Surgical removal of the whole prostate is called radical prostatectomy. For some patients it is a very appropriate attempt for a cure. It involves four to five days in hospital and another four to six weeks recuperating at home and has a relatively short treatment and recovery period.
The disadvantages are that the risk of impotence (inability to get an erection) and incontinence (inability to fully control leakage of urine) . There is a risk of infection, as with any surgery.
Radical prostatectomy side-effects have considerably improved over the last ten years. Long-term severe incontinence is down to very low figures (about 2%). Sexual side-effects after surgery are also far less common in certain groups of patients. Nerve-sparing techniques in experienced hands can now give far more rapid return
The skill, experience and result record of the surgical and theatre team who would be treating you are paramount to the outcome. Intending patients should enquire carefully into these matters before making a selection. Some specialists offer "nerve sparing" and "nerve grafting" procedures during surgery to minimise the risk of impotence
Early post-operative use of Viagra-like medications and/or penile injections appears to speed up the recovery of natural erections. Erections do, however, take quite a long time to recover and generally take 12 to 18 months to return, but may even take up to three years. Erection recovery after open or minimally invasive surgery depends more on the skill of the nerve sparing technique rather than the type of surgery. With both open and minimally invasion surgery nerve sparing techniques require considerable skill and experience. The other sexual side-effects that occur with surgery are the loss of ejaculation fluid and infertility, some penile shortening and a small risk of ejaculating urine at the time or orgasm. Most men state that their quality of orgasm is maintained.
After treatment, you will have further PSA tests, which should drop to 0.1 or zero within a few months if the surgery has been successful. Failure to achieve this may result in your doctor recommending further treatment. Your removed prostate will have been sent to a pathologist for examination. You should ask your doctor for details of what the pathologist’s report discloses, as this may have a bearing on your prospects of being "cured" or whether further treatment may be necessary.
Detailed information about radical prostatectomy, which has the best track-record of curing organ-confined disease, can be found in the book "Localised Prostate Cancer - a guide for men and their families".
New treatments for localised prostate cancer include different approaches for a radical prostatectomy
Nerve-sparing surgery aims to protect the erection nerves, minimising the side-effects of surgery. The technique of nerve-sparing surgery is becoming more common and potency rates, now as high as 80% or 90%, can be achieved in young patients who are potent with very early stage cancer.
Laparoscopic radical prostatectomy and Robot assisted laparoscopic radical prostatectomy
This is keyhole surgery involving the insertion of telescopes through small incisions in the body. Robotic means with the assistance of a machine in conducting the surgery.