Surgery for prostate cancer

Doctors and nurses in surgery

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The aim of surgery is to fully get rid of the cancer. Surgery to remove your prostate is called a radical prostatectomy. It involves removing your prostate gland and the seminal vesicles, which are glands near your prostate that produce some of the fluid in semen. Sometimes lymph nodes and nearby tissues may be removed as well. 

Who can have prostate surgery?

Surgery is suitable if the cancer is found only in your prostate gland and you are fit and healthy.

What are the types of prostate surgery?

  • Robot-assisted laparoscopic prostatectomy (robotic surgery): This operation is a type of keyhole surgery but with the use of a computer and robotic arms to help to remove your prostate.
  • Open prostatectomy: Open surgery means removing your prostate through a cut in the wall of your abdomen between your belly button and pubic bone or through a cut between your scrotum and back passage.
  • Laparoscopic prostatectomy: With keyhole surgery, small cuts are made in your abdomen so that special instruments can remove your prostate.

Specially trained surgeons are needed to do keyhole surgery, so it might not be available in every hospital.

Advantages of keyhole (laparoscopic) surgery

Lose less blood

Have less pain

Spend less time in hospital

Heal more quickly than open surgery

Long-term side-effects of this type of operation are the same as for open surgery. 

 

Nerve-sparing surgery

There are 2 bundles of nerves attached to the prostate which control erections.

Sometimes the surgeon has to remove one or both bundles of nerves, if the cancer is near them, but sometimes it’s possible to spare at least one bundle of nerves. If nerve function is damaged on both sides of the prostate gland then you won’t be able to have an erection afterwards.

Ask your surgeon if it might be possible to do nerve-sparing surgery, if this is important to you. Sometimes they won’t know until they start the operation.  

After prostate surgery

You will have a catheter - A tube to drain your urine into a bag. You’ll have this for 1-3 weeks after surgery. Read more about catheters and how to care for them.

You may have stiches or clips if you have open surgery. The stiches will dissolve on their own. The clips will need to be removed. If they’re not removed in the hospital, your practice nurse, public health nurse or GP might remove them when you go home. Contact your GP or the hospital as soon as possible if your wound becomes swollen, red or painful. This could be a sign of infection.

You will need to have your catheter removed 1-3 weeks after surgery in hospital or by your GP. It only takes a few seconds. 

You will probably leak urine for a time after the catheter is removed.  This is normal and usually improves with time. 

You’ll need incontinence pads to catch any leaks. Talk to your specialist nurse, public health nurse or a pharmacist about getting a supply before the urinary tube (catheter) is removed.

Read more about what happens after surgery.

Was the surgery successful? 

The prostate gland will be examined under a microscope in the laboratory. The doctor will check that the edges of the prostate are clear of cancer, called 'checking the margins'.

Negative margins: No cancer cells.
Positive margins: Cancer cells found at the edge of the prostate.

The grade of the cancer will be checked again too. These tests are used to predict your response to the treatment along with PSA checks. Your PSA level should drop within weeks of surgery.

Side-effects of prostate surgery

Almost all men will have trouble with leaking urine in the first weeks and often months after any of the types of surgeries mentioned.

You will probably need to wear an incontinence pad for a time to collect the leaked urine. As time goes on, you are likely to regain control of your urine flow and you won't need to wear pads any more. Or perhaps you will only need one pad a day or just when you exercise. A small number of men do not regain complete control over their urine flow and need to continue wearing pads. Tell your surgeon if this happens.

Read more about urinary symptoms and how to manage them 

Erectile dysfunction 

  • Finding it hard to get or keep an erection

Erectile dysfunction can happen because surgery can damage the nerves and blood vessels that control erections. 

If you had problems with erectile dysfunction before surgery, you’re more likely to have these problems after surgery too.

Up to 7 in 10 men have erectile dysfunction after a radical prostatectomy.

It can take at least a year after surgery to find out if the impotence will get better or not. You may need medication or other treatments to help you get an erection. Read more about erection problems and treatments for them.

If you’re having erection problems, talk to your surgeon when you go for check ups or tell your GP or nurse. 

Can early treatment help erection problems?

There is some evidence that taking tablets or using vacuum therapy for erectile dysfunction soon after surgery may improve your chance of having erections again, depending on what is causing the problem.  You may not be interested in sex at first. But taking the tablets or using a vacuum pump at an early stage may improve your chances of getting erections if and when you are ready to have sex again.

Infertility / ‘Dry’ orgasm

  • No semen when you ejaculate

Dry orgasm means you won’t be able to father a child, as there is no semen. Talk to your doctor before your treatment if you’re worried about this. It’s not safe to assume you are sterile, so you will need to use contraception to avoid pregnancy. Read more about fertility and cancer treatment.

Orgasm changes

  • Longer-lasting orgasms
  • Pain after orgasm in the early days
  • Orgasms that feel ‘different’ than before surgery

Shortening of your penis

Up to a year after surgery you may notice your penis has shortened. Some treatments for erectile dysfunction that encourage blood flow into your penis, such as tablets or a vacuum pump, may help to prevent it. 

Advantages and disadvantages of prostate surgery

Advantages

  • Surgery will completely remove the cancer if it is only in the prostate gland.
  • The prostate can be removed and be fully analysed and staged in the laboratory.
  • The success of the treatment can be easily assessed by PSA testing.
  • If the PSA were to rise after surgery you would still be able to get other treatments like radiotherapy or hormone treatment.

Disadvantages

It involves a general anaesthetic and the usual risks you would expect with surgery, like the risk of bleeding, infection and blood clots. 

  • You will have to stay in hospital for a few days.
  • You may get side-effects afterwards like problems with erections and urinary incontinence.
  • You will not be able to father children after the surgery, as the prostate, which normally makes some of the fluid needed for semen to be made, has been removed.
  • Recovery takes around 6 weeks.

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