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.  

Talk to your surgeon about the possible effects of surgery on your erections. You can ask:

• What are the chances of me keeping my erections?
• Are you able to carry out nerve sparing surgery?

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. 

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. 

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. 

• 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.
• A 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. 

• 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. 

• 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 on its own (salvage radiotherapy).

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).

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

• We have put together some information toolkits to help people access support for their side effects. These can all be found here on the Infopool. Follow the links to find out more about each topic. All the links open in a new window.
  • Dealing with peeing problems (urinary incontinence)
  • Getting support for sexual problems (erectile dysfunction)
  • Emotional and psychological support

Always talk to your healthcare team if you are worried about side effects.