Radical prostatectomy at Cheltenham Hospital

What is a radical prostatectomy?

A radical prostatectomy is surgery to remove the entire prostate gland, along with some of the surrounding tissue. It's carried out to treat prostate cancer.

What conditions does a radical prostatectomy treat?

This surgery is most often used when prostate cancer remains confined to the gland itself, sometimes described as localised prostate cancer. It's typically offered to men who are otherwise in good health, generally with a life expectancy stretching well beyond a decade.

What are the benefits of a radical prostatectomy?

The goal is clearing away all the cancer through a single operation. Outlook tends to be encouraging: one study found that 91 out of every 100 men were still alive a decade on from having the procedure.

Living a genuinely full, healthy life without a prostate is entirely achievable. Its removal doesn't cut life expectancy short, since nothing about staying alive depends on the gland, though fathering children naturally afterward isn't possible.

Are there different types of radical prostatectomy?

• Retropubic surgery, opening things up from just beneath the navel down to the pubic area, generally lasting an hour and a half up to four hours.
• Laparoscopic surgery, working through several smaller openings rather than one larger wound, with slender tools and a camera fed through them.
• Robotic surgery, a variation on the keyhole approach where robotic technology assists the operation, your surgeon directing the instruments and camera from a console positioned nearby; this isn't offered at every hospital.
• Perineal surgery, cutting through the skin in the area lying between the back passage and where the scrotum begins; generally quicker with less blood lost, though it makes avoiding nerve damage or reaching nearby lymph nodes considerably harder, so this route is seldom chosen.

Whichever technique applies, your surgical team takes out the gland itself alongside two small fluid-filled pouches beside it, called the seminal vesicles, working carefully throughout to limit any harm to nearby nerves and vessels. What's left of the waterworks then gets rejoined to the bladder, and nearby lymph nodes sometimes come out too, checked afterwards for any sign of cancer.

Nerve-sparing surgery might come up in conversation with your surgeon too, an approach geared toward protecting the nerves responsible for erections wherever that's genuinely achievable.

What happens before radical prostatectomy?

Expect a thorough physical check, with your urologist making sure anything else going on, diabetes or high blood pressure, for instance, is properly under control beforehand. Mention any medicines you're taking, prescription or otherwise, and flag it if you regularly have more than 14 units of alcohol a week.

• Certain blood-thinning medicines, aspirin or warfarin among them, may need pausing in the weeks running up to surgery
• Cutting back on or giving up smoking altogether can lower your chances of complications
• Sticking to clear liquids the day before tends to be standard, sometimes alongside something to clear your bowel out beforehand
• Follow guidance on exactly when to stop eating and drinking, and sort out a lift home in advance.

What happens during a radical prostatectomy?

1. You're put under with a general anaesthetic, or occasionally given a spinal or epidural instead to temporarily block sensation below the waist.
2. Your surgical team removes the prostate gland along with the seminal vesicles, working to limit damage to nearby nerves and blood vessels.
3. What remains of the waterworks gets reattached to the bladder so passing urine functions as normal again.
4. Nearby lymph nodes sometimes get removed too, examined afterward for signs of cancer.
5. A thin tube may stay in the abdomen briefly to clear excess fluid, alongside a separate tube draining the bladder.

The operation generally spans somewhere around two to four hours, depending on which technique your surgeon uses.

What does recovery look like?

A hospital stay of roughly a handful of days is typical, though those having keyhole or robotic surgery sometimes head home the very next day.

Staying in bed until the following morning tends to be the norm, after which getting up and moving as much as feels reasonable gets actively encouraged. Nursing staff will show you how to shift position safely and run through exercises to keep circulation going, along with breathing techniques aimed at warding off chest infections.

Compression stockings sometimes get added as protection against clots, alongside pain relief and the occasional bladder spasm along the way. You'll likely go home with a drainage tube still fitted, staying in anywhere from several days out to a handful of weeks.

Once home, tiredness and a genuine need for extra rest across roughly a month is common, with soreness around your abdomen or the area near your scrotum easing gradually over two to three weeks or so.

What are the risks and complications?

Possible risks of a radical prostatectomy include:

• difficulty controlling your urine
• trouble getting or keeping an erection
• injury to the back passage
• narrowing of the urinary opening caused by scar tissue
• loss of natural fertility, a lasting effect since the tubes carrying sperm come away during surgery
• a small chance of needing a blood transfusion, generally affecting fewer than 1 in 100 people.

Shifts in sexual function are widely reported after this particular operation. Your surgeon may raise nerve-sparing techniques beforehand as a way of lowering this risk, though whether it's genuinely an option depends on exactly where the cancer sits.