Prostatectomy for prostate cancer
Surgery to remove the prostate to treat prostate cancer is called a radical prostatectomy. The aim of surgery is to remove all of the cancer cells.
It is usually done when the cancer is contained in the prostate (early prostate) and has not spread to the surrounding area.
A prostatectomy may sometimes be done to treat locally advanced prostate cancer. But usually, this operation is not possible. This is because the surgeon would not be able to remove all the cancer cells that have spread outside the prostate. Other types of surgery, such as transurethral resection of the prostate (TURP), can help with the symptoms of locally advanced prostate cancer.
A prostatectomy is a big operation and may not be suitable for everyone. Your doctor can tell you whether it is suitable or if a different treatment may be best for you.
There are different types of radical prostatectomy. Your surgeon will explain the type of operation you will have.
During the operation, the surgeon usually removes the seminal vesicle which helps make semen. They may also remove the lymph nodes close to the prostate and check them for cancer cells. This depends on your risk of having cancer in the lymph nodes.
Laparoscopic radical prostatectomy
In this operation, your surgeon does not need to make a large cut. Instead, they remove the prostate using 4 or 5 small cuts (each about 1cm long) in the tummy (abdomen).
The surgeon puts a small tube with a light and camera on the end (laparoscope) through one of the cuts. This shows an image of the prostate on a video screen. They use smaller, specially designed equipment to cut away the prostate from surrounding tissues. They remove the prostate through one of the small cuts.
Robotic-assisted laparoscopic radical prostatectomy
This is when a laparoscopic prostatectomy is assisted by a machine. It is now a common way of doing a laparoscopic prostatectomy.
Instead of the surgeon holding the tube with the camera (laparoscope) and the surgical equipment, they are attached to robotic arms. The surgeon controls the robotic arms, which they move very precisely. This means the nerves that control erections and passing urine are less likely to be damaged. Your stay in hospital is also likely to be shorter.
Surgeons need special training to do this type of surgery. This means it is not available in all hospitals in the UK. Your surgeon will tell you if it is suitable for you and where you may be able to have it done.
Open radical prostatectomy
The surgeon makes a cut in your lower tummy (abdomen), so they can remove the whole prostate. Or, sometimes they remove the prostate through a cut they make in the area between the scrotum and the back passage. This area is called the perineum.
Before the operation, your surgeon or specialist nurse will explain the possible risks and side effects.
You usually have an appointment at a pre-assessment clinic to have tests to check your general health. The nurses may advise you on what you can do to be fitter for surgery, such as giving up smoking or reducing your weight.
You will be encouraged to start pelvic floor exercises to strengthen the pelvic floor muscles. You can do these at home. This can help reduce urinary leakage (incontinence) after the surgery.
We have more information about eating well and keeping active.
You will be encouraged to start moving around as soon as you can after your operation. This can help reduce the risk of complications such as blood clots. You may also need to have injections when you go home to prevent blood clots. The nurses can tell you more about this.
After a prostatectomy, you will usually have a drip (intravenous infusion) into a vein in your arm. This will stay in for a few hours after your operation, until you are eating and drinking again.
If you have had an open prostatectomy, you will have a wound on your tummy or a wound between your scrotum and back passage. After a robotic or laparoscopic prostatectomy, you will have a few small wounds in the tummy area.
You may also have a small tube going into the wound. This is called a drain. It helps to remove any fluid that is collecting there. It is usually removed after a few days.
Before you go home the nurses will advise you on how to take care of your wound. They will advise you on what to look out for and who to contact if you have any concerns.
You may have some pain or discomfort. Painkillers will help with this. In hospital, you may have pain medicines through a drip in your vein, or by injection. This will then be replaced with painkiller tablets. Tell the staff on the ward if you are still in pain. You will be given a supply of tablets to take home with you.
You might have some discomfort for a couple of weeks, particularly when you walk. Taking painkillers regularly should help this. Talk to your doctor or nurse if you are still getting pain.
You will have a tube (catheter) to drain urine from the bladder into a bag. Your catheter will usually stay in for a short time after you go home. The catheter lets urine drain while any swelling settles down and the urethra heals. The nurses will explain what to expect. Try to drink plenty of fluids to help keep the catheter draining well.
The nurses will show you how to look after your catheter before you go home. They will give you some spare bags. A district nurse can visit you at home if needed. If you have any problems with your catheter, contact your doctor, nurse, or the ward as soon as possible. The catheter is often removed at the clinic 1 to 2 weeks after the operation.
It is normal to leak urine for a period of time after the catheter has been removed. Your doctor and nurse will talk to you about this.
If you had laparoscopic or robotic surgery, you can usually go home after 1 to 2 days. After open surgery, it is usually between 3 and 7 days.
You can usually get back to normal activities 4 to 12 weeks after surgery, depending on the operation you had. If you had robotic-assisted surgery, you usually recover faster.
It is important to remember that even if you have small wounds, you have still had major surgery. You will feel tired so try to get plenty of rest and eat well. Do some light exercise, such as walking, to build up your energy. You can slowly increase the amount you do.
If your prostate has been removed, your PSA level should drop so low that it is not possible to detect it in the blood. Your PSA level will be checked about 6 to 8 weeks after surgery. This can help your doctors to know whether they have removed all of the cancer.
You will have a clinic appointment to see the surgeon. They will check that your wound is healing properly and tell you about:
- the tissue removed during surgery (pathology)
- the stage of the cancer
- any further cancer treatment you need
- your recovery after surgery.
We have more information about follow-up after prostate cancer treatment.
Surgery to the prostate can cause problems getting or keeping an erection. This is called erectile dysfunction (ED). This is caused by damage to the nerves and blood vessels close to the prostate that help you get an erection.
Surgeons can operate in a way that tries to protect these nerves or blood vessels. This is called a nerve-sparing technique. It is only possible if the cancer has not spread to the edges of the prostate. During surgery, if the surgeon thinks there is cancer in the nerves or surrounding area, they remove some or all the nerves.
Whether you will have problems getting an erection after a nerve-sparing operation depends on different factors. For example:
- whether the surgeon was able to spare some or all of the nerves
- being older
- if you have had a TURP.
We have more information about other things that may increase the risk of ED.
You can ask your surgeon about your risk of ED. Your ability to have an erection may slowly return after surgery. But this may take 1 or 2 years. It is less likely to return if you have further treatment after surgery, such as hormonal therapy or radiotherapy.
A prostatectomy can quickly cause erectile dysfunction (ED) problems. You may be offered penile rehabilitation using different ED treatments soon after treatment. This is called an ED recovery package. We have more information about treatments to help ED.
If you have your prostate removed, you can still have an orgasm even without an erection, but there will be no ejaculation. This is called a dry ejaculation or dry orgasm. It may cause some discomfort at first, but this usually improves with time. You may pass a small amount of urine when you orgasm. Talk to your doctor or nurse if you are having this problem. They may be able to give you some advice.
Having your prostate removed will affect your ability to make someone pregnant. The prostate and seminal vesicle produce semen, which is normally mixed with sperm from the testicles. Removing the prostate means you will not be able to ejaculate any more.
It is important to talk to your cancer doctor or specialist nurse about fertility before treatment. It may be possible to store sperm before your surgery.
Bladder problems are a less common side effect of a prostatectomy.
Urine leaking from the bladder (urinary incontinence)
It is usual to have some incontinence when the catheter is first removed. This usually improves within a few weeks or months after surgery. You will be encouraged to do pelvic floor exercises to strengthen the pelvic floor muscles. You can wear a pad to manage the incontinence.
Sometimes, you may have some incontinence when you cough, sneeze, or exercise. This is called stress incontinence. It is rare to be completely incontinent. If you are having problems, talk to your doctor or nurse. They can refer you to a continence team, who can give you advice about treatments. If these are not successful, you may be able to have an operation.
Scarring to the entrance of the bladder (the bladder neck) or the urethra
Scar tissue can narrow the bladder neck or the urethra and make passing urine difficult. This causes urine to build up in the bladder and overflow, causing you to leak urine. This can usually be treated with a small operation that opens up the bladder neck or the urethra. If you are having problems passing urine after your operation, tell your cancer doctor or specialist nurse.
We have more information about bladder problems.
- If the cancer has not spread outside the prostate, removing it may cure the cancer and you will not need any more treatment.
- If the cancer comes back, you will still be able to have further treatment.
- If you had urinary symptoms before surgery, these may improve after surgery.
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131) Available at www.nice.org.uk/guidance/ng131
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