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Learning About a Radical Prostatectomy

Location of prostate below bladder and next to rectum, showing urethra passing through prostate.

What is a radical prostatectomy?

A radical prostatectomy is surgery to remove the prostate gland. It is usually done to treat prostate cancer that has not spread out of the prostate.

The prostate is part of the male reproductive system. It is a small organ below the bladder that makes fluid for semen. The prostate surrounds the urethra. That's the tube that carries urine from the bladder out of the body through the penis.

How is this surgery done?

There are three main types of this surgery. You and your doctor can choose which type is right for you.

During surgery, the nerves that run along the sides of the prostate may be damaged or removed. These nerves affect whether a person can have an erection. In some cases, the doctor may be able to avoid damage to these nerves. This is called nerve-sparing surgery. It makes it more likely that a person can still have an erection after surgery.

Radical retropubic prostatectomy

The doctor makes a 7- to 10-centimetre (3- to 4-inch) cut (incision) in the skin between the belly button and the pubic bone. This is done to remove the prostate. Nerve-sparing may be possible with this approach.

Radical perineal prostatectomy

The doctor makes a cut between the scrotum and anus. The prostate and other tissue are then removed. This surgery does not take as long as a retropubic surgery. And it may cause less pain. But nerve-sparing is hard to do with this approach. So this surgery is not done as often as a retropubic prostatectomy.

Laparoscopic radical prostatectomy

The doctor puts a lighted tube, or scope, and other tools through a few small cuts in the lower belly. Nerve-sparing may be possible with this approach. This surgery may also be done with the help of a robot (robotic-assisted). Robotic arms translate the surgeon's hand motions into finer and more precise action.

What can you expect after a radical prostatectomy?

You will likely stay in the hospital for 1 to 3 days after surgery. Most people can go back to work or their usual routine in about 3 to 5 weeks. But it can take longer to fully recover.

A thin, flexible tube called a catheter usually is left in your bladder to drain your urine for 1 to 2 weeks.

After your surgery, you will need to have routine checks with your doctor. This includes having blood tests to measure your PSA level. PSA is a substance that can help show if your cancer has come back.

You may not need any more cancer treatment after surgery. But in some cases, you may need radiation or hormone therapy.

Erection problems and fertility

Whether you can have an erection after surgery will depend on:

  • Your age.
  • Whether you could have erections before the surgery.
  • Whether the nerves near your prostate were damaged or removed.

If the doctor removes the nerves, you will need to use medicine or other treatment to have erections from now on. If your nerves are still in place, you may not need long-term medicines or treatments. As a rule, the younger you are, the better your chances that you will still be able to get an erection. Even if your nerves are not damaged, it will probably take 3 to 12 months after surgery before you can have an erection on your own. During this time, you can use medicine or other treatments to get an erection.

If you have this surgery, you won't be able to ejaculate sperm. That's because the surgery cuts the connection between the testicles and the penis. If you want to be able to have biological children, talk to your doctor about your options. You may be able to save your sperm before the surgery.

Urinary incontinence

After this surgery, you may not be able to control when you pass urine. Or you may leak urine. This is called urinary incontinence. It may go away within weeks or months after surgery. Or it may never go away. Some people will have leakage only once in a while. But others may find it hard to control their urine all the time. Doctors can't say who will have problems and who will not. And they can't tell how long after surgery the problem may last. Medicine and exercises to strengthen the muscles that control the bladder can often help.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

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