What is Radical Prostatectomy?

Prostate cancer is uncommon in men under 40, but the risk of getting the disease significantly increases after the age of 50. If your doctor suspects you have prostate cancer based on a physical exam or blood test results, she may recommend a biopsy. This diagnostic procedure collects tiny samples of tissue from the prostate, typically with the use of a special needle. The samples are then examined in a laboratory to determine whether any abnormal cells are present. Biopsies of the prostate are most often done transrectally, or through the rectum.

If your biopsy shows that you have prostate cancer, your doctor will discuss available options with you, such as watchful waiting, radiation therapy, hormone therapy, chemotherapy, and surgery. Together, you will develop a treatment plan that best fits your condition. If your doctor recommends surgery, you will likely have a radical prostatectomy. There are three ways this prostate removal procedure can be performed:

  • Open radical prostatectomy, which uses a large incision, usually in your abdomen.
  • Laparoscopic radical prostatectomy, which requires several small incisions in your stomach. A long, thin tube with a camera is inserted through one of the cuts. Your surgeon uses this instrument to view the inside of your belly during the operation.
  • Robotic radical prostatectomy, which uses the above laparoscopic techniques but with the help of a robot.
While incisions for the laparoscopic and robotic approaches will always be on the lower abdomen, there are two possible incision locations for the open procedure. More commonly, the cut will start just below the belly button and end at the pubic bone. The other possible but less frequently used incision location is the area between the base of your scrotum and anus. After the cut is made, your surgeon will separate the prostate from the tissues surrounding it. Extra care will be taken to cause as little injury as possible to the blood vessels and nerves. You will wake up from surgery with a small pouch that drains fluids from your belly and a long tube that drains urine from your bladder.

Radical prostatectomy is recommended for cancer that is contained within the prostate. If cancer has spread to other parts of the body, non-surgical treatments like chemotherapy, radiation therapy, or hormone therapy may be more appropriate.

The average hospital stay is one day for a laparoscopic or robotic radical prostatectomy, and one to three days for an open radical prostatectomy. You will be advised to stay in bed until the morning following your operation. Strenuous activities like running and heavy lifting must be avoided for four to six weeks. Although radical prostatectomy aims to remove all of your cancer cells, you will still need to see your doctor regularly after surgery to make sure that the cancer does not return.

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