What is prostate cancer?

Prostate cancer is a harmful growth that starts in your prostate gland.

Radical prostatectomy involves removing your prostate gland and the section of urethra that runs through it. The operation is effective only for localised prostate cancer.

What are the benefits of surgery?

Radical prostatectomy gives the best chance of you being free of prostate cancer and is the most effective treatment in younger men.

The tissue and lymph nodes that your surgeon removes will be examined under a microscope to help decide on any further treatment.

Are there any alternatives to radical prostatectomy?

For some men, it may be possible to have external beam radiotherapy or brachytherapy, which involves placing small radioactive beads in your prostate gland.

There is a new technique called high-intensity focused ultrasound (HIFU). This involves surgery to remove the centre of your prostate gland and then placing an ultrasound probe into your rectum to kill off cancer cells using heat energy.

What will happen if I decide not to have the operation?

The cancer may not be controlled by other treatments, or the cancer may be controlled at first and then spread in a few months or years.

Not removing your prostate gland may reduce the chance of you being cured.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 2 to 3 hours.

Your surgeon will make a small cut on or near your belly button so they can insert an instrument in your abdominal cavity to inflate it with gas (carbon dioxide). They will make several small cuts on your abdomen so they can insert tubes (ports) into your abdomen. Your surgeon will insert surgical instruments through the ports along with a telescope so they can see inside your abdomen and perform the operation.

Your surgeon will remove your prostate gland and the section of urethra that runs through it. Your surgeon will connect your urethra to your bladder.

They may remove some or most of the lymph nodes in your pelvic region, which helps your surgeon to decide on any further treatment.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Acute kidney injury.
• Bleeding during or after the operation. If the bleeding is heavy you may need a blood transfusion or another operation.
• Developing a hernia in the scar.
• Blood clot in your leg (deep-vein thrombosis – DVT).
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs.
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

Keyhole surgery complications

• Damage to structures such as your bowel, bladder or blood vessels when inserting instruments into your abdomen. About 1 in 3 of these injuries is not obvious until after the operation.
• Developing a hernia near one of the cuts used to insert the ports.
• Surgical emphysema (a crackling sensation in your scrotum caused by trapped carbon dioxide).
• Gas embolism. This is when gas (carbon dioxide) gets into the bloodstream and blocks a blood vessel.

Prostatectomy complications

• Problems having an erection.
• Difficulty passing urine.
• Incontinence. This usually happens for only a short while but can be permanent.
• Lymphocele, where fluid collects in the areas where lymph nodes are removed.
• Damage to your rectum. You may need another operation and a temporary colostomy (your large bowel opening onto your skin).
• Narrowing of your urethra or neck of your bladder. Urine can sometimes leak internally after the catheter is removed if the connection with your urethra is slow to heal.
• Damage to your ureters (tubes that carry urine from your kidneys to your bladder).

Consequences of this procedure

• pain

How soon will I recover?

You should be able to go home after 2 to 3 days.

You should be able to return to work after 6 to 8 weeks, depending on your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

The healthcare team will arrange for you to come back to the clinic within 3 weeks.

Your surgeon will tell you the results and discuss with you any treatment or follow-up you need.

Summary

Radical prostatectomy gives the best chance of you being free of localised prostate cancer. The operation involves removing your prostate gland. It usually involves removing some or most of the lymph nodes in your pelvic region, which helps your surgeon to decide on any further treatment.

The operation and treatment information on this page is published under license by Healthdirect Australia from EIDO Healthcare Australia and is protected by copyright laws. Other than for your personal, non-commercial use, you may not copy, print out, download or otherwise reproduce any of the information. The information should not replace advice that your relevant health professional would give you. Medical Illustration Copyright © Medical-Artist.com.

For more on how this information was prepared, click here.