Surgery to remove prostate cancer

Surgery is one of the main treatments for prostate cancer. You usually have surgery to remove your prostate gland. This is a radical prostatectomy.

A radical prostatectomy is a major operation with some possible side effects. You may not need this type of surgery if you're an older man with a slow growing prostate cancer. This is because your cancer might grow so slowly that you're more likely to die of old age or other causes than from prostate cancer.

When you might have a radical prostatectomy

Your doctor might recommend a radical prostatectomy if:

• your cancer hasn't spread outside the prostate gland. This is localised prostate cancer
• your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland. This is locally advanced prostate cancer
• you are well enough to have this operation

The aim of a radical prostatectomy operation is to cure prostate cancer.

How your surgeon does the operation

There are different ways of having a radical prostatectomy:

• keyhole or laparoscopic surgery
• robotic surgery which is a type of keyhole surgery
• open surgery

Most people in the UK have a keyhole or robotic surgery.

Keyhole surgery

Keyhole surgery is also called minimal access surgery or laparoscopic surgery. It means having an operation without needing a major cut in your tummy (abdomen).

You have this type of surgery in specialist centres by a trained surgeon. The surgeon makes a few small cuts in your abdomen. They put surgical instruments and a laparoscope through these cuts to carry out the operation. A laparoscope is like a narrow telescope that lights and magnifies the inside of your body. Your surgeon can see the images on a TV screen.

Robotic surgery

Robotic surgery is a type of keyhole surgery. This is also called robotic assisted laparoscopic radical prostatectomy.

A surgeon does the surgery but uses a special machine (robot) to help. The robot is sometimes called da Vinci. It is not available at all cancer hospitals in the UK but is becoming more common.

Robotic surgery involves 2 machines. The patient unit and the control unit.

The patient unit

You lie on the operating table and the patient unit is beside you. The unit has 4 arms. One arm holds the camera and the others hold the surgical instruments.

The surgeon makes 5 or 6 small cuts in your abdomen. The camera and instruments are put in through the cuts to do the surgery. The patient unit is controlled by the control unit.

The control unit

The control unit is where the surgeon sits. It is in the operating theatre with you but is separate from the patient unit.

The surgeon can see the operating area on a screen. This gives the surgeon a 3D view that they can magnify up to 12 times.

Below the screen are the controls. The surgeon uses these controls to move the instruments in the patient unit.

This turns any movements the surgeon makes into much smaller movements of the machine. It also reduces any shaking, allowing the surgeon to make very tiny, accurate movements. Cutting and putting in stitches is easier with the robot. 

Open surgery

Your surgeon usually makes a cut into your abdomen. This is a retropubic prostatectomy. You will have one long scar on your tummy afterwards.

The operation

You usually have the operation under general anaesthetic or spinal anaesthetic. A general anaesthetic means that you will be asleep and won’t feel anything. A spinal anaesthetic makes you numb from the waist down. This means that you won’t feel the operation being done.

Your surgeon removes the:

• prostate gland and surrounding tissues
• tubes that carry semen. These are the seminal vesicles

They may also remove nearby lymph nodes in case they contain cancer cells.

Removing lymph nodes

During the operation, your surgeon examines the prostate and surrounding area. They may take out some of the lymph nodes from the area between the hip bones. This is a bilateral pelvic lymph node dissection.

Your surgeon takes out lymph nodes in case they contain cancer cells. Taking the nodes out reduces the risk of your cancer coming back in the future. It also helps your doctor recommend what further treatment you may need.

The number of lymph nodes your surgeon removes varies depending on the risk of the cancer coming back.

Nerve sparing prostatectomy

Nerve sparing surgery is for prostate cancer that hasn’t spread outside the prostate gland. This surgery aims to avoid the nerves that control erections.

Your surgeon cuts the prostate tissue away from the nerve bundles without damaging them. If your cancer is growing close to the nerves, they'll have to remove them. This is because your cancer won't be cured if the surgeon leaves cancer behind whilst trying to spare the nerves. Speak to your surgeon before the operation about this.   

Problems after surgery

There is a risk of problems or complications after any operation. Some complications can be life threatening. Treating them as soon as possible is important.

Infection

You have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of an infection. They include:

• feeling generally unwell
• shivering
• feeling hot and cold
• feeling sick
• swelling or redness around your wound
• a temperature of above 37.5C or below 36C

Some infections, including chest infections, can be serious. You can lower your risk of developing a chest infection by:

• stopping smoking before your operation
• getting up and moving as soon as possible after your operation
• doing breathing exercises your physiotherapist teaches you

Difficulty getting an erection

You might have problems having an erection after a radical prostatectomy. This is called impotence or erectile dysfunction. Or you might produce less or no semen. This is known as a dry orgasm.

Impotence is more likely to happen if you are older. Nerve sparing surgery and robotic surgery may reduce the risk for some men. Speak to your doctor before you have surgery to get an idea of your risk of problems afterwards. 

There are medicines that can help with erection problems after surgery. You might need a drug like sildenafil or Viagra to help you get an erection. Your doctor or specialist nurse can also refer you to a clinic for people who have sexual problems after treatment. You can store sperm before your operation if you would like to have children in future. 

Leakage of urine

You might have problems controlling your bladder after a radical prostatectomy. This is incontinence. Ask your surgeon how likely it is that you might have this problem and how long it may take to recover. A few men may never get back full control.

Your doctor can refer you to a special clinic if leakage becomes a problem. They will teach you muscle exercises to control your bladder. Medicines can also help to relieve this symptom.

Feeling tired and weak

Most people feel weak and lack strength for some time afterwards. How long this lasts varies between people.

Tell your doctor or nurse if the weakness continues for more than a few weeks. They can suggest things to help, such as physiotherapy.

Coping and support for you and your family

Coping with the side effects of prostate cancer surgery can be difficult. There are things you can do, and people who can help you and your family to cope.