What is a radical prostatectomy?

  • A radical prostatectomy is the surgical removal of your prostate gland, the cancer inside it and the seminal vesicles.
  • Watch our short animation to learn more about radical prostatectomy.

     

Important things to know

Who can have a radical prostatectomy?

You can have a radical prostatectomy if:

  • Your prostate cancer is contained within your prostate (localised or early stage)
  • Your cancer has spread to the area just outside of the prostate (locally advanced).

     

Who can’t have a radical prostatectomy?

You cannot have a radical prostatectomy If you have other health conditions such as:

  • Heart disease 
  • Problems with your lungs. 

Speak to your doctor about any other health conditions you have. 

Benefits of treatment

  • If your cancer is contained within your prostate, taking it out may remove all of your cancer. This means you may not need any other treatment.
  • If your cancer does come back, you will still be able to have other treatment.
  • 99 out of 100 people who chose to have a radical prostatectomy were still alive at 10 years. 
Radical prostatectomy overall survival
  • This figure only applies for those with Cambridge Prognostic Group 1, 2 and 3 localised prostate cancer. Ask your doctor or nurse specialist if you are unsure of your grading. Also, take a look at our page on the grading and staging of prostate cancer (link will open in a new tab).
  • For more accurate and personalised information on the likely risk and benefit from treatment you can visit the Predict website (this will open an external tab). This site is best used with the support of a healthcare professional. 
Image
Ian
“I would have the same treatment again, because if I can go back in time, I know how it happens and it worked well for me and has been successful.”
Ian
Frequently asked questions (FAQs) about radical prostatectomy

The surgeon will take out:

  • Your prostate and the cancerous cells inside it
  • The seminal vesicles (two glands next to the prostate that make some of the fluid contained in semen)
  • Lymph nodes just outside your prostate, if your cancer has spread there. Lymph nodes are part of the immune system and help the body to fight infection. 

There are nerves and blood vessels around your prostate. These nerves help you to get an erection. The surgeon can operate in a way that will protect them. But, if your cancer has spread into these nerves or the area around the prostate, they may remove some or all of these nerves.  

 

Illustration showing male reproductive organs

 

Radical prostatectomy can be carried out as:

  • Keyhole (Laparoscopic) surgery 
  • Robot-assisted keyhole surgery
  • Open surgery.

Keyhole 

  • The surgeon makes four or five small 1cm cuts in your tummy (abdomen). These allow room for the instruments to go in.
  • Your tummy will be expanded with carbon dioxide gas. This gives your doctor a better view of the prostate.  
  • A small tube with a light and camera on the end (laparoscope) goes through one of the cuts. This allows the doctor to see a picture of the prostate on a screen. 
  • The prostate is taken out through one of the small cuts.   

Robot-assisted keyhole radical prostatectomy

  • All the pieces of equipment, including the camera, are attached to robotic arms.
  • The surgeon controls the robotic arms from a distance. These arms can move very accurately. 
Robotic surgery scene
Robotic radical prostatectomy

Open radical prostatectomy

  • The urologist makes a larger cut in your tummy to remove the whole prostate. 
  • Sometimes the cut is made in the area between the scrotum and the back passage (perineum). 

You will be asked to come along to a pre-assessment clinic one-to-two weeks before your surgery. This will be at the hospital where you will be having your surgery. You will:

  • Have blood tests
  • Have heart monitoring (an ECG)
  • Be weighed
  • Be screened for a bacteria called MRSA. 

You will be asked to empty your bowel on the morning of your surgery. So, you may be given a small enema to use. An enema puts a small amount of fluid into your rectum. This helps to clear out your bowel. You can do this yourself. 

picture of 3 microenemas in the palm of the hand
Micro enemas

You will be shown how to do exercises to strengthen your pelvic floor muscles. This can help reduce leakage of pee after the surgery. It is a good idea to start these before your surgery. Ask your healthcare team about pelvic floor exercises. 

You will be visited by your surgeon who will:

  • Explain what they are going to do
  • Give you the chance to ask questions
  • Ask you to sign a consent form. This is a written record that says you have agreed to the operation and the anaesthetic. Always make sure you understand what is going to happen before you sign the form. Ask your doctor about any worries you may have.

You will also be seen by your anaesthetist who will ask you questions about:

  • Your health
  • Allergies
  • Pain control after the operation.   

You may be asked to wear a pair of compression stockings.  These are sometimes called TED stockings. You may also have a heparin injection. This helps to thin your blood. Both help to stop blood clots (deep vein thromboses) forming in your lower legs. 

Compression socks

  • You will be encouraged to get up and about as soon as possible. This helps to stop blood clots.  
  • You will have a tube to drain pee from your bladder into a bag. This is called a urinary catheter.
  • urinary catheter in the bladderA nurse will show you how to care for the catheter. They will give you some spare bags to take home. The catheter is removed at clinic, one-to-two weeks after the operation.  

 

  • Surgeons usually use dissolvable stitches. These will dissolve on their own in a few weeks. 
  • If you had keyhole or robotic surgery, you should be able to go home after one-to-two days. If you had open surgery this will be about three-to-seven days. 
  • You will have your PSA level checked about every six months for the first year after surgery. Your PSA should be undetectable at the first review.

You may get:

  • Some bruising and swelling around the keyhole cuts or the wound on your tummy. You may continue to get some discomfort for a few weeks. This is normal.
  • Swelling and puffiness of your scrotum.
  • Puffiness in your face because you lie head-down during the operation.
  • Shoulder pain (keyhole surgery only) caused by the carbon dioxide gas used to inflate your tummy. This will disappear quite quickly.
  • Bloating in your tummy. This should ease once your bowel starts working properly again. 

Pain will vary between people. It will also depend on what type of operation you have. Your healthcare team will give you advice on how to manage this. 

Older Black man talking to doctor in white coat

 

  • Yes. You will need to take some time off work to recover.

 

  • How long you need to take off will depend on the type of work that you do. If you do physical work, you may be off for longer. 

 

  • Your doctor will be able to advise you about when it is safe to get back to work. 

blood in test tube

  • After your surgery, you will have your PSA levels checked every six months for the first year. 
  • If your PSA starts to rise, your doctor will talk to you about other treatments. 

This could be:

radiotherapy

    

      Radiotherapy on its own (salvage radiotherapy).

 

 

Hormone therapy injections

    

Hormone therapy injections and regular monitoring.

  • You will need to avoid heavy exercise, lifting or straining for about four-to-six weeks. This may be longer if you had open surgery. This gives the wound time to heal. 
  • You will not be able to drive until you feel are able to make an emergency stop. This is usually about two-to-four weeks. Ask your healthcare team about what you can and cannot do at home. 
  • You will be given information about how to care for your catheter and your wounds. 
  • You will no longer produce sperm after a radical prostatectomy. This means that you will not be able to get someone pregnant. If you think you may want children, please talk to your doctor before your surgery. 
  • You may be able to have some of your sperm saved and frozen. This is called sperm banking or sperm cryopreservation.
  • You can learn more about sperm banking from the Human Fertilisation and Embryology Authority (HFEA). You can visit HFEA’s website here (this will open an external tab).
  • Cancer Research UK (CRUK) also have information about sperm collection and storage on their website. You can visit CRUK’s website here (this will open an external tab).
Sperm banking

Our services search tool (link will open in a new tab) will allow you to search for hospitals near you that offer:

  • Radical prostatectomy 

and/or

  • Robotic assisted prostatectomy

 

Frequently asked questions about radical prostatectomy: A patient's view.

Listen to Urologist Marcus, quizzing radical prostatectomy patient Denzil, about his experience of having surgery for prostate cancer. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is risk?

  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn’t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can’t tell you if you will be the ‘one’ man who gets this side effect.
Image
Risk vs Benefit
Problems peeing
problems pooing

This data is for people with CPG 1, 2 and 3 localised prostate cancer. Click here to learn more about CPG groups (this will open in a new tab).

erectile dysfuntion

This data is for people with CPG 1, 2 and 3 localised prostate cancer. Click here to learn more about CPG groups (this will open in a new tab).

  • The information on the risks comes from very large clinical studies. These typically involved thousands of people being watched over many years. 
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (This link will open in a new tab).

What is the impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them ‘a lot’ in each of the different areas.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing’. This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However, it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

71 out of 100

Effect on relationships

Ability to make good connections with others

61 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

84 out of 100

Sense of self

Knowing who you are and what motivates you

68 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

68 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

65 out of 100

Fatigue

Feeling of constant physical and/or mental tiredness or weakness

67 out of 100