Radical prostatectomy - Further information
The prostate gland is located in the lower abdomen and lies below the urinary bladder. It surrounds the urethra, which passes urine from the bladder to the penis.
Radical prostatectomy removes the whole prostate gland, along with the nearby lymph nodes. This procedure is usually recommended for males with a localised prostate cancer (one that has not spread to other organs). A radical prostatectomy can be performed in several ways.
- robot-assisted radical prostatectomy, where the prostate is removed via small, lower-abdominal incisions. The surgeon controls a robot surgical device (e.g. the "da Vinci Surgical System"), which performs the procedure with great precision.
- open radical prostatectomy, where the surgeon commonly removes the prostate via the lower abdomen (retropubic surgery). On rare occasions, this procedure is also accomplished via an incision between the scrotum and anus (perineal surgery).
- laparoscopic radical prostatectomy, where a tiny camera and special surgical tools are used for removal of the prostate.
Open simple prostatectomy is the technique commonly advised for males who have severe urinary symptoms and a much-enlarged prostate. Benign prostatic hyperplasia (BPH) is the term used for this enlarged prostate condition, which is usually addressed by a partial removal of prostate tissue to stop the organ obstructing the normal flow of urine.
Your doctor will talk through any proposed treatment with you to help decide the best options in your particular case.
Who offers a prostatectomy?
A prostatectomy is often provided by private health clinics, which are in some cases managed by universities, insurers, mutual societies or religious institutions. In addition, there are state-run hospitals, which also employ skilled surgeons who specialise in prostatectomy techniques.
What does a prostatectomy help with?
A prostatectomy is often recommended for non-cancerous (benign) urinary retention, and as a common treatment for prostate cancer, as well as other pelvic cancers.
When is a prostatectomy used?
A radical prostatectomy (complete removal) is commonly considered where diagnostic tests indicate that the cancer has not spread beyond the prostate gland to other organs.
Radical prostatectomy is also occasionally employed to relieve urinary obstruction in males with more advanced cancers. However, a different surgical technique, known as a transurethral resection of the prostate (TURP), is the most common method employed for that purpose.
What are the risks of a prostatectomy?
Erection difficulties can be a serious side effect of radical prostatectomy. The nerves that control a male’s ability to achieve an erection lie beside the prostate. As a result, they are susceptible to damage during a surgical intervention. With some surgery, it is possible to preserve these nerves and thus maintain erectile function.
Though it can take time to return, around half of all patients find they recover some of their ability to achieve an erection. In some cases, this occurs within three months, but most males will find it takes more like six to 12 months.
Functional recovery will be influenced by:
- the patient’s erectile function prior to surgery
- how the nerves controlling erectile function were affected by the surgery
- the age of the patient at the time of the procedure
Some medications, such as Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) may help to alleviate the impotence that can occur after treatment, and contribute to a restoration of sexual function.
It is estimated that as many as 50% of males may experience urinary incontinence following a radical prostatectomy.
The urethra, which is the tube used to pass urine from your bladder through to your penis, is routed through the centre of the walnut-shaped prostate gland. During prostate removal, the urethra is cut and then reconnected to the bladder. Such a delicate operation requires great skill, and the surgeon’s experience can be a factor in reducing the risk of incontinence problems.
If urinary incontinence persists for more than 12 months after a prostatectomy, it may require treatment.
Radical prostatectomy is a major surgical procedure, which thus carries similar risks to other major interventions. These include heart problems, blood clotting, allergic reaction to anaesthesia, serious blood loss, and wound infections.
In addition, a radical prostatectomy could cause complications such as:
- erectile function issues
- urinary incontinence
- urethra damage
- rectum damage
Are there alternatives to prostatectomy?
Any alternative treatments are likely to depend on medical opinion about the stage of your cancer and any chance that it may return. Some alternative options may include:
- active surveillance (watch and wait)
- radiation therapy
- hormone therapy
- cryotherapy (freezing)