Radical prostatectomy is a surgical treatment option for locally-advanced prostate cancer. The aim is to remove as much of the tumour as possible. This is done by removing the entire prostate gland and both seminal vesicles, as well as surrounding tissue affected by the tumour. The procedure also includes the removal of lymph nodes in the pelvic area. For radical prostatectomy you will receive general anaesthesia.
It is not always possible to remove the entire tumour with radical prostatectomy. Because of this, your doctor may recommend additional treatment with radiation therapy or hormonal therapy.
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. The surgeon will also remove any other tissue that is affected by the tumour. Then, the bladder and the urethra are attached together (Fig. 1). 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 help of a surgical robot system.
For the removal of a locally-advanced tumour with radical prostatectomy, open and laparoscopic surgery appear to be equally effective.
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
The removal of pelvic lymph nodes may cause lymphorrhea. This is a leakage of lymph fluid on the skin. The fluid leads to skin damage, and may cause an infection. Discuss the treatment of lymphorrhea with your medical team.
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 the surgery is erectile dysfunction. Because the surgeon may need to remove tissue outside of the prostate, there is a risk that vessels and nerves are damaged or removed during surgery. This is a common cause of erectile dysfunction. During surgery, 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 erectile dysfunction.
Keep in mind that the main goal of radical prostatectomy is to remove the tumour and cure you. 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 locally-advanced prostate cancer. In most cases, other treatments are necessary to completely remove the tumour. The most common treatments after radical prostatectomy are radiation therapy and hormonal therapy. These treatments can cause side effects or have an impact on your quality of life.Treatment after surgeryIf 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 option is best for you.
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 option is best for 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 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.