Radical Prostatectomy

A prostatectomy (more specifically, a radical prostatectomy) is a surgical treatment for localized prostate cancer, where the goal is to remove the entire prostate gland and the tissue around it. In many cases, the nearby seminal vesicles are also removed, and some pelvic lymph nodes may be removed to check whether the cancer has spread.

When is a radical prostatectomy recommended?

It is commonly considered for people who:

• Have localized prostate cancer (the cancer is confined to the prostate).
• Have locally advanced disease in selected cases, often as part of a broader treatment plan.
• Are healthy enough to undergo surgery and have a life expectancy of around 10 years or more.

Your healthcare team will also consider factors such as:

• PSA level
• Biopsy results (including the Gleason score or Grade Group)
• MRI and other imaging findings
• Age, overall health, and personal preferences

Types of surgery

There are three main approaches:

• Robot-assisted laparoscopic prostatectomy (the most common in many centres today)
• Laparoscopic (keyhole) prostatectomy
• Open radical prostatectomy

All aim to achieve the same cancer control. Robot-assisted surgery may offer smaller incisions, less blood loss, and a quicker recovery, but long-term cancer outcomes are generally similar when performed by experienced surgeons.

Benefits

Potential benefits include:

• Removing the cancer completely if it is confined to the prostate.
• Providing detailed information about the cancer by examining the removed tissue.
• Allowing PSA levels to be monitored afterward; PSA should become very low or undetectable if all prostate tissue has been removed.

Risks and side effects

Like any major operation, prostatectomy has risks, including:

• Bleeding
• Infection
• Blood clots
• Temporary pain and fatigue

Longer-term side effects may include:

• Urinary incontinence: Leakage of urine is common initially after surgery. Most people improve over several months, though some have persistent leakage.
• Erectile dysfunction: Damage to the nerves that control erections can occur. Recovery depends on age, erectile function before surgery, whether nerve-sparing surgery is possible, and other factors. Improvement may continue for up to two years or longer.
• Infertility: Removal of the prostate means semen is no longer ejaculated, so natural conception is no longer possible.
• Less commonly, narrowing of the urethra or swelling of the legs if lymph nodes are removed.

Recovery

Typical recovery includes:

• A hospital stay of 1–3 days (varies by hospital and surgical approach).
• A urinary catheter for about 1–2 weeks.
• Light activities within a few days, with gradual return to normal activities over 4–6 weeks.
• Avoiding heavy lifting for several weeks.
• Pelvic floor exercises, which can help improve urinary control.

Is surgery always the best treatment?

Not necessarily. Other options may be equally appropriate depending on the stage and characteristics of the cancer:

• Active surveillance for some low-risk cancers.
• Radiotherapy (external beam radiotherapy or brachytherapy), often with hormone therapy for higher-risk disease.
• Hormone therapy.
• Other treatments in selected situations, such as focal therapy or systemic treatments for more advanced cancer.

For many people with localized prostate cancer, surgery and radiotherapy offer similar chances of curing the cancer, but they have different side-effect profiles. The decision often comes down to balancing these risks and benefits based on individual priorities.

Robotic Prostatectomy

Surgeon: Mr Paul Butterworth, Consultant Urologist , MD, FRCS (Urol) and patient Michael Newell discuss his recent prostate cancer  Robotic surgery that took place at Dept of Urology Leicester General Hospital, University Hospitals Leicester.

Leicester General – DaVinci Surgical Robot

Robot-assisted Radical Prostatectomy (RARP)

This animation shows how a robot-assisted radical prostatectomy procedure is performed. Radical prostatectomy is the removal of the entire prostate and the seminal vesicles. This procedure is performed under general anaesthesia.

Understanding Robotic-Assisted Radical Prostatectomy

linical Champions Wissam Abou-Chedid and Maria Innes from the Stokes Centre for Urology at Royal Surrey talk through radical prostatectomy treatment, exploring what to expect and some side effects to support men in making an informed decision when choosing treatment options.

Radical prostatectomy, 3 most common questions I get asked

The Prostate Clinic – Australia

Radical prostatectomy: all about the prostate-removing surgery

Robotic Prostatectomy vs Radiation – Which Gives Better Results?

Whether you’re looking into robotic urology surgery or exploring the realm of oncology tips for better cancer prognosis, this video aims to provide a comprehensive overview of what to expect from surgery and radiotherapy, helping you navigate the complex landscape of prostate cancer treatment and post-surgery care.

F&Q about radical prostatectomy – A patients view.

Listen to Urologist Marcus, quizzing radical prostatectomy patient Denzil, about his experience of having surgery for prostate cancer. Chapters 00:00 Introduction from urologist and patient 0:43 What treatment did you have and why? 3:30 What were you main anxieties before surgery? 6:27 What lifestyle advice were you given pre-surgery? 9:24 Did you meet a clinical nurse specialist? 10:36 Blood thinning injections and catheters 11:56 Constipation 13:52 What other information would have been helpful? 16:38 Tips for others planning to have a radical prostatectomy.