Types of surgery
There are several ways of removing the prostate gland.
Open surgery
There are two types of open surgery.
- A retropubic prostatectomy is done through a long cut in the
abdomen above the pubic bone area. This is the most common type of
open prostatectomy.
- A perineal prostatectomy is done through a cut in the area
between the testicles and back passage (the perineum). It is less
common and not widely available in the UK.
Keyhole (laparoscopic) surgery
The surgeon makes five or six small cuts in your tummy, which they
insert a camera and instruments into.
There are two ways of doing this operation:
These are similar, but with robot-assisted surgery the surgeon
uses robotic arms to move the surgical instruments. Robot-assisted
surgery is fairly new and only available in some hospitals in the
UK.
All of these methods appear to be equally good at treating
prostate cancer.
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What are the advantages
and disadvantages?
The advantages and disadvantages of all types of surgery depend
on your age, health and the stage of your cancer. Your surgeon
should discuss this with you.
Advantages
- If the cancer is completely contained within the prostate,
surgery will remove all of it.
- The prostate is sent for testing which will give a clearer
picture about how aggressive the cancer may be and how far it may
have spread.
- It is easy to measure how successful the surgery was, as your
PSA should drop to less than 0.1 ng/ml a few weeks after the
operation.
- If your PSA starts to rise, you may be able to have further
treatment with radiotherapy or hormone therapy.
Disadvantages
- There are risks in having a radical prostatectomy, as with any
major operation.
- You will need to stay in hospital and it will take some time to
recover afterwards.
- If the cancer has broken out of the prostate gland, the surgeon
may not be able to remove all of it.
- There is a risk of side effects such as erection and urinary
problems.
- You will not be able to father children after surgery as the
prostate gland, which produces some of the fluid in semen, is
removed.
What might be an advantage for one person may not be for someone
else.
Some of the success of surgery and risk of side effects will
depend on your surgeon's experience and skill. Your surgeon should
be able to tell you how many operations they have done and the
outcomes of these.
As well as these advantages and disadvantages, there are some
specific advantages and disadvantages to the different types of
surgery.
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What does treatments
involve?
Before the operation
A few days or weeks before your operation you will have several
tests to make sure you are fit enough for the surgery. If you are
overweight, you may need to lose weight before your operation.
Doing pelvic floor
muscle exercises for a few weeks before the operation may help
you recover more quickly from problems leaking urine caused by
surgery.
The operation
The operation will take two to four hours. You will have a general
anaesthetic so you will be asleep and won't feel anything.
If possible, your surgeon will try to save the nerves around the
prostate which control erections. This is called nerve-sparing
surgery. However, if the cancer has spread too close to the nerves,
the surgeon may need to remove them. This may mean you will have
problems getting an erection.
After the operation
When you wake up you will have a tube in your arm or hand, to give
you fluid. You will also have a tube in your abdomen to drain away
any fluid from the wound. These will be removed before you go
home.
You will have a catheter (a tube to drain urine out of the
body). Most men go home with the catheter and it is removed one to
three weeks after the operation. You nurse will show you how to
look after it.
You will be able to go home one to seven days after the
operation. Men who have had keyhole surgery may be able to go home
sooner than men who have had open surgery.
You will see your doctor around six weeks after your operation.
You will have regular appointments every three to six months to
monitor your PSA level and any side effects. If your PSA rises,
this may be a sign that there is still cancer present, and you will
be offered further treatment with radiotherapy or hormone
therapy.
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What are the side
effects?
The most common side effects of surgery are difficulty getting
and keeping an erection (erectile dysfunction) and leaking urine
(urinary incontinence).
The risk of getting side effects depends on your overall health,
the stage and grade of your cancer and your surgeon's skill and
experience.
The side effects from all types of prostate surgery are
similar.
Some men have problems passing urine after surgery because of
scar tissue around the neck of the bladder. Let your doctor or
nurse know if you have any problems. If you have a sudden and
painful inability to pass urine (acute urinary retention), you
should get treatment straight away. Contact your doctor or nurse or
go to the hospital accident and emergency (A&E) department.
Watch Paul's story for one man's experience of managing urinary
problems after surgery:
Some men find that their penis gets shorter following surgery.
Using a vacuum pump, or taking a PDE5 inhibitor such as sildenafil
(Viagra®), may also help to prevent shortening and improve
erections.
The prostate gland produces some of the fluid in semen. As this
is removed, you will not be able to ejaculate any semen. This means
you will be infertile. If you wish, you may be able to store your
sperm before the operation for use in IVF (in vitro
fertilisation).
Watch Kevin's story for one man's experience managing side
effects of surgery:
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When to call your
doctor or nurse
You should contact your doctor or nurse as soon as possible if
you experience any of the following symptoms.
- Urine stops draining out of the catheter and your bladder feels
full.
- Your urine contains blood clots or turns red.
- You have strong smelling, dark or cloudy urine, or it burns
when you pass urine. This could be a sign of an infection.
- Your catheter falls out.
- Your wound edges become red, swollen or painful. This can be a
sign of infection.
- You get pain or swelling in your legs.
- You have a temperature of more than 38ºC or 101ºF. This could
be a sign of an infection.
- You feel sick (nauseous) or vomit.
- You get cramps in your stomach that will not go away.
Your doctor or nurse may ask you to come into the hospital or
they may advise you to visit the accident & emergency (A&E)
department at your local hospital.
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Questions to ask your
doctor or nurse
You may find it helpful to keep a note of any questions you have
to take to your next appointment.
- What type of surgery do you recommend for me and why?
- How many of these operations have you done and how many do you
do a year?
- Will you try to do nerve-sparing surgery if possible?
- How long should I expect to be in hospital?
- What pain relief will I get after the operation?
- If I have problems with the catheter or wound, who should I
contact?
- How soon will we know whether the operation has been
successful?
- How often will my PSA level be checked?
- What is the risk of side effects, such as urinary or erection
problems?
- What treatment will I have to help me get erections and when
will I start it?
- What is the chance of needing further treatment for cancer
after surgery?
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