Sometimes men with locally advanced prostate cancer may be offered surgery, with or without adjuvant radiotherapy (i.e. radiotherapy given after surgery). The prostate will be removed in a procedure called a radical prostatectomy. This involves the removal of the entire prostate gland as well as some of the tissues surrounding it. Surgery is generally offered to healthy men whose cancer has not spread to other parts of the body.

Some locally advanced prostate cancers are more aggressive than others, and the exact treatment will depend on a number of factors that your doctor will take into account. If the cancer has spread just beyond the prostate, surgery is a possibility, if you are suitable for surgery. For cancer that has spread further, radiotherapy and hormone treatment is a standard treatment. 

A radical prostatectomy can be done in different ways

  • Open radical prostatectomy – A cut is made below the navel to the pubic bone, to get to the prostate gland. 
  • Laparoscopic radical prostatectomy – This is also known as ‘keyhole surgery’. A number of small cuts are made to allow insertion of a camera and instruments. The actual procedure is the same as open surgery, but done through smaller incisions, so you recover faster. 
  • Robotic-assisted radical prostatectomySimilar to laparoscopic surgery, but performed with instruments that have a greater range of movement than standard laparoscopic ones. This may not be offered at your local public hospital.

[Note: Laparoscopic and robotic forms of surgery have similar recovery periods and side effects, so the choice of surgery is largely dependent on what your surgeon feels most comfortable with. At this time, there is no high level evidence that one technique is better than the other.] 

Radical prostatectomy

Radical prostatectomy (the dotted line shows organs that are removed)

Surgery can cause side effects such as erectile problems, being unable to produce semen, incontinence, and change in penis size. Surgery will also cause infertility so if you wish to have children in the future, you will need to discuss alternatives such as having some of your sperm stored before treatment starts (this is called sperm banking). 

You can read more about side effects in one of the booklets in this series: Side Effects.

Further questions to ask 

As well as the questions in Section 3, the following questions could be useful for you to ask your healthcare team about the form of radical prostatectomy that is recommended to you: 

  • Why are you recommending this particular option instead of radiotherapy? 
  • What are the advantages and disadvantages of this form of surgery for my situation?