Surgery

There are several surgical treatments for prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. The surgical removal of all or part of the prostate glandAn organ with the ability to make and secrete certain fluids. is called prostatectomy and the aim is to remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. if it is only in the prostate glandAn organ with the ability to make and secrete certain fluids. and to stop it spreading outside the prostate.

Recommended if you:

  • Have localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Do not have any pre-existing significant medical condition, and are healthy enough to have a general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body..

There is a choice of operation depending on various considerations, including the stage of the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and the particular symptoms that you may be experiencing:


Brief animation showing you what happens during the TURP operation

Following surgery

In the following sections, the common side effects or risks for each treatment option are highlighted.

Your doctor will tell you what to look out for following surgery. If you notice any of the following, you should contact your doctor immediately:

  • Your bladderThe organ that stores urine. feels full but you cannot pass urine
  • You pass large amounts of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. in your urine
  • You develop signs of an infectionInvasion by organisms that may be harmful, for example bacteria or parasites., such as high temperature, painful urination, swollen testicles or smelly urine
  • You get pain or swelling in your legs.

Radical prostatectomy

The most common surgery for treating prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is radical prostatectomyThe surgical removal of the entire prostate gland., sometimes called total prostatectomy. It involves the removal of the entire prostate glandAn organ with the ability to make and secrete certain fluids. and some surrounding tissues (the seminal vesicles). The aim of this operation is to remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. if it is contained within the prostate and to stop it spreading outside the prostate.

Recommended if you:

  • Have intermediate or high-risk, localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Are fit enough for surgery.

Radical prostatectomy may be suitable for some men who have locally-advanced prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. As there is an increased risk of spreading the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., the operation is not recommended for every man.

This operation is performed under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body. by your surgeon, who makes a small incision in the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. below your navel (a retropubic radical prostatectomyThe surgical removal of the entire prostate gland.) or in the area between the testicles and the rectum The last part of the large intestine, where faeces are stored before being passed.(a perineal radical prostatectomyThe surgical removal of the entire prostate gland.). The method used usually depends on your surgeon.

Two approaches to radical prostatectomy

There are very few differences in the overall outcome, whether the retropubic or perineal approach is used. However, some recent research shows that there is some variation in the short-term differences between the two approaches.

Erectile function and continence can return to normal slightly sooner when a retropubic radical prostatectomyThe surgical removal of the entire prostate gland. is performed. Perineal radical prostatectomyThe surgical removal of the entire prostate gland. is less invasive and a slightly shorter operation.

In both approaches, the entire prostate glandAn organ with the ability to make and secrete certain fluids. is removed. To increase the chances of removing all the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells, your surgeon may also remove some of the tissue A group of cells with a similar structure and a specialised function.(the seminal vesicles) that surrounds the prostate glandAn organ with the ability to make and secrete certain fluids..

Your surgeon may be able to use a type of surgery that avoids damaging the nerves that control erections (nerveBundle of fibres that carries information in the form of electrical impulses.-sparing surgery). This may not always be successful, and it may not remove all of the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., so you should discuss this fully before the operation.

The operation takes between two and four hours. You will probably need to stay in hospital for up to a week and may be given pain medication if you need it. You will be fitted with a catheterA tube used either to drain fluid from the body or to introduce fluid into the body. for up to three weeks so that you can pass urine while you heal from the surgery. You may be unable to return to work for up to a month.

Side-effects of radical prostatectomy

Possible side effects of a radical prostatectomyThe surgical removal of the entire prostate gland. can include urinary incontinenceThe involuntary passage of urine or faeces. and problems getting or keeping an erectionThe enlarged, rigid state of the penis during sexual arousal.. There is considerable variation between individuals in the severity and type of side effects.

It is important to talk to your surgeon about the latest developments in this type of surgery, and what they mean for your own chances of developing incontinenceThe involuntary passage of urine or faeces. or problems having sex.

Advantages of radical prostatectomy

  • If the tumour is fully removed, this surgery can completely cure the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Radical prostatectomy produces good results for the majority of men
  • For men who also have benign prostatic hyperplasiaEnlargement of the prostate, which may cause difficulty in passing urine. (BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine.), radical prostatectomyThe surgical removal of the entire prostate gland. offers a 'double cure' as by removing the prostate, the source of BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine. symptoms is also removed
  • The tissues removed can be checked to ensure that the cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells have been taken away.

Disadvantages of radical prostatectomy

  • There is a chance that cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. will return
  • Erectile dysfunction
  • Problems with ejaculationThe discharge of semen from a man’s penis at the time of sexual climax.
  • Problems with bowel function
  • Urinary incontinenceThe involuntary passage of urine or faeces.
  • General risks of surgery: bleeding, infectionInvasion by organisms that may be harmful, for example bacteria or parasites., bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots, reaction to anaestheticA medication that reduces sensation..

Laparoscopic radical prostatectomy

In laparoscopic radical prostatectomyThe surgical removal of the entire prostate gland., the surgeon removes the entire prostate and some of the surrounding tissues using special instruments that only require small cuts (about 1 cm each) to be made in the skin of the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.. Carbon dioxide gas is pumped into the abdominal cavityThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs. to inflate it and this enables the surgeon to see the operation site clearly through a tiny video camera linked to a television monitor. The aim of this operation is to remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. if it is contained within the prostate, along with some of the surrounding tissues to stop the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. spreading.

Recommended if you:

  • Have intermediate or high risk localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Are fit enough for surgery.

Radical prostatectomy may be suitable for some men who have locally-advanced prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. As there is an increased risk of spreading the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., the operation is not recommended for every man.

In some countries, robotic-assisted surgery is being used to treat prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., using the da Vinci robot. Under the control of the surgeon, a manipulator arm equipped with sensors can be programmed to carry out delicate manoeuvres with great precision, guided by the results of computer imaging tests. This improves the surgeon's ability to operate through the small incisions made for laparoscopic surgery. The robotic arm guides the instruments and helps to increase accuracy in removing the prostate, while minimising trauma to healthy tissue in the surrounding area. This type of operation is called robotic laparoscopic radical prostatectomyThe surgical removal of the entire prostate gland..

Robotic surgery

Research has shown that both laparoscopic and robotic laparoscopic radical prostatectomies are as effective as the open type of radical prostatectomyThe surgical removal of the entire prostate gland. in treating localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Advantages of laparoscopic radical prostatectomy

  • If the tumour is fully removed, this surgery can completely cure the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • Radical prostatectomy produces good results for the majority of men
  • For men who also have benign prostate hyperplasia (BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine.), radical prostatectomyThe surgical removal of the entire prostate gland. offers a 'double cure' as by removing the prostate, the source of BPHAn abbreviation for benign prostatic hyperplasia, which is enlargement of the prostate that may cause difficulty in passing urine. symptoms is also removed
  • The tissues removed can be checked to ensure that the cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. cells have been taken away.

Disadvantages of laparoscopic radical prostatectomy

  • There is a chance that cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. will return
  • Erectile dysfunction
  • Problems with ejaculationThe discharge of semen from a man’s penis at the time of sexual climax.
  • Problems with bowel function
  • Urinary incontinenceThe involuntary passage of urine or faeces.
  • General risks of surgery -bleeding, infectionInvasion by organisms that may be harmful, for example bacteria or parasites., bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots, reaction to anaestheticA medication that reduces sensation.
  • Other risks include damage to the intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus. and release of gas bubbles into the bloodstream.

Compared with open surgery, in laparoscopic prostatectomy:

  • There is significantly less bleeding and less scarring
  • You only have to stay in hospital for a short time - 50 per cent of men are discharged after one day
  • There is less pain when you are discharged from hospital
  • You should be able to return to work two to three weeks after the operation
  • The chances of completely removing the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. are higher
  • The chances of the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. not returning may be improved
  • There is a similar risk of bladderThe organ that stores urine. problems
  • The risk to your ability to get and maintain an erectionThe enlarged, rigid state of the penis during sexual arousal. is similar
  • You may be anaesthetised for a longer time.

Transurethral resection of the prostate (TURP)


Brief animation showing you what happens during the TURP operation

If a growing cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is squeezing the urethra enough to cause problems with urination, your doctor may recommend you have a TURP. The aim of this operation is not to remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. It is to remove some prostate tissue to reduce pressure on the urethra.

A TURP is recommended if your problems urinating are having a significant impact on your quality of life.

TURP involves passing a thin tube (called a resectoscope) through the urethra into the prostate. The tube contains a miniature camera and an instrument to cut away areas of the prostate glandAn organ with the ability to make and secrete certain fluids. that press on the urethra. Water solution is used to wash the tissue back up into the bladderThe organ that stores urine., which then flushes it away naturally.

This surgery takes about 90 minutes and can be done under general anaestheticAny agent that reduces or abolishes sensation, affecting the whole body. or using an epiduralOn or over the dura mater, the outermost of the three membranes covering the brain and spinal cord. The epidural space is used for anaesthetising spinal nerve roots, for example during pregnancy. - where your lower body is numbed by an anaestheticA medication that reduces sensation. injection into the spine. This means that you can remain awake during the operation and there is a lower risk of side effects, although no anaestheticA medication that reduces sensation. is without risks.

You may need to stay in hospital and have a catheterA tube used either to drain fluid from the body or to introduce fluid into the body. for a few days afterwards. It is normal to have bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots in your urine following this procedure, and you may need to have these flushed out to prevent the catheterA tube used either to drain fluid from the body or to introduce fluid into the body. becoming blocked.

Advantages of transurethral resection of the prostate

  • Fast relief from problems with urination.

Disadvantages of transurethral resection of the prostate

  • Blood clots in your urine
  • Excessive bleeding
  • Erectile dysfunction
  • Ejaculatory problems
  • Incontinence
  • Recurring urinary tract infections
  • Narrowing of the bladderThe organ that stores urine. neck (stricture)
  • General risks of surgery: bleeding, infectionInvasion by organisms that may be harmful, for example bacteria or parasites., bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots, reaction to anaestheticA medication that reduces sensation.
  • Risk of TUR syndrome: can cause abdominal cramps, nausea, vomiting, lethargy and dizziness.

There are a number of variations of the TURP procedure. For example, transurethral electrovaporisation of the prostate A gland that surrounds the urethra near the bladder. It produces a fluid that forms part of the semen. (TUVP) is a similar procedure using a high-frequency electrical current to cut and vaporise excess tissue, while sealing off the remaining tissue to prevent bleeding.