the prostate gland. The incision may be in the lower belly. Or it may be in the perineum between the anus and the scrotum.

When the incision is made in the lower belly, it is called the retropubic approach. The surgeon may also remove lymph nodes in the area so that they can be tested for cancer.

Laparoscopic surgery

For laparoscopic surgery, the surgeon makes several small incisions in the belly. A lighted viewing tool called a laparoscope is inserted into one of the incisions. The surgeon uses special tools to reach and remove the prostate through the other incisions.

Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the belly. It's done with robotic arms that translate the surgeon's hand motions into finer and more precise action. This surgery requires specially trained doctors.

The main goal of either type of surgery is to remove all the cancer. Sometimes that means removing the prostate and the tissues around it, including a set of nerves to the penis. These nerves affect the ability to have an erection. Some tumours can be removed using a nerve-sparing technique. This means carefully cutting around those nerves to leave them intact. Nerve-sparing surgery sometimes preserves the ability to have an erection.

What To Expect

You will likely stay in the hospital for 1 to 3 days after surgery. Most people can go back to work or their usual routine in about 3 to 5 weeks. But it can take longer to fully recover.

A thin, flexible tube called a catheter usually is left in your bladder to drain your urine for 1 to 2 weeks. Your doctor will give you instructions about how to care for your catheter at home.

After the catheter is removed, it may take several weeks or more for you to control your urine. And it may take 6 months or more for you to be able to have erections again. But with time, most people regain urine control and much of their previous sexual function. If not, medicines or other treatments may help.

Although prostatectomy often removes all cancer cells, be sure to get follow-up care.

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Why It Is Done

A radical prostatectomy is done to remove prostate cancer. It is most often used if testing shows that the cancer has not spread outside the prostate.

It is sometimes used to relieve urinary obstruction in people with advanced cancer. But a different surgery, called a transurethral resection of the prostate (TURP), is most often used for that purpose. Surgery usually is not considered a cure for advanced cancer. But it can help relieve symptoms.

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How Well It Works

Radical prostatectomy is a surgery that removes the prostate. It often works well to treat prostate cancer that has not spread outside of the prostate (localized prostate cancer). PSA levels drop almost to zero if the surgery successfully removes the cancer and the cancer has not spread. If cancer has spread, advanced cancer may develop even after the prostate has been removed.

For people who have localized prostate cancer, this surgery works about as well as radiation. With either treatment, the chance of the cancer spreading is low. One study looked at men with localized prostate cancer and found that the risk of early death was very low and about the same, no matter what option men chose.^{footnote 1}

For people with advanced prostate cancer, other treatments may work better than surgery. Radiation, hormone therapy, and other medicines are often used to help control cancer that has spread beyond the prostate.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the method of surgery, including robotic surgery.^{footnote 2}

Risks

The main risks of a radical prostatectomy are:

Loss of bladder control (urinary incontinence).

The urethra runs through the middle of the prostate gland. To remove the prostate, the surgeon has to cut the urethra and reconnect it to the bladder. Many people regain bladder control over time.

Erection problems.

Often the nerves that control an erection are damaged or have to be removed during surgery. In time, some people are able to have erections again. This depends on many things, including age and whether a person could have an erection before surgery.

Radical prostatectomy is major surgery, so it also has general surgery risks. These include bleeding, infection, heart problems, blood clots, and a reaction to anesthesia.