Prostatectomy

How it works

To treat your cancer, your entire prostate gland, including the tumour, is removed, along with the seminal vesicles that carry semen. To make sure all the cancer is removed, some additional tissue surrounding the gland may also be removed, including your lymph nodes. There are a few ways your surgeon can remove it:

• Open surgery involves your surgeon accessing your prostate through a large cut in your abdomen. Open surgery is rarely done nowadays, but is sometimes recommended if your prostate is very large.
• Laparoscopically (keyhole surgery), where instruments are inserted into small holes in your abdomen along with a laparoscope (a camera with a light) so your surgeon can see what they’re doing on a screen. Laparascopic techniques are used for lots of surgeries, because it’s quicker to recover from compared with open surgery.
• Robotically (another form of keyhole surgery), where a robot is controlled by a surgeon to complete the surgery. The Da Vinci robot can make cuts and movements very accurately, reducing blood loss.

To get rid of your cancer and stop it coming back most effectively, prostatectomies are often used in combination with other treatments, such as radiotherapy or hormone therapy.

These procedures are often described as ‘radical’ due to the high risk of side effects afterwards.

Suitability

If you have localised or locally advanced prostate cancer, you might be recommended a radical prostatectomy. However, not everyone can have surgery. If your overall health isn’t very good, you are older or you can’t tolerate anaesthetic, you won’t be suitable.

Success rates

Radical prostatectomies have been shown to be effective in the long-term at controlled cancer. Newer techniques, such as nerve-sparing prostatectomies, are also more effect in preserving your erection and bladder control. However, there is still a risk of impotence and incontinence after surgery.

• Cancer control: Men who have lower grade prostate cancer that is confined to the organ can have different outcomes at 20 years after their treatment. On average, 3% will die of their prostate cancer, 5% see their cancer spread to other organs, and 6% have a localised recurrence. For men with a Gleason score of above 7 or a PSA above 20, the risk of prostate cancer mortality is 22%.
• Sexual potency (for people that had full erectile function before treatment): Around 85% of men will have issues with sexual function after a prostatectomy. However, this drops to around 50% after a complete nerve-sparing procedure.
• Urinary continence: Around 40% of men will experience some kind of incontinence after their procedure, although for some people this resolves as they recover. A very experienced surgeon could expect around 90% of their patients to have recovered their bladder control after 3 years.

Side effects

With all surgeries, there is a risk of infection. You will be prescribed antibiotics to reduce this risk and your symptoms will be monitored during your follow-up appointments.

Difficulty getting and maintaining an erection, and controlling your bladder, are the most common side effects. This is because of the volume of tissue removed during a prostatectomy and the likelihood of removing or damaging the nerves that control erections and going to the bathroom.

Many men can find these symptoms distressing. If you want to avoid them, The Focal Therapy Clinic offers minimally-invasive treatments that could be right for you. Find out more>>

On the day

When you arrive at hospital, your nurse will complete some checks and answer any questions you might have. You’ll need an anaesthetic, you might have some medicine to help you relax and you might also have a drip to keep you hydrated.

During the procedure

Depending on the type of surgery, it can take up to 4 hours. Your surgeon will make one large or some small incisions, depending on whether your surgery is open or laparoscopic (keyhole). They will remove your prostate and any additional tissue to make sure all the cancer is gone, then reconnect your bladder to your urethra.

Recovery

You’ll need to stay in hospital after your surgery for your initial recovery, which can take up to 7 days. To help your bladder recover, you’ll need a catheter for around 2 weeks, but you’ll be shown how to look after this yourself whilst you’re at home.

After you go home, it can take 4-12 weeks until you are able to get back to your normal activities. You’ll need to attend a check-up around 4 weeks after your operation. You’ll continue to have follow-ups to monitor your cancer, usually every 3 months for 1 year then every 6 months for the next 2 years.