After you are diagnosed with prostate cancer, your urologist may advise treatment with either surgery or radiotherapy. Prostate cancer surgery is called radical prostatectomy.
A radical prostatectomy takes about 3 to 4 hours from the time the patient goes to sleep until they wake up after the operation. During a radical prostatectomy, the urologist takes out the prostate gland and the seminal vesicles. The seminal vesicles are small structures behind the prostate gland.
The urologist also may remove lymph nodes near the prostate gland. This is done for patients who have a higher risk of cancer spreading to these lymph nodes. A patient’s level of risk is based on their PSA level, Gleason score, and how much their cancer has spread. Before you agree to surgery, your urologist should talk with you about whether or not your lymph nodes need to be removed.
After surgery, a Foley catheter (a tube placed in the penis to drain urine from the bladder) will be inserted for 10-14 days. Some men will have a small plastic drain in their abdomen for a couple of days that helps collect fluid after the operation.
Most men who have a radical prostatectomy will stay in the hospital overnight and go home the first day after the operation. Some urologists may send patients home the same day of their surgery and some men may need to stay in the hospital longer.
Patients must get out of bed and walk after prostate surgery. If possible, it’s best to start walking the same night as the operation. Moving is important to avoid blood clots in the legs and lung infections (pneumonia).
The most common problems after a radical prostatectomy include bleeding, infection, and damage to nearby structures, such as the rectum. However, these complications happen in less than 5% of operations. A radical prostatectomy also can cause long-term risks such as urinary incontinence (urine leaking) and erectile dysfunction (impotence).
The chances of long-term risks depend on how well a patient functioned before their surgery and the details of their cancer. How much surgery they need will also make a difference. However, these are common risks. Each patient should discuss their situation with their urologist to better understand how these risks may affect their life.
After surgery, men will typically follow up with their urologist 10-14 days later. At that time the Foley catheter is removed and the incisions are checked. The pathology results will be discussed with the patient. This is a report that shows much cancer there is and how aggressive it is.
In 2022, most patients will have a robotic-assisted radical prostatectomy. Open surgery was the standard for many years and also remains an appropriate choice. With open surgery, the urologist makes an incision (cut) from the pubic bone to just below the belly button.
During a robotic-assisted radical prostatectomy, the urologist controls small robotic instruments to remove the prostate gland through 4 to 5 small (about 8-12 mm) incisions. It is important to note that the robot does not perform the surgery. The surgeon controls the robot, which acts as a tool to remove the prostate gland. Benefits of robotic surgery include less blood loss during the operation and faster recovery after surgery.
It's important to talk with your urologist before your surgery about the benefits and risks of radical prostatectomy. That way you can make the decisions that are best for you.