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A quick guide to what's on this page

Removing the prostate gland (radical prostatectomy)

A radical prostatectomy means an operation to remove the whole prostate gland. It is a common operation for prostate cancer. The operation used to be called total prostatectomy. A specialist surgeon removes the prostate through a cut made in your abdomen or between the testicles and the back passage. The aim of this type of surgery is to cure the cancer. Your surgeon may suggest radical prostatectomy if

  • Your cancer has not spread outside your prostate
  • You are younger, rather than older, and have a high grade tumour

Keyhole surgery (laparoscopic prostatectomy) 

Often, a radical prostatectomy is done using keyhole (laparoscopic) surgery. The doctor uses a long tube with a light at the tip to look inside the body. A tiny video camera gives a magnified view of the prostate gland on a video screen. The surgeon cuts away the prostate gland from surrounding tissues and removes it through a small cut in the abdomen. The main difference with this surgery is that you won't have a big wound in your abdomen afterwards.

Robot assisted surgery

Robot assisted surgery is similar to laparoscopic surgery. You have several small cuts in the abdomen. The surgeon controls the instruments and camera using a machine (robot). It is sometimes called da Vinci surgery.

 

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Removing the prostate gland

Removing the prostate gland is called a radical prostatectomy. It is a common operation for treating prostate cancer. It used to be called total prostatectomy. This means using surgery to remove the whole prostate gland. The surgeon does this through a cut in your abdomen or the area between the testicles and the back passage (perineum). The aim of this type of surgery is to cure the cancer. Your surgeon may suggest radical prostatectomy if

  • Your cancer has not spread outside your prostate
  • You are younger, rather than older, and have a high grade tumour
 

Who has removal of the prostate?

Removal of the prostate gland is done more often in younger men because they are more likely to

  • Be fit enough for such major surgery
  • Have a faster growing tumour that needs radical treatment
  • Die from their cancer rather than other health conditions if it is not successfully treated

Radical prostatectomy is major surgery with many possible side effects. If you are an older man with a slowly growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer may grow so slowly that you are more likely to die of old age or other causes than from the prostate cancer. In many cases, it isn't worth putting you through the side effects if the treatment will not lengthen your life span.

There is detailed information about choices of treatment for prostate cancer in this section. There is also general information about the side effects of surgery.

 

How surgeons remove the prostate gland

Removing the prostate gland is carried out by specialist surgeons. They take out the whole prostate gland with the aim of getting rid of all the cancer. The surgeon makes a cut in the abdomen (retropubic) or between the testicles and the back passage (perineal). This operation is called open prostatectomy. As well as the prostate gland, the surgeon also removes the surrounding tissues, the lymph nodes, and the tubes that carry semen (seminal vesicles). The surgeon then closes the wound.

Diagram showing before and after a radical prostatectomy

 

Keyhole surgery (laparoscopic prostatectomy)

Often, the prostate can be removed using keyhole (laparoscopic) surgery. The surgeon uses a tube with a light and eyepiece to look inside the body. They fill the abdomen with carbon dioxide gas so they can see the prostate clearly. A tiny video camera gives a magnified view of the prostate gland on a video screen. The surgeon cuts away the prostate gland from the surrounding tissues and puts it in a small bag before removing it through one of the cuts in the abdomen. The main difference with this surgery is that you won't have a big wound in your abdomen afterwards. Instead you have several small cuts.

Most studies have shown that laparoscopic surgery is as good at treating prostate cancer as open surgery. Men also lose less blood, have less pain, and spend less time in hospital. Most men also recover and go back to normal activities more quickly than with open radical prostatectomy surgery. Two of the most common side effects of prostatectomy are problems with control over when to pass urine (urinary incontinence) and inability to have an erection (impotence). There doesn’t seem to be any difference in the number of men who have these side effects after open prostatectomy or after laparoscopic prostatectomy.

There can be risks with laparoscopic surgery though and these include heavy bleeding for some men and damage to healthy tissue close to the prostate. These complications are uncommon when the operation is carried out by a surgeon with specialist training and experience in laparoscopic techniques.

The National Institute for Health and Care Excellence (NICE) has issued guidance on radical laparoscopic prostatectomy. They say that this procedure is safe and works well enough to use on the NHS. As with all operations, the surgeon should explain the risks and benefits to you fully beforehand. And only surgeons who have had special training and experience in this type of surgery should offer it. Your surgeon may need to refer you to another hospital to have it.

 

Robotic assisted prostatectomy

Robotic assisted prostatectomy is a new type of keyhole (laparoscopic) surgery for prostate cancer. It is also called da Vinci surgery. A surgeon uses a special machine (robot) during the operation. Doctors need to have special training before they can carry out this type of surgery. It is available in some hospitals in the UK. We don't yet know whether this type of surgery is better than other types of surgery for prostate cancer or whether it is cost effective. You can read more about it on our page about robotic surgery for prostate cancer.

 

Checking for clear margins

After your operation, your surgeon will send the tissue they removed to the laboratory. The aim of the surgery is to get all the cancer out with a safety margin of cancer free tissue around it. This is called a clear margin. It helps to make sure that all the cancer is gone and that it is unlikely to come back. 

In the laboratory a pathologist looks very closely at the edges of the tissue to make sure there are no cancer cells there. If you don't have clear margins, there is a risk that some cancer cells have been left behind. You might then need to have radiotherapy or hormone therapy to try to get rid of any cancer cells that are still there. Your doctor will look at your prostate specific antigen (PSA) level to help decide whether or not you need more treatment.

 

Nerve sparing surgery

Surgeons have developed a technique to try to prevent erection difficulties after the operation. This is called a nerve sparing prostatectomy. Two bundles of nerves run alongside the prostate. These nerves help control erections. During nerve sparing prostatectomy, the surgeon cuts prostate tissue carefully away from the nerve bundles without damaging them. If the surgeon can remove the prostate without harming the nerves it is much more likely that you will still be able to have erections afterwards. But with nerve sparing surgery there is a higher risk of some cancer cells being left behind.

Nerve sparing surgery is only suitable for men with very early prostate cancers. The cancer must be completely inside the prostate (as it is for all total prostatectomy operations). And it must be as far away from the bundles of nerves as possible. If your cancer is growing too close to, or into the nerve bundles, then they have to be removed. If the surgeon leaves them behind, the cancer will not be cured by the operation.

If your biopsies show that the cancer is only on one side of your prostate gland, you may be able to have the nerve bundle on the other side left untouched. This may still cause some difficulty with erections but drugs like sildenafil (Viagra) can sometimes help.

If you are interested in nerve sparing surgery, you can ask your surgeon if it is likely to be suitable for you.

 

After surgery to remove the prostate

After surgery to remove the prostate gland, you will have 

A drip

You will probably have a drip (intravenous infusion) giving fluid into a vein to maintain your body fluids. It will be taken out as soon as you are drinking normally again. It is important to drink plenty of fluids.

A drain

You will probably have a tube (drain) coming out of a small hole in the tummy (abdomen) to take away fluids from the operation area. Your nurse will take out the drain when it is no longer draining much fluid. This is usually 2 to 3 days after surgery.

A catheter

You will also have a tube (catheter) into your bladder to drain your urine into a collecting bag. 

Diagram showing a urinary catheter in a man who has had his prostate removed

After this surgery, it is quite normal to have blood clots forming in your urine. The blood in your urine will slowly clear and then the catheter can be taken out. This is normally about 1 or 2 weeks after your surgery. You must tell your nurse as soon as you pass urine after your catheter has been removed. 

Rarely, men cannot pass urine when their catheter first comes out. This may be because there is still swelling around the neck of the bladder and the prostate after your surgery. If you can't pass urine, you will probably need to have the catheter put back and you can try without it again in a day or so. Sometimes you need the catheter to stay in place for a while after you go home. Before you leave hospital your nurse will show you how to look after it.

Your wound

You will have a wound and perhaps a small drain to collect any fluid that is produced. Your nurse will take the drain out when it is no longer producing fluid.

Painkillers

You will almost certainly have some pain for the first few days after your operation. But you will have painkillers to control this. For the first couple of days, you may have a pump with a button you can press to give yourself painkillers whenever you need them. You may need to plan your pain relief by giving yourself a boost before you are going to get up or before your physiotherapist comes to see you. 

Pain is likely to be less with keyhole (laparoscopic) surgery. If you are in pain it is important that you tell the nurse or doctor as soon as possible. With your help, they can find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

A few days in hospital

You can usually go home about 3 to 7 days after an open prostatectomy and 1 or 2 days after keyhole surgery. If you think you might have problems at home, let your nurse or social worker know when you are admitted so that they can arrange help. They can also arrange for a district nurse to visit you.

There is general information about the side effects of surgery in the section about cancers in general.

 

Long term side effects

Removal of the  prostate can cause 

It is important to remember that doctors can't know for certain which men will have problems with getting an erection or incontinence after surgery. You must be very clear about these risks before your operation. Ask your doctor to discuss the operation with you in detail. You can also ask about the chance of having other types of treatment.

Erection problems

Erection problems (impotence) occur in up to 7 out of 10 men (70%). Impotence means you can't have an erection. This is more likely to happen if you are older. Your doctor will explain this to you and offer you the chance to store sperm before the operation if you wish to have children in the future. 

If erection problems occur, early treatment with medicines can help to reduce this. There is information about the medicines and other ways of controlling erection problems on our page about sex and cancer for men. Your doctor or specialist nurse can also refer you to a sexual dysfunction clinic for specialist help.

Leakage of urine 

The operation can also cause problems controlling the flow of urine (incontinence) because of swelling or damage to the muscle that holds urine in your bladder. With modern surgery techniques these problems are less common than they used to be. About 2 out of every 10 men (20%) will have minor problems with urinary incontinence. About 1 in 20 men (5%) will have more severe problems with urinary incontinence after this type of surgery. For many men the incontinence is temporary and does not last longer than 6 months.

If urine leakage becomes a long term problem your doctor can refer you to a specialist incontinence clinic. Staff there can help you with muscle exercises, bladder training and medicines.

 

More information about removing the prostate gland

You can look at the page about having surgery for prostate cancer for information about what happens before and after prostate surgery. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. They will be happy to answer any questions. 

Our prostate cancer organisations page gives details of other people who can give information about surgery for prostate cancer. Some organisations can put you in touch with a cancer support group.

Our prostate cancer reading list has information about books and leaflets about prostate cancer treatments.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 21 February 2014