Removal of part or all of the prostate is a major operation. Here we cover how the surgery is performed and what the potential side-effects are.

What is a radical prostatectomy?

One prostate cancer treatment option is a radical prostatectomy. A radical prostatectomy is a major operation which involves the removal of all of the prostate gland and tissues surrounding it. This usually includes the seminal vesicles and some nearby lymph nodes. This operation is different to a TURP (transurethral resection of the prostate), a different type of prostate cancer surgery, which only removes some of the prostate.

Radical prostatectomy can be done by a variety of routes. The cut can be abdominal (retropubic) or perineal (between the testicles and the back passage) or by keyhole surgery (laparoscopic or by robotic surgery). Most are done with robotic assistance.

Your PSA should fall to a very low level after the operation. As long as it does not rise, it is generally considered that you are free of the cancer. In three or four out of ten men having a radical prostatectomy, the cancer will already have spread to surrounding tissue, making the operation less effective. In about three in ten men, the PSA will rise at some time after a radical prostatectomy. You may need to have additional treatment with radiotherapy or hormone therapy.

Radical prostatectomy

Which men should choose to have a radical prostatectomy?

The surgeon (who can perform a radical prostatectomy) and the clinical oncologist (who can offer you radical radiotherapy) will help you decide between active surveillance, radical prostatectomy and radical radiotherapy. Radical prostatectomy is generally only recommended for men with a life expectancy of at least 10 years. Your decision may be influenced by the side-effects of each option and how they might affect your quality of life.

Potential side-effects

  • About one out of ten men will suffer mild urinary incontinence. This means you may leak urine when you cough.
  • About three out of 100 men will suffer major problems with urinary incontinence. This means you will have continuous leakage of urine.
  • Almost all men will have some difficulty getting erections (impotence), although about half will recover to some extent.
  • All men will be infertile and have a dry orgasm.
  • About one out of 20 men will have problems passing urine due to scarring at the new join made by the surgeon between the urethra and the bladder.

There are treatments available for impotence and incontinence, which your doctor can discuss with you. If you think your life expectancy is limited, the side effects of surgery on your quality of life may not be worth any possible gain. Even if your life expectancy is not limited, you may be more concerned about your quality of life.

This is a decision only you can make.

Consenting to treatment

The consent form is a formal agreement between you, the surgeon and the hospital. It says that you are willing to have the treatment shown on the form. It is important that you read the consent form carefully before signing.

The surgeon who is operating on you, or one of his doctors, should bring the consent form to you to sign. You might also be asked to agree to provide spare prostate tissue for research or take part in a clinical trial. This will be your decision. It is important that you are aware of the side effects of treatment before you sign a consent form.

What does the operation involve and are there any risks?

Radical prostatectomy is a major operation with potential risks and complications. On average you will have to wait about one month for your operation. Bring any medication you are taking with you and show this to the nursing staff or doctor.

At the hospital

You will be asked to go to the hospital before the operation for routine checks, including:

  • your blood pressure, pulse and temperature;
  • a urine test;
  • an ECG (tracing your heartbeats electrically);
  • blood tests;
  • a chest X-ray.

Usually, you will be admitted early on the day of your operation. Make sure that you do not eat or drink anything after midnight. On the day you go to hospital for your operation, you may have your blood pressure, pulse and temperature checked again. Most men are in hospital for between three and seven days.

Before the operation

The anaesthetist who will be looking after you during the operation will visit you and ask you questions about:

  • Previous operations and anaesthetics – this is to make sure you have had no problems with anaesthetics in the past.
  • Medicines – it is important that the anaesthetist knows about the medication you are taking.
  • Dental problems – the anaesthetist will have to put a tube in your mouth to help you breathe during the operation. It is important to know about caps and crowns. You will need to leave any false teeth on the ward.
  • Chest problems and smoking – if you smoke, you are more likely to suffer complications from anaesthetics. You should give up smoking at least a week before you go into hospital. Smoking is now forbidden in hospital.
  • Allergies – you must tell the anaesthetist about any allergies that you have.

If you are overweight you may be asked to lose weight before the operation.

The surgeon will also take precautions to prevent you developing a blood clot. You may be asked to wear elastic stockings and be given injections of blood-thinning drugs.

After the operation

After the operation you will be taken to the recovery ward. Here a nurse will check your pulse and blood pressure regularly. You will usually be brought back to your ward within one hour.

You will have to wait before you have a drink because the anaesthetic may make you feel sick. You will receive food and drink gradually. However, within 24 hours you should be able to eat and drink normally. If you feel sick or have some pain, tell the nurse, who can give you something to help. Being free of pain will help you recover more quickly, so it is important to tell the nurse if you need painkillers.

You will have a bag of fluid above your bed called a drip (intravenous fluids) which runs through a needle into your arm. This will probably be removed within a few hours. You will have a catheter (plastic tube) passing through your penis into your bladder to drain urine. You may also have one or more plastic tubes in your belly that are attached to drainage bags by your bed – these can be either to drain urine from your bladder or any fluid from the site of the operation. The drain tube is usually removed on the day after surgery.

What happens in the days after the operation?

You may experience some pain in the first few days. But it is important to walk around after the operation to help prevent clots forming in your legs. If you need painkillers ask for them.

Your catheter will stay in for about one to two weeks, so you will take it home attached to your leg. (Do not worry though, it is easy to hide this.) It is important to keep the catheter clean to help prevent infection. A daily bath or shower will help, but if you notice any discharge or pain around the tip of your penis, tell your nurse or doctor. You should try to drink two to three litres of fluid each day. After the operation there may be blood in your urine.

Occasionally a blood clot forms and blocks the catheter, preventing the urine from coming out. This can be painful and you should tell a nurse or doctor so they can remove it for you.

What happens when I go home?

Although you should take it easy for a month, It is important to take some gentle exercise like walking, as you will still be at risk of developing clots in your legs. Paracetamol should be enough to deal with any pain. You will be given a drainage bag for your catheter which you can strap to your leg. You will be shown how to do pelvic floor exercises to improve
continence. One to two weeks after you go home you will have to return to the hospital to have the catheter removed. This is not usually painful although it can be a bit uncomfortable.
If you had clips rather than dissolvable stitches, you will have these removed by the nurse at your GP’s surgery. This is not usually painful. You can return to work after a month although you will probably still feel more tired than usual.

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