For some men with prostate cancer, their doctor may recommend surgery to remove the prostate. This is called a radical prostatectomy. It depends on the stage and risk of your cancer, as well as your overall health and preferences.
What Happens During Radical Prostatectomy?
During a radical prostatectomy, the surgeon removes the prostate gland and the seminal vesicles. The seminal vesicles are small glands behind the prostate that help make semen.
Your surgeon may also remove nearby lymph nodes. This is more likely if you have a higher risk that the cancer has spread to the lymph nodes. Your risk is based on factors such as your PSA level, Gleason score, Grade Group, and how far the cancer has spread. Before surgery, ask your urologist if lymph node removal is recommended for you and why.
A radical prostatectomy usually takes about 3 to 4 hours.
Robotic-Assisted vs Open Surgery
Radical prostatectomy can be done using different methods. Today, robotic-assisted surgery is commonly used, but open surgery is still a good option for some men. Robotic surgery uses small incisions, and open surgery is done with a single large incision. You can learn more about each below. Your surgeon can explain which they advise for you and why.
What is Robotic-Assisted Radical Prostatectomy?
During robotic-assisted surgery, the surgeon makes 4 to 5 small incisions in the abdomen. The incisions are about 8 to 12 millimeters each. Small tools that are part of a specialized robotic system are put through these incisions. The surgeon controls the tools at all times. The robotic system does not perform the surgery on its own.
Compared with open surgery, robotic-assisted surgery results in:
- Less blood loss
- A faster recovery for some people
What is Open Radical Prostatectomy?
With open surgery, the surgeon makes one larger incision in the lower abdomen. The incision extends from the pubic bone toward the belly button. Open surgery was the standard approach for many years. It’s still a good option for some men.
What to Expect After Surgery
After the surgery, you will have a Foley catheter. This is a thin tube put into the penis to drain urine from your bladder. The catheter usually stays in place for about 5-7 days, but may stay up to 10 to 14 days based on your surgeon’s preference.Some men also have a small drain in the abdomen for a few days. The drain helps remove fluid from the surgical site while you heal.
Your care team will encourage you to get out of bed and walk soon after surgery. If you are able, you may start walking on the evening of your surgery. Moving around after surgery is important. It helps lower your risk of blood clots in your legs and pneumonia.
Most men stay in the hospital overnight and go home the next day. Depending on the method of surgery and how you’re recovering, you may go home the same day or need to stay more than one night.
Follow-Up After Surgery
You will usually see a member of your urologist’s team for Foley catheter removal (5-7 days after surgery) and then see your urologist about 10 to 14 days after surgery. At this visit, your doctor will:
- Check your incisions.
- See how you are doing after surgery.
- Talk with you about your pathology report.
The pathology report gives detailed information about the prostate cancer that was removed during surgery. It can show how much cancer was present, how fast-growing (aggressive) it was, and if the cancer had spread beyond the prostate or into nearby lymph nodes. This information helps your doctor determine if you need more treatment or monitoring.
Treatment
Side Effects:
Surgery
What Are the Risks of Radical Prostatectomy?
As with any surgery, radical prostatectomy has risks. Short-term problems can include:
- Bleeding
- Infection
- Injury to nearby organs or structures, such as the rectum
Serious complications are not common. They happen in fewer than 5% of surgeries.
There are also two important long-term risks:
- Urinary incontinence. This means leaking urine or having trouble controlling your bladder.
- Erectile dysfunction. This is trouble getting or keeping an erection.
Your risk of these problems depends on:
- Your bladder function before surgery
- Your sexual function before surgery
- The location and extent of your prostate cancer
- How much tissue was removed
- If the nerves involved in erections can be spared during surgery
- Your overall health
These side effects are common concerns after prostate surgery, but not every man will have them, and recovery can take time. Talk with your urologist before surgery about your own risk and what you can expect during recovery.
Making Your Decision
Before deciding whether to have a radical prostatectomy, talk with your urologist about the possible benefits, risks, and alternatives. Ask about your personal risk of side effects, and what recovery is likely to be like. Understanding what to expect can help you make a treatment decision that is right for you.