Prostate Cancer Surgery 101

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When a man is diagnosed with prostate cancer and surgery is proposed as an option, the decision to move forward should be made only after the patient and his loved ones, along with his medical team, have fully evaluated all of the pros and cons, short-term and long-term side effects, postsurgical needs, and prognosis while also considering the man’s lifestyle, physical and emotional state, support systems, and financial means.

Basically, because prostate cancer is typically a slow-growing disease, men usually have time to arrive at their decision. Once the prostate has been removed, there’s no going back. The procedure is especially delicate because of the gland’s location and proximity to the urethra as well as the presence of multiple nerve endings. Damage to these nerves can result in loss of sexual function; that is, erectile dysfunction. This is why many surgeons attempt to do a bilateral nerve-sparing radical prostatectomy, which helps preserve the surrounding nerve structures.

What happens during prostate cancer surgery?

Radical prostatectomy is a surgical procedure that involves removing either part or all of the prostate gland and some surrounding tissue, the seminal vesicles, and lymph nodes. The surgery can proceed in several ways:

  • Open radical prostatectomy (open prostatectomy), which is not performed as much today as it used to be. It involves the surgeon making a large incision in the lower abdomen to remove the prostate.
  • Laparoscopic radical prostatectomy, in which the surgeon makes several minute incisions in the lower abdomen and inserts special tools that help remove the prostate.
  • Robot-assisted radical prostatectomy, in which surgeons make several small incisions in the lower abdomen and then use a computer-assisted mechanical device (robot) to remove the prostate.

Before you undergo prostatectomy, your doctor may prescribe an antibiotic to help avoid the risk of infection. As part of your preparation for surgery, you will be given a general anesthetic, although infrequently surgeons use a spinal anesthetic or give intrathecal injections.

Risks of prostatectomy (prostate cancer surgery)

The risks associated with undergoing radical prostatectomy include the following. You should discuss these and any questions regarding the possible consequences and side effects of prostatectomy with your doctors.

  • Bleeding
  • Urinary tract infection
  • Erectile dysfunction, which occurs in up to about 70 percent of men and can last for years
  • Rectum injury (rare)
  • Urinary incontinence, which affects nearly all men to some degree following prostatectomy and can last for about 12 months
  • Development of cysts that contain lymph (known as lymphoceles)
  • Narrowing of the urethra or neck of the bladder

Note the risk of complications associated with open prostatectomy compared with laparoscopic or robotic prostatectomy can be significant. For example:

  • The need for a blood transfusion in open surgery was 20.8 percent compared with 7 percent in men having laparoscopic surgery
  • Rate of respiratory complications was 6.6 percent among open surgery patients and 4.3 percent in minimally invasive surgeries

What to expect after prostate cancer surgery

After surgery you can expect the following:

  • You will likely be up and walking either on the day of surgery or the day after.
  • You can go home usually the day after surgery if your doctor decides it is safe for you to do so.
  • You will be sent home while the catheter is still in place, and your doctor or another healthcare professional will explain how to take care of it
  • Resume your typical activity level gradually. It usually takes four to six weeks to return to your normal presurgery routines
  • Do not return to driving until the catheter has been removed, you are not taking prescription pain medication, and your doctors have deemed you to be fit
  • Return to sexual activity within several weeks of surgery or as noted by your physician. Continued sexual activity is healthy physically, emotionally, and mentally. However, because of the high rate of sexual dysfunction (e.g., erectile dysfunction) that occurs following prostatectomy, men and their partners are encouraged to seek help in this area, such as penile rehabilitation and sex counseling.
  • Post surgery, some men ejaculate very little or no semen even though they experience an orgasm. This is normal. Another possibility, seen in about 20 percent or more of men, is climacturia, which means men ejaculate urine. This is often accompanied by a decline in sex drive and less sexual satisfaction.

Robot-assisted prostatectomy can result in reduced pain and blood loss, reduced tissue trauma, a shorter hospital stay, and a quicker recovery period than a traditional prostatectomy. You usually can return to normal activity, with minor restrictions, two to four weeks after surgery.

Bottom line

Choosing prostatectomy is a life-changing decision. Because prostate cancer is slow growing in the majority of cases, men are encouraged to not rush into making a decision and to carefully review all of their options and information about the surgery.

Read more in our Prostate Cancer Health Center.

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