Radical Prostatectomy

Indications:

A radical prostatectomy is carried out for prostate cancer confined within the prostate in a healthy male.

Surgery:

The operation is performed under general anaesthetic, through an incision in the abdomen.

It is common for the anaesthetist to place a fine tube in the space around the spinal cord, known as an epidural anaesthetic. This greatly reduces post-operative pain, and quickens recovery.

The first step of the operation is to evaluate and remove the lymph glands that drain the prostate. It is important to determine whether these glands contain tumour cells. This is usually done after the operation has been completed, where all of the specimens are examined in the laboratory under the microscope. Very occasionally, if the lymph glands are obviously enlarged, the surgeon may send these for immediate analysis whilst you are under anaesthetic.



The prostate is removed in its entirety, along with the seminal vesicles (the glands that contain the fluid component of semen).

A vasectomy is required as part of the operation. In many cases, your surgeon will attempt to conserve the nerves responsible for initiating erections. If the cancer is close to the surface of the prostate, the nerve on the affected side may be removed with the prostate.

After the prostate and
related structures have been removed, the bladder outlet is reconstructed, and joined directly onto the urethra (waterpipe) over a catheter. A drainage tube is placed at the site of the operation, and passes out of the body through a small, separate incision.

Post-Operative Recovery:

Most patients require careful observation in the first 24 hours after this operation, and it is common for this to be done in a high-dependency unit. Regular observations and blood tests are performed. Patients are usually returned to the ward on the second post-operative day, and fluids, followed by a normal diet, are re-established. The drainage tube is removed on the second post-operative day, assuming minimal drainage is required. Pain relief is often given in the form of a continuous pump, and a top-up button which you can press as you feel necessary. The epidural tube is usually removed after 48 hours, and the catheter after one week.
It is common to leak urine when you cough, sneeze, or strain. Pelvic strengthening exercises are usually commenced after the catheter is removed. Permanent incontinence is unusual (2-3%), however, impotence (which can occur even if the nerves are spared) occurs in approximately 50% of all cases.
Skin stitches or clips are removed after 10-14 days. The period of hospitalisation is, on average, between 5 and 7 days. You should rest at home for several weeks, and should avoid heavy lifting for a period of 3 months to prevent a hernia developing.
If all of the prostate tissue and cancer has been removed, your PSA (Prostate Specific Antigen) level should become, and remain, undetectable. This will be checked initially every 3 months. A rising PSA following this procedure, may indicate a few cancer cells are left behind, and further treatment, depending on the rate of rise of PSA, is usually required.