Surgery to remove prostate cancer
Surgery is one of the main treatments for prostate cancer. You usually have surgery to remove your prostate gland. This is a radical prostatectomy.
A radical prostatectomy is a major operation with some possible side effects. You may not need this type of surgery if you have a slow growing prostate cancer. This is because:
- your doctors can safely monitor your cancer with active surveillance until you need treatment
- if you're an older man, your cancer might grow so slowly that you're more likely to die of old age or other causes than from prostate cancer
When you might have a radical prostatectomy
Your doctor might suggest surgery as a treatment option if you're well enough and your cancer:
-
hasn't spread outside the prostate gland
-
has broken through the prostate and spread to the area just outside the prostate gland
The aim of a radical prostatectomy operation is to cure prostate cancer.
How your surgeon does the operation
There are different ways of having a radical prostatectomy:
- robotic assisted laparoscopic surgery - this is a type of keyhole surgery
- open surgery
- keyhole surgery or laparoscopic surgery (without a robot)
Most people in the UK have robotic assisted laparoscopic surgery.
Robotic surgery
Robotic surgery is a type of 
. This is also called robotic assisted laparoscopic radical prostatectomy.
A surgeon does the surgery but uses a special machine (robot) to help. The robot is sometimes called da Vinci. It is available at most cancer hospitals in the UK.
Robotic surgery involves 2 machines. The patient unit and the surgeon console.
The patient unit
You lie on the operating table and the patient unit is beside you. The unit has 4 arms. One arm holds the camera and the others hold the surgical instruments.
The surgeon makes 5 or 6 small cuts in your abdomen. The camera and instruments are put in through the cuts to do the surgery. The patient unit is controlled by the control unit.
The surgeon console
The surgeon console is where the surgeon sits. It is in the operating theatre with you but is separate from the patient unit.
The surgeon can see the operating area with a pair of 3D goggles. They can make the image bigger (magnify) up to 12 times.
Below the screen are the controls. The surgeon uses these controls to move the instruments in the patient unit.
This turns the surgeon's movements into much smaller movements of the machine. It also reduces any shaking. This allows the surgeon to make very tiny, accurate movements. Cutting and putting in stitches is more accurate with the robot.
Open surgery
Your surgeon does the operation through a large cut (incision) in your tummy (abdomen). This is a retropubic prostatectomy. You will have one long scar on your tummy afterwards.
You might have open surgery if you have any medical conditions which mean you cannot have robotic surgery.
Keyhole surgery
Keyhole surgery is also called minimal access surgery or laparoscopic surgery. It means having an operation without needing a major cut in your tummy (abdomen).
The surgeon makes a few small cuts in your abdomen. They put surgical instruments and a through these cuts. They carry out the operation by hand. Your surgeon can see the images on a TV screen.
The operation
You have the operation under general anaesthetic. This means that you will be asleep and won’t feel anything. Your surgeon removes the:
- prostate gland and sometimes some of the surrounding tissues
- glands that produce semen - these are the seminal vesicles
They may also remove nearby in case they contain cancer cells.
Removing lymph nodes
During the operation, your surgeon may take out some of the lymph nodes around the organs in your . This is called a bilateral pelvic lymph node dissection.
Your surgeon may take out lymph nodes if they suspect that they contain cancer cells. Taking the nodes out may reduce the risk of your cancer coming back in the future. And it might also help your doctor recommend what further treatment you need.
Removing lymph nodes may increase the length and risk of the operation. Speak to your surgeon before the operation about this. They will talk to you about the risks and benefits of removing lymph nodes.
Nerve sparing prostatectomy
Nerve sparing surgery aims to save (preserve) the nerves that control erections. These nerves pass close to the prostate. Your surgeon tries to save as much nerve tissue as possible. This increases your chances of recovering erections after surgery.
Your surgeon will try to remove the prostate tissue from the nerve bundles without damaging them. If your cancer is growing close to the nerves, they'll have to remove them. This is because the surgery won't cure your cancer if the surgeon leaves cancer behind. Speak to your surgeon before the operation about this.
After surgery
After your operation, you will wake up in the recovery room. Once it’s safe to do so, you usually go back to the ward.
Most people go home 1 day after robotic prostate cancer surgery.
Problems after prostate cancer surgery
There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.
Problems after prostate cancer surgery include leaking urine and difficulty getting an .
Coping and support for you and your family
Coping with the side effects of prostate cancer surgery can be difficult. There are things you can do, and people who can help you and your family to cope.
