Prostate cancer - prostatectomy

What is a prostatectomy?

A prostatectomy or radical prostatectomy is the operation for treating prostate cancer. The overall aim is to cure the patient of prostate cancer by removing the entire prostate and seminal vesicles. A radical prostatectomy is offered to patients who are younger, whose prostate cancer has not spread out of the prostate, and who are fully informed of the potential benefits and possible adverse outcomes. Typically this means a radical prostatectomy is for those men who are at risk of dying from their prostate cancer if it is not successfully treated. A radical prostatectomy is major surgery which does have associated side effects. Due to the nature of the surgery only specialist urological surgeons perform this operation either through open surgery which is known as "Open Prostatectomy" or keyhole surgery known as "Laparoscopic Prostatectomy".

Open Prostatectomy

This involves a single large abdominal opening through which the whole of the prostate gland and the seminal vesicles are removed. This is major abdominal surgery and carries with it the side effects of abdominal surgery and a long recuperation period.

Laparoscopic Prostatectomy

Using the keyhole surgery technique, the surgeon makes five small incisions through which a small camera and light provide a magnified view of the patient's anatomy. The surgeon removes the prostate gland and the seminal vesicles using small instruments which enter the abdominal cavity through the small incisions made. The prostate and seminal vesicles are then removed through one of the small incisions. The major advantage of this method of surgery is that there isn't one big wound and the avoidance of open surgery increases the likelihood of a shorter recuperation period.

The following lifestyle changes can help make the operation a success:

• Giving up smoking
• Eating healthily. If overweight, you have a greater chance of developing complications
• Exercising regularly. (Your GP can recommend exercises.)

Possible complications

• Pain, which happens with every operation
• Bleeding during or after surgery Infection in the surgical wound, which may need treatment with antibiotics
• Discomfort or pain in the groin

With either method there is a risk post-operatively of urinary incontinence and impotence. Many skilled specialist urologists practice nerve sparing prostatectomy where they aim to cut the prostate gland out protecting these important nerve pathways to minimise the chances of these side effects occurring.

Recovery

Irrespective of the method of surgery, a urinary catheter will be necessary post-operatively. Usually 2-3 weeks post-operatively, the catheter is removed. In total it takes about 3 weeks to recover from laparoscopic surgery and a few weeks longer to recover from open prostatectomy. You are safe to drive as soon as you are comfortable enough to brake hard to avoid a possible accident (usually by 10 days).

Cancer Checks Post Operatively

At the time of surgery, the prostate gland and seminal vesicles are taken away for histology. Whilst the aim of the prostatectomy is to remove the cancer, occasionally (around 10-15%) there are cancerous cells identified at the outer margin of the removed prostate. In roughly half of these cases additional treatment such as radiotherapy or hormone therapy is advised to increase the chance of a successful outcome. The PSA level is also monitored post operatively at each outpatient appointment. Initially you will be seen every 3 months for a year, every 6 months for 5 years and then annually until 15 years.

Paying for your procedure

The costs of this procedure are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost of the operation will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.

For further information or to book a consultation or treatment, please get in touch with our cancer enquiries team: Call us on 0800 157 7747

Content reviewed by Mr Ian Dunn MBChB FRCS (Urol), Consultant Urological Surgeon: September 2014