What is radical prostatectomy?
The prostate is a gland in the male reproductive system, between the bladder and penis. The urethra, the tube that lets urine flow out of the body, runs through the prostate from the bladder to the penis.
During radical prostatectomy, a surgeon removes the entire prostate gland. They usually also remove tissues around your prostate. These include seminal vesicles (glands that help make semen) and lymph nodes (glands that help your body fight infection).
Why is radical prostatectomy done?
Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.
For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:
- Prostate ultrasound and biopsy.
- MRI-guided prostate biopsy.
- PSA (prostate-specific antigen) test for elevated PSA levels.
- CT scans.
- MRI scans.
- Bone scans.
What are the types of radical prostatectomy?
Your surgeon will choose among several types of radical prostatectomy:
- Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
- Robot radical prostatectomy: Your surgeon makes several small incisions (robotic radical prostatectomy) or one single incision (single-port radical prostatectomy) across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.
How common is radical prostatectomy?
Radical prostatectomy is a very common surgery for prostate cancer that hasn’t spread outside the prostate. Other than skin cancer, prostate cancer is the most common cancer found in men in the U.S. About one in eight men receive a prostate cancer diagnosis, at an average age of 66 years old.
What happens before radical prostatectomy?
Before radical prostatectomy, your provider will ask you about your health history. You’ll also need to tell your provider what drugs and vitamins you take. You may need to stop taking some of your medications a few days before your surgery, especially drugs that cause blood thinning.
Your hospital will give you specific instructions, including how long before your surgery to stop eating and drinking.
To check your health before your procedure, you also may need:
- Blood tests.
- CT scan or MRI scan of your pelvis and abdomen.
- Prostate ultrasound and biopsy.
What happens during radical prostatectomy?
You will have general anesthesia (where you’re asleep) during your prostate surgery. Your surgical team inserts a catheter (thin, flexible tube) to drain urine.
After your surgeon removes your prostate, they check it under a microscope to see if cancer has extended beyond the edge of the prostate or into the seminal vesicles or lymph nodes. If it has, the cancer may have spread. In that case, you may need other treatment.
What happens after radical prostatectomy?
Patients are usually discharged within 24 hours of surgery after radical prostatectomy.
You may have a drain that gets rid of excess fluid from the surgery site. If a drain is placed at the time of surgery, it is typically removed before you leave the hospital.
A urinary catheter continues to drain your urine into a bag. You may need to leave the catheter in place at home for a few days to one week.
After a surgeon removes your prostate, you’ll no longer ejaculate semen. But you can still be sexually active.
How painful is radical prostatectomy?
Although there is some incisional pain after surgery, patients are routinely walking the morning after surgery and have their pain controlled with over-the-counter medications by the time they leave the hospital.
Risks / Benefits
What are the advantages of laparoscopic instead of open surgery?
Compared to open surgeries, people who have robotic surgeries tend to have:
- Less pain after surgery.
- Quicker return to activities.
- Reduced hospital stay.
- Shorter recovery time.
- Smaller incisions and less scarring.
What are the risks or complications of radical prostatectomy?
Radical prostatectomy is generally very safe. Surgeons try to protect the nerves that run from the prostate to the penis. But problems due to nerve damage can occur. There is a risk that you may experience:
- Urinary incontinence: Some people experience urinary incontinence, although most people recover continence. Your provider can help you manage loss of bladder control and urine leakage.
- Erectile dysfunction: Many people have problems maintaining erections after this surgery. The likelihood of recovery of erectile function depends on your erections before surgery and your surgeon’s ability to spare the nerves that control erection at the time of surgery. You may need to use erectile dysfunction medications or other treatments. The older you are, the more likely problems may occur.
There is also a small risk that you may experience:
Recovery and Outlook
What is the outlook after radical prostatectomy?
The likelihood of recurrence-free survival depends on the pathologic stage. You’ll need to have regular follow-up appointments with your healthcare provider to make sure the cancer has not returned.
What is the recovery time after radical prostatectomy?
You may feel tired for a few weeks after surgery. Light exercise such as walking can help with the healing process. You should avoid heavy lifting for several weeks.
You may have urinary incontinence or leakage for weeks to months after the surgery, although most people recover continence after surgery. Recovery of sexual function is expected to take months. Your doctor may start you on a medication to help with recovery of erections.
You’ll need regular follow-ups with your healthcare provider to monitor for evidence of cancer recurrence and manage effects from the surgery. They can work with you to improve any problems with erectile dysfunction or bladder control.
When can I go back to work/school/drive/eat?
If you have open surgery, you can usually return to your regular activities two to four weeks after surgery. If you have robotic surgery, you can often go back to your everyday activities in one to two weeks. Your healthcare provider can tell you when it’s safe to do so.
When to Call the Doctor
When should I see my healthcare provider?
Talk to your healthcare provider if you have any of these symptoms after your surgery:
- Bleeding, swelling or drainage from the incisions.
- Inability to have a bowel movement.
- Inability to urinate after catheter removal.
- Increased pain around the incisions.
A note from Cleveland Clinic
Radical prostatectomy is a common surgery to remove the entire prostate gland. This prostate cancer surgery may be robotic surgery or open surgery. Robotic surgery has a shorter recovery time. Full recovery can take weeks, with some side effects lasting for months. Light exercise and medication can help you heal faster.
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