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Surgery

What is Radical Prostatectomy (Surgery) for Prostate Cancer?

Before and after radical prostatectomy

Before and after radical prostatectomy
(Click image to enlarge)
Cancer Research UKA radical prostatectomy is the surgical removal of the prostate, seminal vesicles and nearby tissue. Often the lymph nodes in the pelvis that drain from the prostate are also removed.

For radical prostatectomy you will need anesthesia and a short hospital stay. Your surgeon may use open surgery, perineal open surgery or robotic surgery.

As with all surgery, there is risk for bleeding, infection and pain in the short term. Erectile dysfunction and urinary incontinence may also be of concern. In general, smoking, older age and obesity increase risks for these problems.

There are four types of radical prostatectomy surgery:

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP)

Robotic Assisted Laparoscopic Radical Prostatectomy (RALP) is the most common type of prostate surgery today. The surgeon is assisted with a robotic system that holds and guides the laparoscopic surgical tools and camera. It also allows the prostate to be removed through tiny ports placed in your belly. In experienced hands, RALP and retropubic prostatectomy (see below) have similar outcomes. There is also less blood loss with robotic surgery than other methods.

The success of this surgery depends on how experienced your surgeon is. The more surgeries your doctor has done, the better he/she will be at this surgery.

Retropubic Open Radical Prostatectomy 

Retropubic radical prostatectomy
Retropubic radical prostatectomy

For this procedure, your surgeon will make a cut (incision) in your lower belly and remove the prostate through this opening. The entire prostate gland is removed. Your surgeon can assess the prostate gland and surrounding tissue at the same time, while reducing injury to nearby organs. There can be enough blood loss to need a transfusion.

Perineal Open Radical Prostatectomy

Perineal radical prostatectomy
Perineal radical prostatectomy

The prostate is removed through a cut between the anus and scrotum during a perineal open radical prostatectomy. Because the complex pelvic veins are avoided using this procedure, bleeding is rare. This type of surgery is not often performed today because of the newer techniques that are used.

Laparoscopic Radical Prostatectomy

Incisions (cuts) made for laparoscopic and robotic-assisted prostatectomy
Incisions (cuts) made for laparoscopic
and robotic-assisted prostatectomy

This surgery uses small cuts in the abdomen to remove the prostate with small tools and a camera. This surgery has mostly been replaced with robotic assisted laparoscopic surgery.

What to Expect After the Prostate is Removed

After the prostate has been removed, the urinary tract and the bladder are reconstructed. A catheter is passed through the urethra into the bladder to drain the urine while the new connections heal. One or two suction drains may be left in the pelvic cavity after surgery. They are brought through the lower belly to drain fluid from the wound. They help lower the risk of infection. The drains are removed before you are discharged from the hospital.

After surgery, your surgeon will review the final pathology report. Together you will make plans for next steps.

What Are The Benefits, Risks and Side Effects of Surgery?

The main benefit of a radical prostatectomy is the prostate with cancer is removed. This is true as long as the cancer hasn't spread outside the prostate. Surgery also helps the healthcare provider know if you need more treatment.

The goal of surgery is to get a PSA value of less than 0.1 ng/mL for 10 years. Surgery is often a good choice if prostate cancer has not spread beyond the prostate.

Surgery always comes with risks. Some complications from surgery can happen early and some later. Bleeding or infection can happen with any major operation, so you will be monitored to prevent or manage these problems.

Not everyone has the same side effects for the same amount of time. With surgery (and with radiation therapy), there are two main side effects to consider: erectile dysfunction (ED) and urinary incontinence (a loss of urine control). For some men, surgery can relieve pre-existing urinary obstruction. Most men have to find ways to manage these side effects over time.

Nerves surround the prostate gland

Nerves surround the prostate gland
(Click image to enlarge)
NIH Medical Arts, National Cancer Instutute (NCI)

Erectile Dysfunction and Sexual Desire

All men have some form of erectile dysfunction after prostate surgery. Erectile dysfunction is the inability of a man to have an erection long enough for satisfying sexual activity. Nerves involved in the erection process surround the prostate gland, and they can be affected by surgery. They can also be affected by radiation treatment. The causes of ED are due to damage to the nerve bundles that control blood flow to the penis. The length of time ED lasts after treatment depends on many things. Some functions may take up to one year to recover. In the meantime, your doctor may have ED treatment options for you. If it's possible, nerve-sparing surgery may help prevent long-term damage. Older men have a higher chance of permanent ED after this surgery. For more information on how prostate cancer surgery can affect your erections, read our After Treatment: Erectile Dysfunction Issues After Prostate Cancer Treatment section.

It may surprise you to know that men are still able to have an orgasm (climax), even after a radical prostatectomy. An erection is not needed to climax. There will be very little, if any, fluid with an orgasm. In addition, you can no longer cause a pregnancy after surgery. This is because the prostate, seminal vesicles, and connections to the testicle were removed and the vas deferens was divided during surgery.. Planning for fertility preservation in advance of surgery is an option for men who want to have children. Read our Fertility Preservation fact sheet to learn more on this.

It is important to know that sexual desire is not lost with this surgery or radiation treatment. The exception to this is if hormones are also given as part of treatment, (usually given temporarily with radiation therapy).

Incontinence

Incontinence is the inability to control your urine. After prostate cancer surgery, you may experience one or more type of Incontinence.

Stress Incontinence - is urine leakage when coughing, laughing, sneezing or exercising. It is the most common type of urine control problem after radical prostatectomy.

Overactive Bladder (Urge Incontinence) - is the sudden need to go to the bathroom even when the bladder is not full because the bladder is overly sensitive. This type of incontinence is the most common form after radiation treatment.

Mixed Incontinence - is a combination of stress and urge incontinence with symptoms from both types.

Continuous Incontinence - is the inability to control urine at any time. It is not very common.

Because incontinence may affect your physical and emotional recovery, it is important to understand your treatment options. For more information on how prostate cancer surgery can affect incontinence, read our After Treatment: Incontinence Issues After Prostate Cancer Treatment article.

 
 

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