A radical prostatectomy is a type of surgery used to treat prostate cancer. During this operation, a surgeon will remove the prostate, surrounding tissues, and glands that produce fluids for semen.

The goal of radical prostatectomy is to remove all cancer cells while minimizing the risk of side effects. These include blood clots, infection, and damage to nearby organs. Some people may also experience erectile dysfunction or difficulty urinating.

Despite these risks, having a radical prostatectomy can lead to a longer lifespan than watchful waiting. One 2018 study found that the surgery can extend the life of a person with prostate cancer by 3 years.

Read on to learn about prostatectomy, including the different types, risks, benefits, and more.

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A radical prostatectomy is a surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. These are the glands that produce the fluids needed to make semen. The surgeon may also remove nearby lymph nodes.

This procedure aims to remove the whole prostate and the cancer cells inside it while minimizing the risk of side effects.

If a person’s cancer has not metastasized — or spread to other parts of their body — their doctor may recommend a radical prostatectomy to try to cure their cancer. However, if the prostate cancer is advanced or keeps coming back, doctors may recommend different types of surgery, such as removing the lymph nodes.

There are three main types of radical prostatectomy: open, laparoscopic, and robot-assisted laparoscopic. At present, the vast majority are robot-assisted. Open and traditional laparoscopic surgeries are less common.

Open radical prostatectomy

During an open radical prostatectomy, the surgeon makes an incision in the lower abdomen or the area between the anus and scrotum, known as the perineum. Then, they remove the prostate through this incision.

Laparoscopic radical prostatectomy

During a laparoscopic radical prostatectomy, the surgeon makes multiple small incisions in the abdominal wall.

They then insert a thin tube with a light and viewing lens called a laparoscope. This allows them to see while operating with surgical instruments that they insert into the other incisions.

Robot-assisted laparoscopic radical prostatectomy

During a robot-assisted laparoscopic radical prostatectomy, the surgeon makes multiple small cuts similar to a regular laparoscopic prostatectomy. They also insert a camera and surgical instruments, but they use robotic arms.

The surgeon gets a 3D view of the prostate and surrounding area on a computer monitor and uses the robotic arms to operate.

Radical prostatectomy’s main potential side effects are urinary incontinence (losing the ability to control urination) and erectile dysfunction (difficulty getting or maintaining an erection).

As with all major surgery, a radical prostatectomy carries risks. These include:

  • reaction to the anesthetic
  • bleeding due to the surgery
  • blood clots in the legs or lungs
  • damage to nearby organs
  • infection at the surgical site
  • injury to the intestines, which may require more surgery
  • accumulated lymph fluid, if lymph nodes are removed

In rare cases, complications can be fatal.

Any person undergoing a radical prostatectomy has a range of things to consider before, during, and after their surgery.

Before a radical prostatectomy

Before the operation, a person’s healthcare team explains the surgery’s possible risks and side effects.

Typically, a person attends a clinic appointment to have tests to check their general health. A healthcare professional may make lifestyle recommendations to better prepare the person’s body for surgery, such as stopping smoking or eating a nutritious diet.

Additionally, their healthcare team will encourage them to start pelvic floor muscle-strengthening exercises at home. This is to reduce their chances of developing urinary incontinence following surgery.

During a radical prostatectomy

A person will typically go to the hospital on the day of their operation or the day before. They should not eat for around 6 hours before surgery, but drinking clear liquids might be allowed until 2 hours before the operation. Then, they will take medication to clear their bowels.

Before the procedure, they will put on knee-length compression stockings to reduce their risk of blood clots.

This surgery requires a person to have a general anesthetic and usually takes 2–4 hours. However, in some cases, it may take longer.

After a radical prostatectomy

For a few hours after the operation, a person usually has a drip (intravenous infusion) in their arm. The drip can come out once the person can eat and drink again.

Healthcare teams usually encourage people to start moving around again as soon as possible. This reduces the risk of blood clots and other complications. Some people may also need injections to prevent blood clots once they get home.

Before discharge, a nurse will teach the person how to care for their surgical wounds and instruct them on painkiller use.

A 2017 meta-analysis compared radical prostatectomy with external beam radiotherapy for treating localized prostate cancer.

After reviewing data from 12 studies with 17,137 patients, the authors found an association between radical prostatectomy and reduced risk of overall mortality and cancer-related mortality, including after 5-year and 10-year follow-ups.

They also said that external beam radiotherapy might be a promising alternative in people at low to intermediate risk.

In people with localized prostate cancer who are otherwise healthy, radical prostatectomy can extend their life by an average of nearly 3 years.

Having the prostate removed provides a significantly greater life extension than watchful waiting. However, this benefit depends on the person’s baseline risk.

A radical prostatectomy is a type of surgery for treating prostate cancer. It involves removing the prostate, seminal vesicles, and surrounding tissue.

The procedure has various potential risks and side effects, including erectile dysfunction. However, it has a high success rate, including increasing lifespan compared with watchful waiting.