The aim of surgery for prostate cancer is to take out the prostate gland and the cancer contained within it. The surgeon will also take out the seminal vesicles, which are two glands next to the prostate that make some of the fluid in the semen.

Your surgeon may also remove the nearby lymph nodes if there is a risk that the cancer has spread there. The lymph nodes are part of the immune system and help the body fight disease and infection. Your surgeon should discuss this with you before your operation.

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 than the retropubic operation and not widely available in the UK. Perineal prostatectomy is not used if there is a chance that the cancer has spread to the lymph nodes, as the surgeon cannot reach them this way.

Keyhole surgery
This is also called a laparoscopic prostatectomy. Your surgeon will make five or six small cuts in your tummy, rather than one large one. There are two ways of doing this type of operation:

• by hand
• using a robot.

The robot-assisted operation is relatively new and is only available in some hospitals in the UK. If your hospital does not carry out robot-assisted surgery, they may be able to refer you to one that does.

All of these methods appear to be equally good at treating prostate cancer.[1] Your doctor or nurse can tell you which types of operation are available in your area.

Radical prostatectomy is an option for men with cancer that is thought to be contained within the prostate (localised prostate cancer) and who are otherwise fit and healthy. It is as effective at treating localised prostate cancer as radiotherapy.[1, 2, 3]

Surgery 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. Surgery is less common for locally advanced cancer as it may not be possible to remove all the cancer cells that have spread. Researchers are looking at how effective surgery is for men with locally advanced prostate cancer, and you may be offered it as part of a clinical trial.[2, 4, 5]

A radical prostatectomy is a major operation and it may not be suitable for you if you have other health problems, such as heart disease, as these increase the risks of surgery. It is uncommon for men in their late 70s or older to have a radical prostatectomy.[6] This is because the risks of surgery, such as having an anaesthetic and the chance of urinary problems after the operation, can be greater for older people.

If you are overweight, your doctor may advise you to lose weight before your operation. Overweight and obese men are more likely to have problems during and after surgery. For example, they may lose more blood during the operation and have an increased risk of wound infection and urinary problems.[7]

Alternative treatments for localised prostate cancer may include:

• active surveillance
• external beam radiotherapy
• brachytherapy
• watchful waiting.

You may also be offered high intensity focused ultrasound (HIFU) or cryotherapy. These are not widely available in the UK and researchers are studying better ways of carrying out these treatments. They may be available in specialist centres or as part of a clinical trial.

If you have had radiotherapy as your first treatment and your cancer has started to grow again, further treatment with surgery is not usually possible. There are other possible treatments. Our booklet, Recurrent prostate cancer: A guide to treatment and support, has more information.

Unsure about your diagnosis and treatment options?
If you have any questions about your diagnosis you can ask your doctor or nurse. They will be happy to explain your test results and talk you through your treatment options. It is important you feel you have enough time and all the information you need before making a decision about treatment. We have more information about diagnosis and treatments. You can also speak to our Specialist Nurses.

The advantages and disadvantages of all types of surgery to remove the prostate depend on your age, health and the stage of your cancer. Your surgeon should discuss your individual situation with you.

Advantages

• If the cancer is completely contained within the prostate, surgery will remove all the cancer.
• The surgeon will remove your prostate gland and send it 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 the success of the surgery by monitoring your PSA level. If the surgery is successful, your PSA should drop to less than 0.1 ng/ml a few weeks after the operation.
• If your PSA starts to rise after surgery, 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.
• Treatment involves a stay in hospital and a period of recovery afterwards.
• If the cancer has broken out of the prostate gland, the surgeon may not be able to remove all of it and some cancer cells may be left behind.
• 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 give you information about how many operations they have done, the outcomes of these and the rate of side effects. Research suggests that 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.[8] Hospitals should carry out more than 50 radical operations for prostate or bladder cancer in a year.[9]

As well as the advantages and disadvantages of surgery explained above, there are some specific advantages and disadvantages to the different types of surgery. These are described in the below. All types of surgery appear to be as good as each other in treating prostate cancer[1] and have similar side effects.

Open prostatectomy – retropubic

Advantages

• It is widely available across the UK.

Diadvantages

• You are more likely to need a blood transfusion than with laparoscopic prostatectomy.
• You will have a bigger wound so it will take longer to heal.

Keyhole (laparoscopic) prostatectomy – by hand

Advantages

• You will spend less time in hospital and recovery is quicker than with open surgery.[10]
• You are less likely to need a blood transfusion[10] and less likely to get a wound infection than in open prostatectomy.
• You will have small wounds which will heal more quickly.

Disdvantage

• It can take some time for surgeons to gain experience and improve their technique. However, some surgeons do have a lot of experience in keyhole prostatectomies.

Keyhole (laparoscopic) prostatectomy – robot-assisted

Advantages

• This has the same advantages as keyhole prostatectomy done by hand[11, 12] (see above).

Disadvantges

• This has the same disadvantage as keyhole prostatectomy done by hand (see above).
• There are only a few robots in the UK.

Before the operation
A few days or weeks before your operation you will have several tests at the hospital. These include blood and urine tests, an electrocardiograph (ECG) which measures your heart’s activity, a chest X-ray and a physical examination. These are to make sure you are fit enough for the anaesthetic.

Your doctor or nurse may suggest you practise pelvic floor muscle exercises for a few weeks before the operation. These may help you recover more quickly from problems leaking urine caused by surgery.

A radical prostatectomy is a major operation, and as with any major surgery there are some risks. These include:

• bleeding and the possible need for a blood transfusion
• injury to nearby tissues and nerves
• blood clots in the lower leg that could travel to the lung
• infection of the wound.

If you take medication to thin the blood such as warfarin, you may need to stop taking it a week before your operation to reduce the risk of bleeding. Speak to your doctor or nurse about this.[13]

You will go into hospital on the day before your operation, or the day of the operation. An anaesthetist, who is responsible for your anaesthetic and pain relief, will explain these. You will not be able to eat for about six hours before the operation, although you may be able to drink up until two hours before the operation. You may be given carbohydrate drinks to drink. If you need to take regular medication, ask the nursing or medical staff for advice.

You will need to wear elasticated stockings during and after the operation. This is to reduce the chance of blood clots forming in your legs. You will keep these on until you are moving around normally again. You may also be given some medication to reduce the risk of blood clots.[13]

The operation
The type of operation you have will partly depend on what is available at your hospital and what your surgeon recommends.

Open surgery
With this type of surgery, the surgeon will make a vertical or horizontal cut in your lower abdomen, below the belly button. The operation takes three to four hours. You will have a general anaesthetic so you will be asleep during the whole operation and will not feel anything. You may need to be given blood (a blood transfusion) during the operation.

Keyhole surgery
The surgeon will make five to six small cuts (less than 1cm or half an inch long) in your abdomen. They will insert a small camera through one of the cuts so they can see the prostate and what they are doing. The surgeon uses the other cuts to insert the instruments to carry out the operation.

This operation will normally take between two and three hours. You will have a general anaesthetic. You may need to have a blood transfusion but this is less likely than with open prostatectomy because there is usually less blood loss.[14]

In rare cases the surgeon may need to switch to open surgery.[14] This may happen if the operation is taking longer than expected or if there is a lot of bleeding.

The robot-assisted operation is similar to the operation done by hand but the surgeon uses two or three robotic arms to move the surgical instruments. They control the robotic arms through a computer.

Nerve-sparing surgery
One of the side effects of surgery is problems getting an erection. This is because there are two bundles of nerves attached to the prostate which control erections. These nerves can be damaged during the operation. If possible, your surgeon will try to save these nerves. This is called nerve-sparing surgery. However, if the cancer has spread too close to the nerves, the surgeon may need to remove one or both bundles of nerves.

These nerves only control erections. They do not control sensation in the penis or surrounding area. So even if the surgeon is unable to save the nerves, you will not lose any feeling and you may still be able to have orgasms.

After the operation
You will wake up from the operation in the recovery room and then be taken back to the ward.

Tubes and drips
When you wake up you will have a tube called a drip, usually in your arm or hand, to give you fluid. This will be removed once you are eating and drinking normally.

You will also have a small tube in your abdomen to drain away any fluid from the wound. This will be removed 24 to 48 hours after the operation and before you go home.

Catheter
A catheter is a thin tube which is passed through your penis into the bladder to drain urine out of the body. You will have a catheter after your operation. Most men go home with the catheter and it is removed at the hospital one to three weeks after the operation.

Pain
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. They will find the right type and amount of pain relief for you.

You will be given pain-relieving drugs either into the spine (epidural), or into a vein in your arm (intravenous). You may have a pump so that you can top up your pain relief yourself if you need to. You will be shown how to use this.

You will then be given pain-relieving tablets, which you can take at home.

Eating and drinking
You may be able to eat and drink as soon as you feel able to after the operation. You may also be given energy drinks two or three times a day.[15]

Getting out of bed
You will be encouraged to get out of bed as soon as you can after the operation and start to move around. You will be able to go home one to seven days after the operation, depending on your recovery and your doctor’s advice. Men who have had a keyhole prostatectomy may be able to go home sooner than men who have had an open prostatectomy.

Personal experience
Initially, moving in bed is uncomfortable and sore. But this soon gets much easier.

Care of your catheter
Before you leave hospital, the nurse will show you how to look after your catheter. The catheter will be attached to a bag that can be worn inside your trousers, strapped to your leg. Make sure that the catheter is not pulled too tight as this can be uncomfortable and could slow down the healing. The urine must be able to drain freely into the bag. If urine is allowed to build up in the bladder, it can put pressure on the wound and the stitches.

Once you are home, a district nurse will check how your wound is healing and help you to look after your catheter. If there are any problems with the catheter, the district nurse should contact your doctor or nurse at the hospital. Tell the nurse if you notice any urine leaking from the outside of the catheter, or if it is not draining properly.

You may also notice some fluid with blood in it around the catheter when you open your bowels or pass wind. This is normal, but if there is a lot of bleeding you should contact your doctor or nurse at the hospital or go to your GP as soon as possible.

Urine infections can be common if you have a catheter. You may be given some antibiotics to take to prevent infection. The following tips can also help.

• Always wash your hands before and after handling your catheter.
• Wash the area where the catheter enters the body every day with a downward movement away from the tip of your penis. 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 to drink.
• Eat plenty of fibre to avoid constipation as constipation can stop the catheter draining properly.

Contact your doctor or nurse if you have a high temperature, burning sensation or dark, cloudy or unpleasant smelling urine. These could be signs of a urine infection.

Personal experience
“Loose trousers were best when I had the catheter. Jogging trousers with elasticated bottoms were ideal.”

You will have your catheter removed at the hospital one to three weeks after the operation. This can be uncomfortable but it should not be painful. Your doctor or nurse will make sure you are able to pass urine before you can go home. This may mean that you are at the hospital for a few hours.

You may find that you leak urine after the catheter has been removed. This is common, and should improve over time. It is a good idea to take some continence pads and a spare pair of underpants and trousers to the hospital. Loose fitting trousers may be more comfortable, and underpants will support the pads better than boxer shorts. Some hospitals will provide a few continence pads but you may need to get some more from the chemist or your GP. You may also be able to order them directly from the supplier without paying VAT.

Read more about catheters and leaking urine after surgery.

Your wound
If you had open surgery, you will have one wound with stitches or clips holding it closed. These will be removed after one to two weeks, usually by a district nurse once you have gone home.

If you had keyhole surgery, you will have several smaller wounds with plasters or a type of glue to cover them. These will be removed after a couple of days. You will also have stitches, which will either dissolve or be removed by a district nurse once you have gone home.

If you had open surgery, you may have swelling and bruising in your scrotum (the pouch of skin that contains the testicles) and penis but this should go down after a few days. You may find underpants are more supportive and comfortable than boxer shorts.

The scars from the operation will shrink and fade over time. The muscle and tissue inside your body also has to heal and this may take several months. A healthy diet and drinking plenty of fluids will help the healing process.[16] Read more about eating a healthy balanced diet.

For the first couple of weeks after the operation, gentle indoor activities will help you to recover. 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 operation.

Wait until you feel ready before you try having sex. You might find it helpful to discuss this with your partner. However, it is fine to masturbate and have night-time erections.

Constipation
You may have no bowel movements for several days after surgery, but if this carries on you may need a laxative. This is medicine to help you open your bowels. In some men, bowel habits may take a few weeks to return to normal. Ask your doctor, nurse or GP for advice.

Constipation may be caused by the pain-relief you are given after the operation. Not moving around much, or not eating much because you are not feeling well enough can also cause constipation. Eating high fibre foods, drinking plenty of fluids and gentle physical activity will help.

Your follow-up appointment
You will see your doctor around six weeks after your operation for your test results. This is an opportunity for you to discuss any problems you are having, such as leaking urine or problems getting an erection.

After your prostate is removed it is sent to a laboratory for testing. A doctor called a pathologist looks at all the prostate tissue under a microscope. This can give a clearer idea of how aggressive the cancer might be and whether it has spread, compared to a biopsy, which only looks at smaller samples of the prostate.

You will have a PSA test a few weeks after the operation, and will get the results at your follow-up appointment. The PSA test measures the level of a protein called prostate specific antigen (PSA) in your blood. PSA is produced by healthy prostate cells and also by prostate cancer cells. If the surgery has been successful your PSA level will drop to the lowest possible reading (usually less than 0.1 ng/ml) because all the prostate and prostate cancer cells will have been removed.[2]

You will have regular appointments every three to six months to monitor your PSA level and any side effects. If your PSA level rises and continues to rise, this may a sign that there is still cancer present.[1, 2]

Further treatment
If the cancer has spread outside the prostate gland or comes back, you will be offered further treatment with radiotherapy or hormone therapy.[2]

You may also be able to take part in a clinical trial. Clinical trials are a type of medical research study that aim to find new improved ways of preventing, diagnosing, treating and controlling illnesses.

Our booklet, Recurrent prostate cancer: A guide to treatment and support, has more information about cancer that has come back after treatment.

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. Most men return to work within six to eight weeks if they have had open surgery and two to six weeks if they have had keyhole surgery but you may need longer. If you work, ask your doctor for advice on how much time you will need to take off.

Driving
You will be able to sit in a car as a passenger while your catheter is still in. You may wish to avoid long journeys for the first two weeks after the catheter is removed until you are more used to dealing with any problems leaking urine.

You will be able to drive a car when you feel you can do an emergency stop comfortably. There are no official guidelines for how long you should wait before driving. Advice given by doctors varies from two to six weeks after surgery. Check with your insurance company how soon after surgery you are insured to drive and whether you can drive while you are taking pain-relieving tablets.

Personal experience
"I found that it took me a long time to recover fully my powers of concentration. I was not able to work at full pitch for some 12 weeks."

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.

Men who have keyhole surgery are able to get back to their normal daily activities more quickly than men who have open surgery. However, the side effects from all types of prostate surgery are similar.[14, 17, 18]

You can ask your doctor or nurse for more information about side effects. You can also call our Specialist Nurses.

Urinary problems
Problems leaking urine
Surgery may weaken some of the muscles and damage nerves that help you control passing urine. This can cause you to leak urine. You may leak a few drops when you exercise, cough or sneeze (stress incontinence). Some men may leak larger amounts of urine and need to wear absorbent pads or pants, especially in the weeks after the operation. The risk of urinary problems will also depend on other factors such as your age.

You may continue to leak urine for several months after surgery. This is usual. Pelvic floor muscle exercises may help you regain control of your bladder more quickly after surgery.[19, 20] You may need to practise the exercises for up to three to six months after your operation before you see an improvement in your symptoms.[21] And you may find it helps to continue doing pelvic floor muscle exercises regularly.

A personal experience
"In terms of getting back control of my bladder, some days were better than others. I found pelvic floor exercises really helpful as part of the process."

Urinary symptoms should improve with time and most men will notice an improvement three to six months after surgery. However, some men may still have problems with leaking urine a year after having surgery.

There are treatments available that can help manage urinary problems, as well as things that you can do yourself. You can also call our Specialist Nurses.

Personal experience
“Incontinence pads are effective at keeping urine away from the skin so that it does not cause irritation. They provide significant reassurance.”

Problems passing urine
Some men have problems passing urine after surgery because of scar tissue building up around the neck of the bladder.[10, 22] Symptoms include needing to pass urine more often or urgently, a weak flow of urine, and not emptying your bladder properly.

Speak to your doctor or nurse if you have any of these symptoms. You may need to have a short operation to open the neck of the bladder.

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. They may need to drain your bladder with a catheter.

Some men find their urinary problems difficult to deal with at times, both physically and emotionally. The Bladder and Bowel Foundation have helpful information on how to manage with urinary problems and the way they make you feel.

Sexual problems
Erection problems
During the operation, the nerves that control erections may be damaged or removed. This may mean that you have problems getting an erection (erectile dysfunction) following surgery. Your surgeon may try to save these nerves (nerve-sparing surgery), but this is not always possible. Even if your surgeon does save the nerves, you may still have problems getting an erection.

The likelihood of having erection problems depends on several things such as your age, the strength of your erections before surgery, other medical conditions such as high blood pressure or diabetes, and whether you smoke.[23, 24]

At first, 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.[5] Erections are often not as good as they were before surgery and some men will never get back the ability to maintain an erection without the help of artificial methods such as vacuum pumps or tablets.[26]

There are treatments available to help with erection problems. These include:

• tablets called PDE5 inhibitors such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®)
• vacuum pumps
• injections
• pellets.

You will not be prescribed PDE5 inhibitors if you are taking medicines called nitrates for a heart problem. Your doctor may refer you to an erectile dysfunction clinic for treatment and advice for erection problems.

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, some research suggests that starting treatment soon after surgery may improve your chances of getting erections later on.[2, 27] You may hear this called penile rehabilitation.

If you are able to get erections you will not be able to ejaculate. This is because the prostate gland and seminal vesicles, which produce the fluid in the semen, are removed during the operation. Instead you may have a ‘dry orgasm’ where you feel the sensations of orgasm, but do not release any semen from the penis. This may feel different to orgasms you are used to.

Read more about erection problems following surgery and ways to manage these.

Penis shortening
Some men find that their penis gets shorter following surgery.[28 ]This may be more common in men who have erection problems after surgery.[28] Some research suggests that taking PDE5 inhibitor tablets may help to prevent the penis getting shorter or help it return to its normal length.[28, 29] Using a vacuum pump, either alone or together with a PDE5 inhibitor, may also help to prevent shortening and improve erections.[30, 31]

Infertility
The prostate gland and seminal vesicles, which produce and store some of the fluid in semen, are removed during the operation. This means that you will not be able to ejaculate any semen, even if you can get an erection, and so you will be infertile.

If you are planning to have children, you may be able to store your sperm before the operation for use in IVF (in vitro fertilisation). If this is important to you, speak your GP, doctor or nurse about this. Sperm banking is usually available on the NHS, but this is not always the case and you may need to pay for it.

It can be difficult dealing with having treatment for prostate cancer. But there is support available to help you, your partner and your family. You may find it helps to talk to a partner, friend or relative about how you are feeling. However, some men find it difficult to talk to people close to them.

You and those close to you can speak to one of our Specialist Nurses. They can answer any questions you have about your treatment and help you deal with the emotional effects of prostate cancer. You could also speak to your GP or doctor or nurse at the hospital about how you are feeling. If you would like more support, they can put you in touch with a counsellor.

You might find it helpful to speak to someone who has been affected by prostate cancer. Our support volunteers are men and women who have personal experiences of prostate cancer. They are trained to listen and offer support over the telephone.

There are prostate cancer support groups across the country where you can meet other people affected by prostate cancer. You could also join our online community. Here, you can share your experiences with other men with prostate cancer and their families.

A personal experience
"My local support group meet every week. We regularly have new prostate cancer patients dropping in. It is a great opportunity to meet other men in the same situation and to attend lectures given by local medical experts."

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.

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?

British Association for Counselling and Psychotherapy (BACP)
http://www.itsgoodtotalk.org.uk/
Telephone: 01455 883300
Provides information about counselling and details of therapists in your area.

Bladder and Bowel Foundation
www.bladderandbowelfoundation.org
Helpline: 0845 345 0165
You can leave a message 24 hours a day.
For information and support for all types of bladder and bowel related problems.

CancerHelp UK
http://cancerhelp.cancerresearchuk.org
Freephone: 0808 800 4040 (9am – 5pm, Mon – Fri)
Part of Cancer Research UK, Cancer Help provides information about all types of cancer and a database of cancer clinical trials.

Macmillan Cancer Support
www.macmillan.org.uk
Freephone: 0808 808 00 00 (9am - 8pm, Mon - Fri)
Provides practical, financial and emotional support for people with cancer, their family and friends.

Maggie's Cancer Caring Centres
www.maggiescentres.org
Telephone: 0300 123 1801
Provides information and support to anyone affected by cancer. Their website holds a list of centres across the UK and has an online support group.

National Institute for Health & Clinical Excellence (NICE)
www.nice.org.uk
Provides national guidelines on treating prostate cancer, including an information leaflet on laparoscopic radical prostatectomy.

UK Prostate Link
www.prostate-link.org.uk
Guide to reliable sources of prostate cancer information.

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[2] National Institute for Health and Clinical Excellence. Prostate cancer. Diagnosis and treatment. NICE clinical guideline 58. 2008.
[3] Kupelian PA et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. International Journal of Radiation Oncology, Biology, Physics. 2004;58(1):25-33
[4] Payne H. Management of locally advanced prostate cancer. Asian Journal of Andrology. 2009;11:81-87.
[5] Hoffman KE, Nguyen PL, Chen M-H et al. Recommendations for post-prostatectomy radiation therapy in the United States before and after presentation of randomized trials. The Journal of Urology. 2011;185:116-120.
[6] British Uro-Oncology Group (BUG), British Association of Urological Surgeons (BAUS): Section of Oncology, British Prostate Group (BPG). MDT (Multi-disciplinary Team) Guidance for managing prostate cancer. 2nd edition. 2009.
[7] Murphy DG, Bjartell A, Ficarra V et al. Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. European Urology. 2010; 57: 735-746.
[8] Vesey SG, McCabe JE, Hounsome L & Fowler S. UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database. BJU International. 2011;109:346-354.
[9] National Institute for Clinical Excellence. Improving outcomes in urological cancers: the manual. London: National Institute for Clinical Excellence. 2002.
[10] Ficarra V, Novara G, Artibani W et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55(5): 1037-1063.
[11] Goldstraw MA, Patil K, Anderson C et al. A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom. Prostate Cancer and Prostatic Diseases. 2007; 10: 242-249.
[12] Magheli A, Burnett AL. Erectile dysfunction following prostatectomy: prevention and treatment. Nature Reviews Urology. 2009; 6(8): 415-427.
[13] National Institute for Health and Clinical Excellence. Venous thromboembolism: reducing the risk. NICE clinical guideline 92. 2010.
[14] Coelho RF, Rocco B, Patel MB et al. Retropubic, laparoscopic and robot-assisted radical prostatectomy: A critical review of outcomes reported by high-volume centres. Journal of Endourology. 2010;24(12):2003-2015
[15] Enhanced Recovery Partnership Programme. Delivering enhanced recovery. Helping patients get better sooner after surgery. 2003
[16] Russell L. The importance of patients' nutritional status in wound healing.
Br J Nurs. 2001;10(6 Suppl):S42, S44-9.
[17] Ball AJ, Gambill B, Fabrizio MD et al. Fourth Prize: Prospective Longitudinal Comparative Study of Early Health-Related Quality-of-Life Outcomes in Patients Undergoing Surgical Treatment for Localized Prostate Cancer: A Short-Term Evaluation of Five Approaches from a Single Institution. Journal of Endourology. 2006; 20(10): 723-731.
[18] National Institute for Health and Clinical Excellence. Laparoscopic radical prostatectomy. London: National Institute for Health and Clinical Excellence. 2006.
[19] MacDonald R, Fink HA, Huckabay C et al. Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness. BJU Int. 2007; 100(1): 76-81.
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Reviewed by:

• Vanessa Basketter, Senior Uro-oncology Nurse Specialist, Queen Alexandra Hospital, Portsmouth
• Simon Brewster, Consultant Urological Surgeon, Churchill Hospital, Oxford
• Christopher Eden, Consultant Urologist, The Royal Surrey County Hospital, Guildford
• Ann Tull, Urology Oncology Clinical Nurse Specialist, Southend University Hospital, Essex
• Prostate Cancer UK’s Volunteers
• Prostate Cancer UK’s Specialist Nurses

Written and edited by:
Prostate Cancer UK’s Information Team

Last updated August 2012

To be reviewed August 2014