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 a radical prostatectomy as a treatment option if you're well enough and:

• your cancer hasn't spread outside the prostate gland

• your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland

The aim of a radical prostatectomy operation is to cure prostate cancer by removing the whole prostate gland.

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 keyhole surgery . 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 laparoscope 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 lymph nodes 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 pelvis . 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.   

Problems after surgery

There is a risk of problems or complications after any operation. Some complications can be life threatening. Treating them as soon as possible is important.

Infection

You have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of an infection. They include:

• feeling generally unwell

• shivering

• feeling hot and cold

• feeling sick

• swelling or redness around your wound

• a temperature of above 37.5C or below 36C

Some infections, including chest infections, can be serious. You can lower your risk of developing a chest infection by:

• stopping smoking before your operation

• getting up and moving as soon as possible after your operation

• doing breathing exercises your physiotherapist teaches you

Difficulty getting an erection

Radical prostatectomy can damage the nerves you need to get an erection. So you might have problems having an erection after surgery. This is called impotence or erectile dysfunction. 

Nerve sparing surgery may reduce the risk for some men. Nerve sparing surgery means that your surgeon removes the cancer without cutting or damaging the nerves. But not everyone is suitable for this type of surgery. If your cancer is growing close to the nerves, they will have to remove them. Speak to your doctor before you have surgery to get an idea of your risk of problems afterwards.

Some men will get back their ability to have erections. But this can take time, and some men will need help to get an erection for the rest of their lives. There are medicines that can help with erection problems after surgery. You might need a drug like sildenafil or Viagra to help you get an erection. Your doctor or specialist nurse can also refer you to a clinic for people who have sexual problems after treatment.

Leakage of urine

You might have problems controlling your bladder after a radical prostatectomy. This is incontinence. Ask your surgeon how likely it is that you might have this problem and how long it may take to recover. Leaking urine usually improves with time. But a few men may never get back full control.

There are things that can help you manage this. Your doctor can refer you to a special clinic if leakage becomes a problem. They will teach you muscle exercises to control your bladder. Medicines or further surgery can also help to relieve this symptom.

Feeling tired and weak

Most people feel weak and lack strength for some time afterwards. How long this lasts varies between people.

Tell your doctor or nurse if the weakness continues for more than a few weeks. They can suggest things to help, such as physiotherapy.

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.