(Radical) Prostatectomy

This is removal of the whole prostate gland together with the seminal vesicles in the treatment of early prostate cancer. The procedure is performed through a number of small skin incisions using a ‘key-hole’ or laparoscopic approach or with a robot assisted laparoscopic approach.

Radical prostatectomy is one of the longest running treatments for prostate cancer. It has evolved over the years from open surgery, into laparoscopic (LRP) and robotic assisted laparoscopic (RALP).

In terms of cancer control it has been shown by some to have the best outcomes from all the available treatment options.

The latest research shows that patients best suited for a radical prostatectomy are those with intermediate or high-risk cancer confined to the prostate or those with a high volume of prostate cancer. It is no longer recommended for patients with low risk disease to undergo radical prostatectomy as there may be no overall survival benefit.

The operation normally requires a general anaesthetic and a short 2-3 day inpatient stay. Special stockings will be provided along with an injection to help thin the blood and reduce the risk of deep vein thrombosis (DVT) either during or after the operation. A catheter will also be inserted which is normally removed after 1 – 2 weeks.

The operation is performed using a keyhole technique and may utilise the da Vinci Robot to aid the surgeon. Through small incisions a special 3D camera and arms are placed into the pelvis, which are then controlled by the surgeon. This set-up offers a very high definition view of the prostate and surrounding structures, along with highly accurate movements within the body allowing the prostate, seminal vesicles (tubes which help produce semen) and occasionally lymph nodes to be removed.

The laparoscopic method has revolutionized radical prostatectomy as it has led to a significant reduction in blood loss and reduced the length of hospital stay for the patient over open surgery.

As it is the only procedure where the entire prostate along with the cancerous area is removed, the PSA will normally drop to an undetectable level. Unfortunately, as with all cancer, recurrence is possible and initially your PSA will be monitored on a 3 monthly basis. 

Cancer control outcomes are dependent on the risk of disease being treated. On average 98% of men are still alive 10 years after their surgery, with 75% of men having no evidence of biochemical recurrence (rising PSA).

Side-effects are the main limiting factor of radical prostatectomy. Initial incontinence is present in the majority of men but this normally improves over the first 1-4 months and by 12 months more than 95% of men are completely dry. Pelvic floor exercises can be performed to speed up the recovery of full continence and a pad may need to be worn until continence is achieved.

As the tubes which carry semen are cut, all men will be unable to ejaculate. Semen can be collected and stored prior to the operation if you are planning on having children in the future (sperm banking).

Erections are also effected in 30 – 60% of men. This is dependent on age as well as whether erections were present before the operation.

The nerves to the penis surrounding the prostate on both sides may be damaged. It is possible to spare one or both of these when performing the operation and these patients have the best chance of regaining their erections. However occasionally, to ensure that all the cancer is removed, both nerves have to be removed with a wide margin taken around the prostate.

If erectile dysfunction does occur after surgery than it can be treated with either tablets (PDE5 inhibitors), injections or by using a vacuum penile pump.