Radical Prostatectomy

Surgery to remove the entire prostate and the seminal vesicles (glands that secrete part of the ejaculate) is called a radical prostatectomy (see Figure 1). Like any major surgery, it has risks, and is usually offered to healthy men who have at least a 10-year life expectancy.

The operation can be done by open surgery or by a ‘keyhole’ (laparoscopic) approach. The keyhole approach involves making several small openings in the abdomen. The surgeon may control the instruments using a ‘robot’. Keyhole surgery can take longer, but blood loss is usually less and recovery time and hospital stay shorter. Depending on whether the surgery is open or keyhole, hospital stay is 1–6 days with a recovery period of 3–6 weeks before returning to work or energetic activities such as heavy lifting.

Open and keyhole approaches have similar results. The surgeon’s experience (number of operations performed) in using either approach is important for a good outcome.
Potential long term side effects of a radical prostatectomy are poor erections (impotence) and urinary leakage (incontinence). Because the prostate lies next to nerves and blood vessels that are important for erections, this operation carries a high risk of poor quality erections (70–90% of cases in an Australian study) (1). If the cancer is small, and the nerves controlling erections can be spared, impotence rates are at the lower end of this range. A nerve-sparing operation is less likely to be possible if your cancer is high risk (see Table 1).

The prostate lies at the opening or ‘plug hole’ of the bladder and surrounds the urine outflow tube (urethra). Mild to moderate urine leakage can occur after the operation. Urinary incontinence occurred in 9–16% men in the Australian study1 with severe incontinence at the lower end of this range.

The effectiveness of radical prostatectomy in treating localised cancer is very good: up to 88% of men with localised cancer remaining cancer-free at 12 years compared with 54% of men who did not have surgery (2). For this reason, it is offered as a potentially curative treatment.

Figure 1: The area removed in a radical prostatectomy

Male Reproductive System

Table 1: Assessing risk

Risk Stage, Gleason score and PSA Chance prostate cancer is confined to the prostate
Low Gleason 2–6
PSA less than 10
Cancer can’t be felt or is felt
in only a small area
High
Medium Gleason 7
PSA 10–20
Cancer can be felt in a larger area
Moderate
High Gleason 8–10
PSA greater than 20
Cancer can be felt extending outside the prostate
Low

 

Sources

1. Smith DP, et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. British Medical Journal 2009;339(2):4817.

2. Bill-Axelson A, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. New England Journal of Medicine 2005;352(19):1977–84.

Phone

National Cancer Helpline: 13 11 20

Disclaimer

This information sheet is not intended to take the place of medical advice. Information on prostate disease is constantly being updated. We have made every effort to ensure that information was current at the time of production; however your GP or specialist may provide you with new or different information that is more appropriate to your needs.

Copyright

© Repatriation General Hospital, 2013.