What is a radical prostatectomy?
A radical prostatectomy is a surgery used to treat prostate
cancer. If you’ve been diagnosed with prostate cancer, your doctor will discuss
different options for treatment. If your cancer is only inside the prostate
gland and hasn’t spread to surrounding tissue, your doctor may recommend a
In a radical prostatectomy, a surgeon removes your entire
prostate gland. The prostate is a small organ that wraps around your urethra.
The urethra is the tube that moves urine from your bladder to your penis.
The surgery is called a “radical” prostatectomy because the
entire prostate gland is removed. In other prostate surgeries, such as a
“simple” prostatectomy, only part of the gland is removed.
Why is a radical prostatectomy performed?
A radical prostatectomy might be your best treatment option
if your tumor is inside your prostate gland and hasn’t invaded surrounding
areas. This treatment is done to remove the cancer before it can spread to
other parts of your body. The entire prostate is removed.
Sometimes your surgeon will also remove related structures
such as the seminal vesicles and the vas deferens. Removal of the seminal
vesicles is very common. This is to make sure that the cancer is completely
Your surgeon may also remove nearby lymph nodes. This
procedure is called pelvic lymph node dissection. Lymph nodes are fluid-filled
sacs that are part of your immune system. Your doctor will examine your pelvic
lymph nodes to determine whether your prostate cancer has spread, or metastasized,
to them. The lymph nodes are often the first place cancer spreads from the
prostate. Sometimes you’ll have these lymph nodes removed before your prostate
Whether your lymph nodes are removed depends on your level
of risk for cancer spreading to them. One of the ways your doctor will
determine this risk is using your prostate-specific antigen (PSA) level. PSA is
an enzyme produced by the prostate gland. Normally, small amounts of PSA enter
the bloodstream from the prostate. Larger amounts of PSA enter the blood when
the prostate gland is enlarged, infected, or diseased, such as with benign prostatic hyperplasia (BPH),
prostatitis, or prostate cancer. The level
of PSA in the blood can be determined by a simple blood test.
Am I a good
candidate for a radical prostatectomy?
Other treatment options may be better for you if:
- your health is poor and you’re unable to undergo
anesthesia or surgery
- your cancer is growing slowly
- your cancer has spread beyond your prostate
How do I prepare for a radical prostatectomy?
Your doctor will do a thorough check of your health. Some
health conditions in particular need to be under control before the surgery.
- heart disease
- lung problems
- high blood pressure
Your doctor will order many tests and scans before your
surgery to learn as much as possible about your condition. These will likely
- blood tests
- an ultrasound of the prostate and nearby organs
- a biopsy of the prostate
- a CT or MRI scan of the abdomen and pelvis
Make sure that you tell all of your doctors and nurses what
drugs and vitamins you take, especially any medicines that may thin your blood.
These may cause complications and excessive bleeding during surgery. Problems may
occur with drugs or supplements such as:
Make sure not to eat before the surgery to avoid
complications from the anesthesia. You may need to drink only clear liquids and
take a special laxative the day before the surgery to clear your digestive
How is a radical prostatectomy performed?
The prostate is inside the pelvis and is surrounded by many
other organs, including the rectum, the bladder, and the sphincter. Many
important nerves and blood vessels also surround the prostate.
There are several methods for performing a radical
prostatectomy. The one you undergo will depend on the location of your tumor or
tumors, the extent of your cancer, and your general health and life stage.
All of these surgeries are done in the hospital and require
anesthesia to prevent you from feeling pain. General anesthesia is usually used,
so you’ll be asleep during the surgery. Epidural or spinal anesthesia can also
be used. With this type of anesthesia, you can’t feel anything below your
waist. Sometimes, both types of anesthesia are used to control potential
bleeding and to provide the best pain management.
The three main types of radical prostatectomy surgery are:
1. Open radical retropubic prostatectomy
In this surgery, the doctor makes a cut just below your
belly button down to your pubic bone. The surgeon moves aside muscles and
organs to remove the prostate, vas deferens, and seminal vesicles. Lymph nodes
are also removed. This type of surgery can also be done with a “nerve-sparing”
approach. If so, your doctor tries to not cut any of the tiny nerves that are
needed to maintain an erection. If the cancer has affected these nerves, this
may not be possible.
2. Laparoscopic radical prostatectomy
This type of surgery requires much smaller cuts into the
body. Five small “keyholes” are cut into the abdomen. Then lighted magnifying
devices and cameras are put into the holes to help the surgeon remove the
prostate without making a large cut. The prostate is removed through one of the
holes with a small bag. This type of surgery often involves less pain
afterward, requiring less recovery time. Using the “nerve-sparing” approach
with this method may not be as successful as with the “open” type of surgery.
3. Open radical perineal prostatectomy
This surgery isn’t as common as the others. The operation
involves cutting into the body through the perineum, which is the skin between
the scrotum and the anus. The prostate is removed through this incision.
However, the lymph nodes can’t be removed through this
incision. These organs can be removed through a small cut in your abdomen or
with another procedure such as laparoscopic surgery.
It’s also more difficult to preserve important nerves with an
open radical perineal prostatectomy. This surgery takes less time and involves
less blood loss than the retropubic option.
What happens after a radical prostatectomy?
You may be required to stay in the hospital for up to four
days after the surgery. You’ll be able to drink and eat normally soon after the
While recovering in the hospital you’ll have dressings over
your incision sites. You’ll also have a drain to remove excess fluid from the
surgery site. The drain will be removed after a day or two.
A catheter, or tube, will be threaded through the end of
your penis and into your urethra. The catheter will drain urine into a bag
while you’re healing. Urine that drains from the catheter may be bloody or
cloudy. You may have a catheter in place for one to two weeks.
During your recovery you may need to wear special socks. These
will prevent blood clots in your legs. You may also need to use a breathing
device to keep your lungs healthy.
If you have stitches in your incision, they’ll absorb into
your body and won’t need to be removed. You’ll be given pain medication both in
the hospital and while recovering at home.
What are the risks of radical prostatectomy?
Any surgery carries a risk for potential complications,
- blood clots in the legs
- breathing problems
- reactions to anesthesia
- heart attack
Your doctor and care team will work hard to prevent any of
Problems specific to prostate surgery can potentially
- difficulty controlling the urge to urinate
- difficulty controlling bowel movements
- a urethral stricture
- problems maintaining an erection
- injury to the rectum
What can be expected in the long-term?
Some of the nerves and blood vessels that control erection
may be damaged during the surgery. As a result, you may have difficulties
maintaining an erection after a radical prostatectomy. Medications and pumps
may be able to help you with this problem. It’s important to talk to your
doctor about management options.
After your prostate has been removed, you’ll no longer
ejaculate semen. This means you’ll be infertile. You can still be sexually
active even after prostate cancer treatment. You should still be able to have
an orgasm with stimulation to the penis.
Depending on whether surgery completely removed all cancer
cells, additional treatment with radiation or hormones may be necessary. This
is usually needed only for very aggressive cancers. PSA blood tests and a
pathology report will help you and your doctor decide if further treatment is
To maintain your health, you should get regular blood tests,
PSA levels, and CT and MRI scans, as well as regular checkups. PSA levels are
usually assessed every four to six months for the first three years after