Radical prostatectomy is an operation to remove the prostate and
the cancer contained inside it. The seminal vesicles are also
Surgery is an option for men with cancer that is contained
inside the prostate (localised prostate cancer)
and who are otherwise fit and healthy. It is just as good at
treating localised prostate cancer as external beam
radiotherapy or brachytherapy.
It may also be an option for some men with cancer that has
spread to the area just outside the prostate (locally advanced prostate
cancer). This will depend on how far the cancer has spread.
A radical prostatectomy is a major operation. You have to be fit
enough for surgery. It may not be suitable for you if you have
other health problems such as heart disease, you’re over 75 or
you’re overweight as you’re more likely to have problems during and
See all treatment choices
Types of surgery
There are several ways of removing the prostate.
Keyhole surgery (also called laparoscopy or minimally
- Keyhole surgery by hand – your surgeon makes five or six small
cuts in your abdomen (stomach area) and removes the prostate using
a thin, lighted tube with a small camera on the tip and special
- Robot-assisted surgery – your surgeon uses three robotic arms
(one for the camera and two for the surgical tools) to do the
operation. Your surgeon controls the robotic arms from a computer.
You may hear this called the ‘Da Vinci® Robot’.
Robot-assisted surgery is not available in all hospitals in the
UK. If your hospital doesn’t have it, they may be able to refer you
to one that does.
Your surgeon makes a single cut in your stomach area to
reach the prostate. This is called retropubic prostatectomy.
All of these types of surgery appear to be just as good as each
other at treating prostate cancer.
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What are the advantages
The advantages and disadvantages of all types of surgery depend
on your age, health and the stage of your cancer.
What may be an advantage for one person might not be for someone
- If the cancer is completely contained inside the prostate,
surgery will aim to remove all of it.
- The prostate is removed and sent for testing which will give a
clearer picture about how aggresive the cancer is
and how far it may have spread.
- It is easy to measure the success of your surgery was, as your
PSA should drop to less than
0.1 ng/ml at six to eight weeks after the operation.
- If your PSA starts to rise, you may be able to have radiotherapy or hormone therapy.
- There are risks in having a surgery, as with any major
- You will need to stay in hospital – this may be for one to
- If the cancer has broken out of the prostate, the surgeon may
not be able to remove all of it.
- You won’t be able to have children naturally after
Advantages and disadvantages of different types of
There isn’t much evidence at the moment to show that one
type of surgery is better than another.Some studies suggest you may
be less likely to have erection problems after keyhole surgery (by
hand or robot-assisted) than with open surgery. Some research also
suggests robot-assisted surgery may be better at removing all the
cancer cells than open surgery. This might mean your cancer may be
less likely to come back after robot-assisted surgery than with
open surgery. But we need more research into this.
There isn’t good evidence to show robot-assisted surgery is any
better than keyhole surgery by hand.The main advantages of keyhole
surgery (by hand or robot-assisted) are that you will lose less
blood, have less pain, spend less time in hospital and you will
heal more quickly. Robot-assisted surgery is only available in a
few hospitals in the UK. Doctors also need specialist equipment and
training to carry it out.
The main advantage of open surgery is that it’s available across
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A radical prostatectomy is a major operation, and as with any
major operation, there are some risks.
Risks of surgery include:
- bleeding and the possible need for a blood transfusion
- injury to nearby organs such as the bowel and nerves
- blood clots in the lower leg that could travel to the lung
- wound infection
- side effects such as leaking urine and erection problems.
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, how successful these
were, and the rate of side effects. Surgeons who do at least 20
radical prostatectomies each year, and ideally more than 35 a year,
have better results, including lower rates of side effects.
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What does surgery
Before the operation
A few weeks before your operation you will have tests at
the hospital to make sure you are fit enough for surgery.
Doing pelvic floor
muscle exercises for a few weeks before your operation may help
you recover more quickly from urinary problems
caused by surgery.
If you take drugs to thin the blood such as warfarin or
clopidrogel, you may need to stop taking them a week before your
operation to reduce the risk of bleeding.
The operation will take two to four hours. You’ll have a
general anaesthetic so you will be asleep during the operation and
won't feel anything.
There are two bundles of nerves attached to the prostate which
control erections. These nerves can be damaged during the operation
and cause problems with getting an erection. Your surgeon will try
to save them. This is called nerve-sparing surgery. But if the
cancer has spread too close to the nerves, your surgeon may need to
remove one or both bundles of nerves.
These nerves only control erections. They don’t control feeling
in the penis or the surrounding area. Even if the nerves are
damaged or removed, you won’t lose any feeling and may still be
able to have orgasms.
After the operation
When you wake up from the operation, you may be given
fluids to drink. Let your doctor or nurse know if you feel any pain
or feel sick – they can give you medicine to help with this.
You’ll have a thin tube (called a catheter) passed
through your penis into the bladder to drain urine out of your
body. Most men go home with the catheter. You nurse will show you
how to look after your catheter.
You’ll also have a thin tube in your stomach area to drain fluid
from the wound. This is usually removed 24 to 48 hours after the
You will be given pain-relieving drugs after the operation. These
should control any pain you have, but tell your doctor or nurse if
you are in any pain.
The drugs are usually given into a vein in your arm or hand
(intravenous). You may have a pump so that you can top up your pain
relief yourself if you need to.
After keyhole surgery, you may have some pain in your shoulders
for a few days. Carbon dioxide gas is pumped into your stomach area
during the operation. This can irritate the nerves and cause the
pain. Your stomach may also feel bloated and this can cause some
cramping and tightness.
You may have some bruising and swelling around your testicles and
penis. This can take several weeks to clear, but if you have a lot
of swelling, tell your doctor. You may find underpants more
comfortable than boxer shorts.
Eating and drinking
You will normally be allowed to eat and drink as soon as you feel
able to after the operation.
Getting out of bed
You will be encouraged to get out of bed and start moving around
as soon as you can. This reduces your risk of having a blood
You may need to take daily injections for up to a month after
surgery to reduce the risk of blood clots. If you need injections,
your nurse will teach you how to inject yourself before you go
You will go home one to seven days after your operation,
depending on your recovery and your doctor’s advice.
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You will have the name of someone to contact if there’s a
problem after you go home. A district nurse may also visit you at
home during the first few weeks.
Before you go home, your nurse will show you how to look after
The catheter will be attached to a bag that can be worn inside
your trousers, strapped to your leg. Make sure the urine drains
freely into the bag. If urine builds up in the bladder, it can put
pressure on the wound and the stitches.
Urine infections can be common if you have a catheter. The
following tips can help lower your chances of getting a urine
- Always wash your hands before and after handling your
- Wash the area near the tip of your penis with a downward
movement away from the tip. Use unscented soap and water, and dry
the area afterwards.
- Drink plenty of fluids (about 1.5 to 2 litres or 3 to 4 pints a
day). Your doctor or nurse should tell you how much.
- Eat plenty of fibre to avoid constipation as this can stop the
catheter draining properly.
The catheter is removed at the hospital one to three weeks after
the operation. This can be uncomfortable but it shouldn’t be
painful. Your doctor or nurse will make sure you are able to
urinate before you go home.
You may leak urine when the
catheter is removed. Take some absorbent (incontinence) pads and a
spare pair of underpants and trousers to the hospital. Some
hospitals will provide a few absorbent pads. You can get more from
the chemist or your GP. You may also be able to order them directly
from the supplier without paying VAT.
If you decide to have surgery, our surgery support
pack might be helpful.
After keyhole surgery, the cuts are usually closed with a
type of glue or stitches that slowly dissolve as the cuts heal. If
you had open surgery, the cut is usually closed with stitches or
clips. These are removed after one to two weeks.
It may take several months for your body to fully recover from
surgery. You will need to take it easy for the first couple of
weeks after surgery. Gentle exercise around the home and eating a
healthy diet will help your
recovery. Then light exercise such as a short walk every day will
help improve your fitness. Avoid climbing too many stairs, lifting
heavy objects or doing manual work for eight weeks after the
Wait until you feel ready before having sex. It is fine to
You may not have a bowel movement for several days
after surgery. If this carries on you may need medicine to help
empty your bowels (called a laxative). Bowel habits may take a few
weeks to return to normal. It’s important you don’t strain. Ask
your doctor, nurse or GP for advice.
Eating high fibre foods (such as bran and fruit), drinking
plenty of fluids, and gentle physical activity will
Going back to work
The amount of time you take off work will depend on how
quickly you recover and how much physical effort your work
involves. If you have keyhole surgery you’re more likely to get
back to your usual activities more quickly than after open surgery.
Ask your doctor or nurse about how much time you need to take
You will be able to sit in a car as a passenger
while your catheter is still in. You may want to avoid long
journeys for the first two weeks after the catheter is removed,
until you are used to dealing with any problems, such as leaking
Speak to your doctor about when it’s safe for you to drive. It
should not be before you feel you can do an emergency stop
comfortably. Check with your insurance company how soon after
surgery you are insured to drive.
Watch Colin's story for one man's experience of surgery. He and
his wife talk about how he recovered from the operation.
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When to call your
doctor or nurse
You should contact your doctor or nurse as soon as possible if
you have any of the following symptoms.
- Your bladder feels full or you notice your catheter isn’t
- Your catheter leaks or falls out.
- Your urine contains blood clots, turns cloudy, dark or red, or
has a strong smell.
- The area around your wound becomes red, swollen or
- You have a fever (high temperature of more than 38ºC or
- You feel sick or are sick.
- You get cramps in your stomach that will not go away.
- You get pain or swelling in your legs.
Your doctor or nurse may ask you to come into the hospital, or
they may tell you to go to your nearest accident & emergency
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You will have regular check-ups to monitor your progress (called
follow-up). Your check-ups
will usually start between six to eight weeks after surgery. Then
they could be every three to six months. After two years, you might
have a check-up once a year. But your check-ups might be more often
than this, so check with your doctor or nurse.
You will have a PSA test a week before your
After surgery, your PSA level should
drop so low that it’s not possible to detect it (less than 0.1
ng/ml). A rise in your PSA levels can suggest some prostate cancer
cells were left behind. If this happens, your doctor will talk to
you about further treatment.
After your prostate is removed it is sent to a laboratory
to be looked at under a microscope. This can give a better idea of
how aggressive the cancer might be and whether it has spread.
You may hear your doctor talk about ‘positive surgical margin’
or ‘negative or clear margin’.
- Positive surgical margin – this means an area right on the edge
of the prostate contains cancer cells. It suggests that some cancer
cells may have been left behind. This might mean you’re more likely
to need further treatment.
- Negative or clear margin – this means the cancer cells in the
prostate are surrounded by a rim of normal tissue. It suggests all
the cancer was removed.
If your results suggest some cancer cells may have been
left behind, you might be offered radiotherapy on its own or with hormone therapy. You may also be able
to take part in a clinical trials. Read more about cancer that has come
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What are the side
The most common side effects of surgery are leaking urine (urinary incontinence) and problems
with getting and keeping an erection (erectile dysfunction).
Your risk of getting these side effects depends on your overall
health and age, the stage and grade of your cancer, and your
surgeon’s skill and experience.
Watch Paul's story for one man's experience of managing urinary
problems after surgery:
Erection problems after surgery
After surgery, most men find it difficult to get an
erection strong enough for sexual intercourse and it can take
anything from a few months to three years for erections to return.
Erections are often not as strong as they were before surgery and
some men will never be able to get an erection without the help of
Treatments for erection problems include: tablets called PDE5
inhibitors, vacuum pump, injections, gels or pellets.
Your doctor may suggest that you start treatments for erection
problems in the first few weeks after surgery. Even if you are not
ready to start any sexual activity, starting treatment soon after
surgery may improve your chances of getting erections later on. You
may hear this called penile rehabilitation. Read more about how
prostate cancer treatment can affect your sex
If you’re gay, bisexual or a man who has sex with men, and are
the active partner (the ‘top’) during anal sex, then erection
problems after surgery may be a particular issue. Read our
information for gay
and bisexual men.
Some men find that their penis gets shorter after
surgery. Taking PDE5 inhibitor tablets may help to prevent the
penis getting shorter, or help it return to its normal length.
Using a vacuum pump, on its own or with a PDE5 inhibitor, may also
help to prevent shortening and improve erections.
The prostate and seminal vesicles make some of the fluid
in the semen. Both are removed during the operation. This means you
won’t ejaculate when you have sex or masturbate. Instead you may
have a ‘dry orgasm’ – where you feel the sensation of orgasm but
don’t ejaculate. This may feel different to the orgasms you’re used
After your operation, you won’t be able to father a child
naturally. You may want to think about storing your sperm before
having surgery, so that you can use it later for fertility
treatment – if needed. Ask your doctor or nurse about sperm storage
Watch Kevin's story for one man's experience managing side
effects of surgery:
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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?
- How soon will we know whether the operation has been
- How often will my PSA level be checked?
- What is the chance of needing more treatment after
- What is the risk of having urinary problems and what support
can you offer me?
- What is the risk of having erection problems and what treatment
is available to help me get erections after surgery? When will I
- Who should I contact if I have any problems?
- What support can you offer me if I have long-term side
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