Prostate cancer surgery

The main type of surgery for localised and locally advanced prostate cancer is a radical prostatectomy.

Learn more about:

• What types of surgery are there?
• How the surgery is done
• Radical prostatectomy to remove the prostate
• Making decisions about surgery
• What to expect after surgery

What types of surgery are there?

Radical prostatectomy involves removing the prostate, part of the urethra and the seminal vesicles. After the prostate is removed, the urethra will be rejoined to the bladder and the vas deferens (tubes that carry sperm from the testicles to the penis) will be sealed.

Some people are able to have nerve-sparing surgery, which aims to avoid damaging the nerves that control erections. Your doctor will discuss whether this is an option for you. Nerve-sparing radical prostatectomy is more suitable for lower-grade cancers and is only possible if the cancer is not in or close to these nerves. It works best for those who had strong erections before diagnosis. Problems with erections are common even if nerve-sparing surgery is performed.

Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed (pelvic lymph node dissection).

How the surgery is done

Different surgical methods may be used to remove the prostate:

• open radical prostatectomy – usually done through one long cut in the lower abdomen
• laparoscopic radical prostatectomy (keyhole surgery) – small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen for guidance
• robotic-assisted radical prostatectomy – laparoscopic surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and move robotic arms that hold the instruments.

Radical prostatectomy to remove the prostate

Making decisions about surgery

Talk to your surgeon about the surgical methods available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery. See more about Making treatment decisions.

The surgeon’s experience and skill are more important than the type of surgery offered. Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects (such as urinary and erection problems) and no difference in long-term outcomes.

→ READ MORE: What to expect after surgery

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