Surgery to Remove Your Prostate Gland
The aim of this operation is to cure your prostate cancer. You may have it if:
- your cancer has not spread outside the prostate gland
- you are younger and have a fast growing tumour (high grade tumour)
- as part of planned treatment for locally advanced or high grade prostate cancer
Radical prostatectomy is major surgery with many possible side effects. If you are an older man with a slowly growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer may grow so slowly that you are more likely to die of old age or other causes than from the prostate cancer.
The surgeon removes the prostate gland, surrounding tissues, lymph nodes and the tubes that carry semen (seminal vesicles). This is a radical prostatectomy.
Nerve sparing prostatectomy
This type of surgery is for early prostate cancer that is inside the prostate. The cancer must be as far as possible from the 2 bundles of nerves that run alongside the prostate gland. These nerves control erections.
The aim of the surgery is to reduce the risk of having erection problems after your operation.
The surgeon cuts the prostate tissue away from the nerve bundles without damaging them. They will have to remove the nerve bundles if your cancer is growing close to the nerves or into them. Your cancer will not be cured if the surgeon leaves cancer behind in an effort to spare the nerves. Speak to your surgeon before the operation if you might have this type of surgery.
If your cancer is only on one side of your prostate, your surgeon may be able to leave the other side untouched. You might still have some difficulty with erections.
Removing lymph nodes
During your operation the surgeon examines the prostate and surrounding area. They may take out some of the lymph nodes from the area between the hip bones (pelvis). This is a bilateral pelvic lymph node dissection.
The surgeon takes out lymph nodes in case they contain cancer cells Taking the nodes out reduces the risk of your cancer coming back in the future. It also helps your doctor to decide what further treatment you may need.
The number of lymph nodes your surgeon removes varies depending on the risk of the cancer coming back.
How your surgeon does your operation
There are two types of open surgery:
- retropubic surgery, which means the surgeon makes a cut into your tummy (abdomen)
- perineal surgery, which means the surgeon makes a cut into the area between the testicles and the back passage
Doctors rarely do perineal surgery.
After retropubic surgery you will have one scar on your tummy.
Keyhole surgery is also called minimal access surgery or laparoscopic surgery. It means having an operation without needing a major cut in your tummy (abdomen).
You have this type of surgery in specialist centres by a specially trained surgeon. The surgeon makes a few small cuts in your tummy. They use a long tube called a laparoscope.
Some people will have robotic assisted laparoscopic prostatectomy (RALP). It is also called da Vinci surgery. A specially trained surgeon uses a special machine (robot) to do the operation. This type of surgery is not available in every hospital in the UK.
Having keyhole surgery
UK and USA guidelines for keyhole surgery
The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the stomach but they must:
- tell people having the surgery about the risks and benefits
- monitor people closely
- collect information about any problems people have and report on them
Researchers are looking into whether keyhole surgery is as good as open surgery.