Decorative image

Surgery to remove your prostate gland

You might have surgery to remove your prostate (radical prostatectomy). Find out about who can have a radical prostatectomy and how it's done. 

You might have surgery to remove the prostate if:

  • your cancer hasn't spread outside the prostate gland
  • you are younger and have a fast growing tumour (high grade tumour)
  • as part of treatment for locally advanced or high risk localised prostate cancer

The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with many possible side effects. If you're an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that you're more likely to die of old age or other causes than from prostate cancer.

The operation

Your surgeon removes the prostate gland, surrounding tissues and the tubes that carry semen (seminal vesicles). This is a radical prostatectomy. They might also remove nearby lymph nodes. This depends on how likely it is that you have cancer cells in your lymph nodes.  

Diagram showing surgery to remove the prostate gland.jpg

Nerve sparing prostatectomy

Nerve sparing surgery is for early prostate cancer that is inside the prostate (localised prostate cancer). This surgery aims to avoid the nerves that control erections.

Your surgeon cuts the prostate tissue away 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 your cancer won't be cured if the surgeon leaves cancer behind whilst trying to spare the nerves. Speak to your surgeon before the operation if you might have this type of surgery.   

Removing lymph nodes

During your operation your surgeon examines the prostate and surrounding area. They may take out some of the lymph nodes from the area between the hip bones (pelvis). This is a bilateral pelvic lymph node dissection.

Your surgeon takes out lymph nodes in case they contain cancer cells. Taking the nodes out reduces the risk of your cancer coming back in the future. It also helps your doctor to decide what further treatment you may need.

The number of lymph nodes your surgeon removes varies depending on the risk of the cancer coming back.

Diagram showing lymph nodes around the prostate.jpg

How your surgeon does your operation

Open surgery

There are two types of open surgery:

  • retropubic surgery, which means the surgeon makes a cut into your tummy (abdomen). After retropubic surgery you will have one scar on your tummy
  • perineal surgery, which means the surgeon makes a cut into the area between the testicles and the back passage. This is less common

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).

You have this type of surgery in specialist centres by a specially trained surgeon. The surgeon makes a few small cuts in your tummy. They use a long tube called a laparoscope.

Some people will have robotic assisted laparoscopic prostatectomy (RALP). It is also called da Vinci surgery.  A specially trained surgeon uses a special machine (robot) to do the operation. This type of surgery is not available in every hospital in the UK.

UK guidelines for keyhole surgery

The National Institute for Health and Care Excellence (NICE) has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:

  • tell people having the surgery about the risks and benefits
  • monitor people closely
  • collect information about any problems people have and report on them

Researchers are looking into whether keyhole surgery is as good as open surgery.

Last reviewed: 
18 Jun 2019
  • Prostate cancer: Treatment
    British Medical Journal (BMJ) Best Practice Online, 2018. 

  • Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    C Parker and others,
    Annals of Oncology, 2015. Volume 26, Pages 569-577

  • EAU Guidelines on prostate cancer. 2015
    N. Mottet and others

  • Radical prostatectomy for localised prostate cancer
    Up to date, June 2016.

  • Prostate cancer: diagnosis and management
    NICE guidelines, 2019

Information and help

Dangoor sponsorship

About Cancer generously supported by Dangoor Education since 2010.