You might have surgery to remove your prostate gland (radical prostatectomy) 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 some 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.
You have the operation under general anaesthetic. This means you'll be asleep for the whole 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.
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.
How your surgeon does your operation
There are different ways of having a radical prostatectomy.
Your surgeon usually makes a cut into your tummy (abdomen). This is called retropubic surgery and you will have one scar on your tummy afterwards.
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 surgeons use a robotic system to help with keyhole surgery. 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, but it is becoming more common.
The surgeon sits slightly away from you and can see the operation on a magnified screen. The robotic machine is next to you. The machine has 4 arms. One arm holds the camera, and the others hold the surgical instruments. The surgeon controls the arms of the machine to remove the cancer.
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.