Radical prostatectomy is surgery that attempts to cure prostate cancer by removing the entire prostate gland plus some of the tissue around it, including the seminal vesicles. Because prostate cancer may be scattered throughout the prostate gland randomly, the entire prostate must be removed to avoid leaving cancer cells behind.

When is surgery a viable treatment for prostate cancer?

Surgery is an option if the cancer is thought to be confined within the prostate gland (stage T1 or T2 cancers). Men with a PSA level less than 20 and a Gleason score of less than 8 have a higher likelihood of cure. Prostate cancer surgery is usually restricted to men who have a 10-year or more life expectancy assessed by both patient age and health.

What are the advantages of radical prostatectomy?

The goal of radical prostatectomy is to remove the prostate gland, containing the cancer cells. This assumes all the cancer cells are removed at the time of surgery. Surgery can provide immediate pathology results (seminal vesicle invasion, capsular penetration, margin status) and allows for an early determination of post-operative PSA status. These are potential indicators of remission and the need for post-operative radiation therapy.

What happens during a radical prostatectomy?

You will either be under general anesthesia (asleep) or be given spinal or epidural anesthesia (numbing the lower half of the body) along with sedation during the surgery. In the procedure used most often, the surgeon makes an incision in your lower abdomen, from the belly button down to the pubic bone.

If there is a reasonable chance the cancer may have spread to the lymph nodes, the surgeon may remove lymph nodes from around the prostate at this time. If any of the nodes contain cancer cells, indicating the cancer has spread, the surgeon will not continue with the surgery because it is unlikely that the cancer can be cured.

The surgeon will pay close attention to the two tiny bundles of nerves that run on either side of the prostate. These nerves control erections. If you are able to have erections before surgery, the surgeon will try not to injure these nerves. If the cancer is growing into or very close to the nerves the surgeon will need to remove them. If they are both removed, you will be impotent. If the nerves on one side are removed, you still have a chance of keeping your ability to have an erection, but it is lower than if neither were removed. If neither nerve bundle is removed you may be able to function normally. Usually it takes at least a few months after surgery to have an erection because the nerves have been handled during the operation and they recover slowly.

How long does the procedure take?

The operation will last up to 4 hours.

How long will it take to recover from prostate cancer surgery?

After the surgery, while you are still under anesthesia, a catheter will be put in your penis to help drain your bladder. The catheter usually stays in place for 1 to 3 weeks while you are healing. You will be able to urinate on your own after the catheter is removed. After surgery you will stay in the hospital for about 3 days and will probably be away from work for about a month.

What are the risks associated with prostate cancer surgery?

The risks with radical prostatectomy are much like those of any major surgery, including risks from anesthesia. Among the most serious, there is a small risk of heart attack, stroke, blood clots in the legs that may travel to your lungs, and infection at the incision site. Because there are many blood vessels near the prostate gland, another risk is bleeding during and after the surgery. You may need blood transfusions, which carry their own small risk. In extremely rare cases, people die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

What are the possible side effects of radical prostatectomy?

Long-term complications after surgery are primarily urinary incontinence and loss of erections (erectile dysfunction).

• Urinary Incontinence: Short-term incontinence after radical prostatectomy is common. Although many men will require a protective pad for several weeks or months after surgery, most men will eventually recover urinary control. Long-term (after 1 year) incontinence requiring a protective pad is rare with occurrence in less than 5 percent of all surgical cases, although up to 15 percent of men will have a small degree of urinary leakage (stress incontinence) when straining the abdominal muscles through vigorous exercise, or activities such as lifting, coughing, and sneezing.
• Impotence: The average time until recovery of erections sufficient for intercourse is 4 to 9 months, but in some men it takes longer. Erections usually improve with time, for as long as 2 to 3 years after the operation, because nerve fibers recover slowly. During the first several months, you will probably not be able to have a spontaneous erection. Your ability to have an erection after surgery depends on your age, your ability to get an erection before the operation, and whether the nerves were cut. Everyone can expect some decrease in the ability to have an erection. The medical literature reports a wide range of impotency rates. For example, some cancer centers that perform many radical nerve-sparing prostatectomies report impotence rates as low as 25 percent to 30 percent for men under 60, and as low as 10 percent for men under 50. However, other doctors have reported higher rates of impotence in similar patients. Impotence occurs in about 70 percent to 80 percent of men over 70, even if nerves on both sides are not removed.
• "Dry" orgasm: After surgery you will no longer ejaculate semen because during the prostatectomy, the glands that made most of the fluid for semen (the seminal vesicles and prostate) were removed, and the pathways used by sperm (the vas deferens) were cut.

When can I resume normal activity after the surgery?

Usually between 3 and 6 weeks.

Will I know if I am cured after surgery?

Not completely. Your prognosis will vary depending on the severity of the cancer removed. You will require periodic PSA testing for a number of years and your PSA needs to remain undetectable or less than 0.1 ng/ml.

What is the outcome of radical prostatectomy?

Success rates for a radical prostatectomy can range from 30 to 98 percent, depending on the extent to which the prostate cancer may have spread outside of the prostate. Studies have shown success rates between 76 to 98 percent for low-risk disease; 60 to 76 percent for moderate-risk disease; and 30 to 76 percent for high-risk disease. It is also recognized that the experience of the surgeon is important; surgeons have greater success rates and lower complication rates if they routinely perform the procedure.