Radical prostatectomy

What is radical prostatectomy?

Radical prostatectomy  is the removal of 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.

Who are candidates for radical prostatectomy?

Benign prostate enlargement (BPE)

Because transurethral resection of the prostate (TURP) has similar or better results, open prostatectomy is now only done in certain situations.

Open prostatectomy is recommended if your prostate is larger than 80 millilitres (ml) because other types of surgery would take more time to achieve the same result. Your doctor may also recommend open  prostatectomy if you have bladder stones or a condition called bladder diverticulum.

Localized prostate cancer

Radical prostatectomy is a surgical treatment option for localized prostate cancer. The aim is to remove the entire prostate and the seminal vesicles.

Locally advanced prostate cancer

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.

The procedure

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.

In locally-advanced prostate cancer, the surgeon will also remove any other tissue that is affected by the tumour.

Then, the bladder and the urethra are attached together (Fig. 1b). 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 localized tumour or a locally-advanced tumour with radical prostatectomy, open and laparoscopic surgery appear to be equally effective.

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.

Fig. 1a: During radical prostatectomy the surgeon removes the entire prostate and the seminal vesicles. ig. 1b: The position of the bladder after the surgery.
Fig. 1a: During radical prostatectomy the surgeon removes the entire prostate and the seminal vesicles. ig. 1b: The position of the bladder after the surgery.

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

Preparation

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.

Side effects

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.

Impact on life

What is the impact of the treatment?

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.

Locally-advanced prostate cancer

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.

Follow up

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 opion is best for you.

In need of support?

The European Prostate Cancer Coalition is a global collaboration of patient organisations dedicated to prostate cancer patients.