Funding research and education to beat prostate disease
Surgery
A radical prostatectomy involves removing the whole of the prostate gland and the seminal vesicles. Radical prostatectomy is generally recommended for men with prostate cancer that has not spread outside the prostate. As it is a fairly major operation, it is most suitable for otherwise healthy men, who are below 70 years of age.
There are three main surgical techniques used to perform a radical prostatectomy
Open surgery
Open surgery is carried out under a general anaesthetic and usually takes one to three hours. The hospital stay is generally four to ten days. The procedure involves making an incision into the abdomen and removing the prostate and seminal vesicles. Sometimes nearby lymph glands are also removed. The urethra is joined to the bladder and a catheter is inserted to drain urine. The catheter will usually be in place for two weeks.
Keyhole surgery
A radical prostatectomy can be performed using keyhole (laparoscopic) surgery. This technique involves the surgeon making four to six small incisions in your abdomen to pass tiny instruments through, including a video camera. The surgeon views the operation on a video screen and can perform the radical prostatectomy with limited blood loss and a shorter recovery time for the patient.
Robotic keyhole surgery
The latest development in keyhole (laparoscopic) surgery uses the da Vinci™ robot to assist. The da Vinci™ robot allows the surgeon to complete the operation remotely, using a console. The surgeon’s hand movements are replicated by the robot, but with a precision beyond the capabilities of the human hand. The ability to magnify images of the operation 10-times allows reduced blood loss and greater preservation of the tiny nerve bundles that are important for achieving an erection.
Side-effects of surgery
All the surgical techniques described have side-effects. These include:
Erection problems
Regardless of the surgical technique, potency cannot be guaranteed. Impotence can usually be treated and your surgeon will discuss this with you before your operation.
Temporary urinary incontinence
For most men after a radical prostatectomy, urinary incontinence is mild – a small leakage of urine occurring on coughing, for example. You may have to wear a small pad for security. A small number of men have severe incontinence, which will require further treatment. Very few have a permanent incontinence problem.
Internal scarring
If your urine flow deteriorates after surgery, you may be required to undergo dilation of the joint between the bladder and urethra.
After a radical prostatectomy
The usual period of convalescence following a radical prostatectomy is six to eight weeks, although you may still feel tired after this time. Your doctor will let you know what you can and cannot do after your operation but you may find the following guidelines useful.
Returning to work
- This should be possible after six to eight weeks.
- A longer period will be necessary if your job involves heavy lifting.
- Your doctor will give you a sick note.
Driving
- Do not drive for two to four weeks after the operation.
- Your doctor will give you a sick note.
Sexual activity
- Do not attempt to have sex for six to eight weeks. After this time, you can get back to normal.
- Orgasm can usually be reached but there will be no ejaculation.
- Your erection will be weak initially.
Drinking
- Try to drink more (non-alcoholic drinks) than you would do normally. This will help protect against infection.
- You can drink alcohol, but for your general health, this should be in moderation.
Exercise
- Rest as much as possible for the first two weeks.
- Avoid any heavy work, such as lifting, digging or carrying for several months.
- Sports and exercise can be resumed after one month. Start off gently and be guided by what you feel. Swimming is a good exercise to begin with.
PSA level after surgery
After the operation, your PSA level will be checked every 3 months for at least a year. It should drop to about 0.2 ng/mL (nanograms a millilitre) soon after the operation and then gradually reduce further, ideally to below 0.1 ng/mL.
If your PSA starts to rise because the cancer has not been completely removed, you will usually need further treatment.
When further treatment is needed
In some men who undergo radical prostatectomy, the cancer will be found to have spread to the margin of the prostate once the pathology report is available. This finding is particularly likely in men whose PSA level is above 10 ng/mL. As a consequence, the operation will sometimes not be 100% successful in these men as the cancer has not been wholly removed from the body. If this is the case for you, your doctor may recommend a 'mop-up' course of radiotherapy or some long-term drug therapy with anti-androgens.
