Surgery for prostate cancer

• The aim of surgery is to remove the cancer. The operation is called a radical prostatectomy.
• The surgery 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.
• The surgeon who removes your prostate gland is called a urologist.
• A urinary tube (catheter) will stay in place for 1 to 2 weeks after your surgery.
• Problems with urinary incontinence and erections are common side-effects of surgery for prostate cancer. These problems often improve with time.
• A nerve-sparing prostatectomy may be possible to preserve one or both nerves next to your prostate that are responsible for erections.

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

Surgery may be more risky if you have health problems such as heart disease or if you are very overweight. In this case, your surgeon will advise you to have one of the other treatments for early prostate cancer.

Surgery to remove your prostate gland is a big operation. It can have risks such as bleeding, blood clots and infection. The risks are very low with robotic surgery.

Surgery to remove your prostate gland can be done in a number of ways. Not all of the types of surgery are available in all hospitals in Ireland, so discuss your options with your surgeon.

Robot-assisted laparoscopic prostatectomy (robotic surgery)

The urologist uses a computer and robotic arms to help to remove your prostate through small cuts in your tummy area (abdomen).

You will be in hospital for a much shorter time with robotic surgery than with open surgery. There is also a lower risk of needing a blood transfusion or getting a wound infection.

 The long-term side-effects of this type of operation are the same as for open surgery. Specially trained surgeons are needed to do this type of surgery.

Open prostatectomy

Open surgery means removing your prostate through a cut in the wall of your tummy (abdomen) between your belly button and pubic bone.

Nerve-sparing surgery

Sometimes having to remove all the cancer cells means that the 2 bundles of nerves attached to the prostate cannot be preserved. These nerves control erections. If the nerves are not preserved or are damaged during the operation, it will cause problems with getting or keeping an erection.

If the cancer has spread too close to the nerves, your surgeon may need to remove one or both bundles of nerves. 

In some cases, it is possible to spare nerves on one side of your prostate. This is called a nerve-sparing prostatectomy. It gives you a better chance of regaining erections than if you had both of the nerves removed, but not as good as if you had both bundles of nerves spared. 

Ask your surgeon if nerve-sparing surgery is possible for you. Very often surgeons can’t tell if they can do a nerve-sparing operation until the operation has started.

• The average stay in hospital is 1-2 days if you have robotic surgery and 3-4 days for open surgery. 
• You will need some time to recover at home afterwards as well. Recovery time at home can vary from 4 to 12 weeks depending on the type of surgery you have had.

The main side-effects of surgery are:

• Leakage of urine (urinary incontinence)
• Problems with erections (erectile dysfunction)

Once the prostate gland is removed, it will be examined under a microscope in the laboratory. The doctor will check the grade of the cancer cells again. They will also check that the edges
of the prostate are clear of cancer – this is known as ‘checking the margins’.

• Negative margins: No cancer cells
• Positive margins: Cancer cells found at the edge of the tissue
  removed

These tests are used to predict your response to the treatment
along with PSA checks. Your PSA level should drop within weeks of surgery.