Surgery for prostate cancer

For many people, surgery will be a suggested treatment option. It is worth discussing with your urologist or treating doctor whether there are other options, such as radiation therapy, available to you.

What is a radical prostatectomy?

The main surgery for localised and locally advanced prostate cancer is a radical prostatectomy. It removes all the prostate, part of the urethra and the seminal vesicles. The urethra is rejoined to the bladder, and the vas deferens (that carry sperm from the testicles to the penis) will be sealed.

Some people have a nerve-sparing radical prostatectomy, to avoid damaging the nerves that control erections. This is only for lower-grade cancers where the cancer isn’t close to these nerves, and it works best for those who had strong erections before diagnosis. Problems with erections are common even with nerve-sparing surgery.

Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed (pelvic lymph node dissection).

Radical prostatectomy to remove the prostate

How the surgery is done

There are different surgery methods to remove the prostate:

• open radical prostatectomy – usually done through one long cut in the lower abdomen (belly)
• laparoscopic radical prostatectomy (keyhole surgery) – small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen as a guide
• robotic-assisted radical prostatectomy – laparoscopic surgery performed with help from a robotic system. The surgeon uses a 3D picture and control panel to move robotic arms holding instruments.

Making decisions about surgery

Talk to your surgeon about whether surgery or another treatment such as radiation therapy is the best option for you. Also ask what surgical methods are available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery.

The surgeon’s experience and skill are more important than the type of surgery offered. Compared with open surgery, both standard laparoscopic and robotic-assisted surgery usually mean a shorter stay in hospital, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects. Take the time you need to make the right decision for you.

What to expect after surgery

Recovery time – No matter which surgical method is used, a radical prostatectomy is major surgery and you will need time to recover. You can expect to return to your usual activities within about 6 weeks of the surgery. Usually you can start driving again in a couple of weeks, but heavy lifting should be avoided for 6 weeks.

Managing pain and discomfort – It’s common to have pain after the surgery, so you may need pain relief for a few days.

Having a catheter – A thin, flexible tube (catheter) drains urine from your bladder into a bag. The catheter will be removed after 1–2 weeks once the wound has healed. Some people find this uncomfortable.

Side effects of prostate cancer surgery

You may experience some or all of the following side effects:

Nerve damage

The nerves needed for erections and the muscle that controls the flow of urine (sphincter) are both close to the prostate. It may be very difficult to avoid these during surgery, and any damage can cause problems with erections and bladder control. Sometimes the nerves will need to be removed to try to ensure all cancer is removed.

Loss of bladder control

You can expect to have some light dribbling or trouble controlling your bladder for some weeks to months after a radical prostatectomy. This is known as urinary incontinence or urinary leakage. You can use continence pads to manage urinary leakage. Bladder control usually improves in a few weeks and will continue to get better for up to a year after the surgery. In the long term, you might continue to have some light dribbling. Some people may consider having an operation to fix urinary incontinence. In rare cases, people have no control over their bladder. Learn about managing urinary problems.

Changes in erections

Problems getting and keeping erections after prostate surgery are common. This is often called erectile dysfunction (ED) or impotence. Erections may improve over months to a few years. It’s more likely you won’t get strong erections again if erections were already difficult before the operation. Learn ways to manage problems with erections.

Changes in ejaculation

During a radical prostatectomy, the tubes from the testicles (vas deferens) are sealed and the prostate and seminal vesicles are removed. This means semen is no longer ejaculated during orgasm (a dry orgasm). Your orgasm may feel different – in some cases it may be uncomfortable or, rarely, painful. A small amount of urine may leak during orgasm (which isn’t harmful to your partner).

Infertility

A radical prostatectomy will cause infertility and you will not be able to conceive a child without medical assistance. If you wish to have children, talk to your doctor before treatment about freezing sperm for future use (sperm banking) and other options.

Change in penis size

You may notice that your penis gradually becomes a little shorter after surgery. Talk to your doctor about whether vacuum erection devices and prescription medicines may help. A change to the size of your penis can be difficult to deal with. Find out ways to get support.