Radical prostatectomy is a surgical treatment option for localized prostate cancer. The aim is to remove the entire prostate and the seminal vesicles. For radical prostatectomy you will receive general anaesthesia.
Discuss with your doctor the advantages and disadvantages of radical prostatectomy and if it is right for you.
How is radical prostatectomy performed?
Radical prostatectomy can be performed as an open or laparoscopic surgery. For open surgery, the surgeon cuts the abdominal wall or the perineum to access the prostate directly. The prostate and the seminal vesicles are removed, and the bladder and the urethra are attached together (Fig. 3). The doctor inserts a catheter to help the urethra and bladder heal. Usually the catheter is removed after 7 days.
In laparoscopic surgery, the surgeon inserts small plastic tubes into your abdomen. Through these tubes the surgeon can insert the instruments needed to remove the prostate. One of the small tubes is used to insert a camera which allows the surgeon to see a high-quality image of your prostate on a video monitor. Laparoscopic surgery can also be done with the aid of a surgical robot system.
For the removal of a localized prostate tumour with radical prostatectomy, open and laparoscopic surgery appear to be equally effective.
Fig. 1a: During radical prostatectomy the surgeon removes the entire prostate and the seminal vesicles.
Fig. 1b: The position of the bladder after the surgery.
Pelvic lymph node removal
If the cancer could spread or has spread to lymph nodes in the pelvic region, your doctor may decide to remove pelvic lymph nodes during radical prostatectomy.
How do I prepare for the procedure?
Your doctor will advise you in detail about how to prepare for the procedure. You must not eat, drink, or smoke for 6 hours before surgery to prepare for the anaesthesia. If you are taking any medication, discuss it with your doctor. You may need to stop taking it several days before surgery. Your doctor will advise you on when to start taking it again.
What are the side effects of the procedure?
Usually you can leave the hospital between 3 and 7 days after surgery. The length of hospital stay can vary in different countries. You may experience minor pain in the lower abdomen for some weeks after open radical prostatectomy. After the surgery you may suffer from urinary incontinence or erectile dysfunction. You may need treatment for these conditions.
You need to go to your doctor or go back to the hospital right away if you:
- Develop a fever
- Have heavy blood loss
- Experience severe pain
- Have problems urinating
Read more about recovery after surgery in the section Support after Surgery.
What is the impact of the treatment?
Radical prostatectomy is a common procedure for localized prostate cancer.
Radical prostatectomy may cause stress urinary incontinence (SUI). This is because the prostate surrounds the urethra, helping it to resist the pressure of a full bladder. If your prostate is removed this may have an effect on how much pressure the urethra can resist. There are several treatment options to improve or cure SUI.
Another common risk of radical prostatectomy is erectile dysfunction. During surgery, the surgeon needs to operate close to the nerves and vessels in the penis. The surgeon tries to keep the nerves to the penis undamaged. The success of this depends on the aggressiveness of the cancer and where the tumour is located.
If necessary, your doctor can recommend treatment for SUI or erectile dysfunction. Do not hesitate to discuss any concerns with your doctor. Together you can decide if other treatment options are more suitable for you.
Keep in mind that the main goal of radical prostatectomy is to remove the tumour and cure you.
What will the follow-up be like?
After radical prostatectomy for prostate cancer, your doctor will plan regular follow-up visits with you. Routine follow-up lasts at least 5 years. During each visit the doctor will test the level of prostate-specific antigen (PSA) in your blood. In some cases you may need a digital rectal examination (DRE). Follow-up is important to monitor how you recover from surgery, to check your general state of health, and to detect possible recurrence of the cancer.
Treatment after surgery
If during follow-up the PSA level shows that the prostate cancer has not been completely removed, you may need additional treatment to remove all tumour cells. Discuss with your doctor which treatment options are best for you.
Terms your doctor may use:
Open surgery: a surgical procedure in which the surgeon cuts skin and tissue to have direct access to the prostate
Nerve-sparing surgery: a surgical procedure which helps to keep sexual function by saving nerves on both sides of the prostate gland
Laparoscopic surgery: a minimally-invasive surgical technique in which the surgeon does not need to cut through skin and tissue. Instead, the surgeon inserts the surgical instruments through small incisions in the abdomen
Surgical robot system: an instrument to help surgeons perform laparoscopic surgery. The surgeon controls the robotic instrument with remote control sensors