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A radical prostatectomy is an operation to
prostate gland and some of the tissue around it. It is
done to remove
prostate cancer. This operation may be done by open
surgery. Or it may be done by
laparoscopic surgery through small incisions.
Laparoscopic surgery may be done by hand. But some doctors now do it
by guiding robotic arms that hold the surgery tools. This is called
In open surgery, the surgeon makes
an incision to reach the prostate gland. Depending on the case, the incision is
made either in the lower belly or in the perineum between the anus and the
When the incision is made in the lower belly, it is
called the retropubic approach. The surgeon may also remove
lymph nodes in the area so that they can be tested for cancer.
When the incision is made in the perineum, it is
called the perineal approach. The recovery time after this surgery may be
shorter than with the retropubic approach. If the surgeon wants to remove lymph
nodes for testing, he or she must make a separate incision. If the lymph nodes
are believed to be free of cancer based on the
grade of the cancer and results of the
PSA test, the surgeon may not remove lymph
For laparoscopic surgery, the surgeon makes several small incisions in
the belly. A lighted viewing instrument called a laparoscope is inserted into
one of the incisions. The surgeon uses special instruments to reach and remove
the prostate through the other incisions.
Robotic-assisted laparoscopic radical prostatectomy is surgery done through small incisions in the
belly with robotic arms that translate the surgeon's hand motions into finer
and more precise action. This surgery requires specially trained
The main goal of either open or laparoscopic surgery is
to remove all the cancer. Sometimes that means removing the prostate and
the tissues around it, including a set of nerves to the penis that affect the
man's ability to have an erection. Some tumors can be removed using a
nerve-sparing technique. This means carefully cutting around those nerves to
leave them intact. Nerve-sparing surgery sometimes preserves the man's ability
to have an erection.
Prostatectomy usually requires
general anesthesia and a hospital stay of 2 to 4 days.
A thin, flexible tube called a catheter usually is left in your bladder to
drain your urine for 1 to 3 weeks. Your doctor will give you instructions about
how to care for your catheter at home. Bladder control can be poor for a few
months after the catheter is removed.
Although prostatectomy often
removes all cancer cells, be sure to get follow-up care. This may
lead to early detection and treatment if your cancer comes back. Your regular
follow-up program may include:
Radical prostatectomy is most often
used if testing shows that the cancer has not spread outside the prostate.
is sometimes used to relieve urinary obstruction in men with more advanced
(stage III) cancer. But a different operation, called a transurethral resection
of the prostate (TURP), is most often used for that purpose. Surgery
usually is not considered a cure for advanced cancer. But it can help relieve
Radical prostatectomy is generally
effective in treating prostate cancer that has not spread. This is called
early-stage cancer. Following surgery, the stage of the cancer can be
determined based on how far it has spread. PSA levels will drop almost to zero
if the surgery successfully removes the cancer and the cancer has not spread.
If cancer has spread, advanced cancer may develop even after the prostate has
For men younger than 65 who have early-stage cancer (stages I and II, also called localized prostate cancer), those who had surgery lived longer than those who used active surveillance. But for men older than 65 with early-stage cancer, those who chose surgery lived just as long as men who chose other treatments, including active surveillance.1
Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the kind of surgery you have.2
Erection problems are one of the serious side effects of radical prostatectomy. The nerves
that control a man's ability to have an erection lie next to the prostate
gland. They often are damaged or removed during surgery. Sometimes these nerves can be spared during surgery to preserve erections.
About half of men are
able to regain some of their ability to have erections.3 But this takes time. It can take as little as 3 months. But for most men, it will be 6 months to a year.4
Recovery depends on:
Medicines such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) and mechanical aids may help men who are
impotent because of treatment. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your concerns.
Up to half of all men who
have a radical prostatectomy develop
urinary incontinence, ranging from a need to wear
urinary incontinence pads to occasional dribbling.
The urethra—the tube that carries urine from
your bladder—runs through the middle of the doughnut-shaped prostate gland. To remove the prostate, the surgeon must cut the urethra and later
reconnect it to the bladder. Evidence shows that the greater the surgeon's
experience and skill in making this reconnection, the lower the rate of
If urinary leakage continues
longer than 1 year, you may need
treatment for incontinence after prostatectomy.
Radical prostatectomy is major
surgery. So it carries the same general risks as other major operations,
including heart problems,
blood clots, allergic reaction to anesthesia, blood
loss, and infection of the wound.
Also, these complications
can be caused by radical prostatectomy:
When considering prostatectomy,
take into account your personal wishes, age, and any other medical conditions you may
have, the stage and grade of your cancer, and your PSA level. Your age and
overall health will make a difference in how treatment may affect your quality
of life. Any health problems you have before treatment, especially urinary,
bowel, or sexual function problems, will affect your recovery. Active surveillance or radiation
therapy may be reasonable options for you.
If you and your doctor decide that you need surgery, be sure to choose a highly skilled surgeon at a hospital that has a good success rate. Studies show that men have fewer side effects from
prostate surgery when they have a skilled and experienced surgeon.6
Robot-assisted prostatectomy may be best suited
to a younger man in good health who has a small prostate and a small,
surgery and radiation can cause urinary incontinence (not being able to control
urination) or impotence (not being able to have an erection). The level of
urinary incontinence and how long it lasts and the quality of the erections a
man has after treatment will depend on whether the cancer has spread. These
also depend on what treatment is used.
Surgery may completely
remove your prostate cancer. But it is not possible to know ahead of time
whether the cancer has spread beyond the prostate and is not curable with
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
CitationsLu-Yao GL, et al. (2010). Outcomes of localized prostate cancer following conservative management. JAMA, 302(11): 1202–1209.Zelefsky MJ, et al. (2011). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1220–1271. Philadelphia: Lippincott Williams and Wilkins.National Cancer Institute (2012). Prostate Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional.Schaeffer EM, et al. (2012). Radical retropubic and perineal prostatectomy. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2801–2829. Philadelphia: Saunders.Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.Agency for Healthcare Research and Quality (2008).
Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer: Executive Summary (AHRQ Pub. No. 08-EHC010-1).
Rockville, MD: Agency for Healthcare Research and Quality. Available online:
September 12, 2012
E. Gregory Thompson, MD - Internal Medicine & Christopher G. Wood, MD, FACS - Urology, Oncology
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