Surgery for prostate cancer

Surgery is the most common treatment for cancer that hasn’t spread outside the oesophagus. You’ll have tests before surgery to make sure you are well enough. 

Read more about getting ready for surgery.

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 has risks such as bleeding, blood clots and infection.

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

Robot-assisted laparoscopic prostatectomy (robotic surgery)

The urologist uses a computer and robotic arms to help to remove your prostate. Specially trained surgeons are needed to do these types of surgery.

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 sideeffects of this type of operation are the same as for open 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 or not. Very often surgeons can’t tell if they can do a nerve-sparing operation or not until the operation has started.

• The average stay in hospital is 1-2 days if you have keyhole or 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. 

Read more about recovering after surgery.

Problems with leaking urine (urinary incontinence) and erections (erectile dysfunction) are common side-effects of surgery for prostate cancer. These problems often improve with time. 

Urinary incontinence

Urinary incontinence means you cannot control the flow of your urine. Almost everyone will have trouble with leakage of urine in the first weeks and often months after surgery. The risk of urinary leakage is the same for keyhole and robotic surgery. 

Talk to your surgeon or nurse about the risk of urinary incontinence before you consent to surgery.

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 may not need to wear pads. 

A small number of people do not regain complete control over their urine flow and need to continue wearing pads or other urine control devices. If this happens to you your urologist will discuss some further treatment options.

Erectile dysfunction (impotence)

Surgery to your prostate gland often leads to problems having an erection. This is called erectile dysfunction (ED) or impotence. It is caused by damage to blood vessels or nerves near your prostate. Even a small amount of damage can lead to erections failing, especially if you are older and have high blood pressure or diabetes.

At first you might find it difficult to get an erection, and it may not be strong enough for sex. 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. If you have problems with erections, talk to your surgeon when you go for check-ups, or talk to your GP or nurse. 

Nerve-sparing surgery can improve your chance of getting your erections back after surgery.If you had problems with erectile dysfunction before surgery, you are more likely to have  these problems after surgery too. 

7 or 8 people in every 10 who have a radical prostatectomy will have erectile dysfunction afterwards.

Dry orgasm

After prostate surgery, an orgasm will not cause an ejaculation of semen. This is known as a ‘dry orgasm’. Many people describe the sensation of orgasm as different after their surgery. A few describe it as lasting longer, others describe some pain after orgasm in the early days, or some simply describe it as different. A dry orgasm means that you cannot have a child naturally. Tell your surgeon if you think you might wish to have children after your surgery, as it may be possible to store your sperm before treatment starts. 
 

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.