WHAT IS A RADICAL PROSTATECTOMY?

Surgery to remove the prostate gland and some of the surrounding tissue is called a radical prostatectomy. The aim of surgery is to remove all of the cancer.

Different approaches to radical prostatectomy

The way the urologist gains access to the area to be operated on is referred to as the surgical approach. There are three types of surgical approaches the urologist may take to remove your prostate – Open radical prostatectomy, Laparoscopic radical prostatectomy and Robotic-assisted radical prostatectomy.

  • Open radical prostatectomy is an operation whereby an incision, approximately 10cm in length, is made in the lower abdomen (from below the belly button to the top of the pubic hair line or across the top of the pubic hair line).

OPEN RADICAL PROSTATECTOMY

open-radical-prostatectomy
  • Laparoscopic radical prostatectomy involves the urologist inserting a small camera and instruments (surgical tools) through several small incisions in your abdomen to look inside your body and perform the operation. Your abdomen is filled with carbon dioxide so the prostate and surrounding area can be clearly seen.

LAPAROSCOPIC RADICAL PROSTATECTOMY

laparoscopic-radical-prostatectomy
  • Robotic-assisted radical prostatectomy is laparoscopic surgery performed with the assistance of equipment that helps with dexterity and 3-D vision. The surgeon performs the operation by controlling the surgical tools remotely with the aid of the computer. Small incisions in your abdomen are required. Robotic surgery isn’t available in all hospitals in Australia and currently can be financially costly.

Recovery time may be quicker with laparoscopic or robotic prostate surgery, compared to open surgery, but all three forms of radical prostatectomy have similar rates of side effects. The choice of surgery is largely dependent on the particular technique your urologist has expertise in. At this time, there is no high level evidence that one technique is better than the other.

WHAT HAPPENS DURING YOUR SURGERY?

You will require a general anaesthetic, which means you will be fully asleep during the surgery. The surgery can take 2-4 hours depending on the approach.

In some cases, the urologist may remove a small amount of tissue near your prostate that contains lymph nodes. This will provide information on whether the cancer has spread. One of the first places prostate cancer may spread to is the lymph nodes. Your urologist will discuss this with you before surgery.

BEFORE SURGERY

before-surgery

AFTER SURGERY

after-surgery

The prostate gland is then removed along with the seminal vesicles (glands that produce some of the fluid in semen) and vas deferens (a duct which carries semen). The urethra is then reconnected to the bladder.

The prostate gland, surrounding tissues and lymph nodes (if removed) will then be sent to a pathologist who will examine them and provide information on the stage and grade of the cancer. Your urologist will inform you about the results of this.

TIMEFRAMES
Timeframes on pathology results can vary. Discuss with your healthcare team about when you can expect these results.
NERVE-SPARING SURGERY

There are nerve bundles that run either side of the prostate that affect your ability to have an erection. Depending on the extent of your cancer, these nerves will either be left intact or removed. Sometimes the urologist is able to leave the nerves on one side of the prostate only.

‘They did tell me that I’d possibly have a problem with erections after the operation, depending on whether they were able to spare the nerves or not.’

MORE INFORMATION
For more information on erections following surgery, please see the section on ‘Possible sexual function related side effects’.

URINARY CATHETER AFTER SURGERY

The urethra is the thin tube that travels from the bladder through the penis, and carries urine and semen out of the body. The urethra runs through the middle of the prostate gland so it needs to be cut above and below the prostate. The urethra is then reattached to the bladder later in the operation – this reattachment is called an anastamosis.

To help this area to heal, a urinary catheter is used. A urinary catheter is a thin tube which runs from your bladder through your penis and drains urine into a bag on the outside of your body. The catheter is held in place by a balloon inflated inside your bladder. Generally a catheter is left in place for 1 to 2 weeks following your surgery. This may vary depending on your individual situation.

CATHETER IN PLACE

catheter-in-place

For more information on the care of urinary catheters, please see the section on ‘managing your urinary catheter at home’.

ADVANTAGES AND DISADVANTAGES OF SURGERY

The advantages and disadvantages of all types of surgery can depend on the stage of your cancer, your age, and your overall general health.

Advantages
  • The aim is to remove all the cancer.
  • Surgery provides detailed knowledge about the pathology of the cancer, for example, whether it has spread or if it has been contained within the prostate gland.
  • Surgery is psychologically beneficial to some men, who take comfort knowing that the cancer has been removed.
  • Treatment is completed in a shorter time period compared to other treatment options such as radiotherapy.
  • It results in an immediate, rapid fall in prostate-specific antigen (PSA).
  • It is associated with less chance of bowel problems compared to radiotherapy.
Disadvantages
  • There is a risk of temporary or long term erectile dysfunction (impotence).
  • After surgery there will be no ejaculation at orgasm (dry orgasm).
  • Surgery will result in infertility.
  • Surgery is associated with a risk of temporary or long term urinary incontinence.
  • Penile shortening may occur after surgery.
  • There is a small risk of bowel injury.
  • Some men may need further treatment.
Possible complications

Even though your hospital stay may be short, you should be aware that this operation is still considered major surgery. As with all major operations, there is a risk of side effects or complications. Your urologist and anaesthetist will discuss possible complications with you before your surgery.

The advantages and disadvantages of all types of surgery can depend on the stage of your cancer, your age, and your overall general health.