A radical prostatectomy is an operation to remove the prostate gland and the prostate cancer within it. It is one of the main treatments that may be offered when prostate cancer is localised or, in some circumstances, locally advanced.
Whether surgery is suitable depends on the characteristics of the cancer, your general health, other treatment options and your own preferences. Age alone is not used as a simple cut-off.
Read NHS information about prostate cancer treatment.
What does the operation involve?
The aim of a radical prostatectomy is to remove the whole prostate gland. The seminal vesicles are also usually removed, and nearby lymph nodes may sometimes be removed or sampled depending on the risk that cancer has spread.
The prostate sits below the bladder and surrounds the urethra, so after the prostate is removed the bladder is reconnected to the urethra. A urinary catheter is normally needed for a period after the operation while this heals.
How is prostate surgery performed?
Radical prostatectomy can be carried out using different surgical approaches:
- robot-assisted laparoscopic surgery – keyhole surgery performed using a robotic surgical system
- laparoscopic surgery – keyhole surgery performed without a robotic system
- open surgery – surgery performed through a larger incision
Robot-assisted surgery is now widely used in UK specialist centres. The most appropriate approach depends on the centre, the surgeon’s expertise and your individual circumstances.
Read Prostate Cancer UK information about radical prostatectomy.
Who may be offered surgery?
Surgery may be considered for people with prostate cancer that has not spread to distant parts of the body and who are well enough for a major operation. NICE recommends discussing radical prostatectomy alongside other appropriate options, such as radiotherapy or active surveillance, according to the cancer risk group and the person’s circumstances.
Your specialist team should explain the possible benefits and side effects of each suitable option so that you can make a shared decision.
Read NICE recommendations on prostate cancer treatment.
Possible side effects
Radical prostatectomy can cause side effects. These vary from person to person and can improve over time.
Urinary incontinence
Some people leak urine after surgery, particularly in the weeks and months after the catheter is removed. Pelvic floor exercises are often recommended to help recovery. A smaller number of people have longer-term continence problems.
Erectile dysfunction
Problems getting or keeping an erection are common after prostate surgery. The risk depends on factors including your erections before treatment, your age, the extent and position of the cancer, and whether the surgeon is able to preserve the nerves involved in erections.
Nerve-sparing surgery may reduce the risk for some people, but it is not suitable in every case. Treatments and support are available for erectile dysfunction after surgery.
Changes to orgasm and fertility
After the prostate and seminal vesicles are removed, you will no longer ejaculate semen. You may still be able to experience orgasm, but it will be dry. Natural fertility is lost after radical prostatectomy, so anyone who may wish to have children in the future should discuss fertility preservation before treatment.
What happens after surgery?
Your PSA level should fall to a very low or undetectable level after successful removal of the prostate. You will have follow-up PSA blood tests to monitor this.
If PSA later begins to rise, this can sometimes indicate that prostate cancer cells remain or have returned. Your specialist team will discuss whether further treatment, such as radiotherapy, is appropriate.
Questions to ask your specialist
- Why are you recommending surgery for my cancer?
- What alternatives are suitable for me?
- Which surgical approach would you recommend and why?
- What are my individual risks of urinary problems and erectile dysfunction?
- Is nerve-sparing surgery possible in my case?
- What support is available after the operation?
This information provides a general introduction to prostate cancer surgery and does not replace advice from your urologist, surgeon or specialist cancer team.