Radical Prostatectomy – Prostate Cancer Surgery

Radical prostatectomy is surgery to remove the entire prostate gland and seminal vesicles to treat prostate cancer. The bladder is reconnected to the urethra.

Yes. It is major surgery under general anaesthesia. Although robotic or keyhole techniques use smaller incisions, significant complications and long-term side effects remain possible.

It is keyhole prostate surgery using robotic instruments controlled by the surgeon. The system provides enhanced visualisation and instrument movement. It does not operate independently.

Robotic surgery may reduce blood loss and shorten hospital stay in some settings. Long-term continence, sexual function and cancer outcomes depend on multiple factors. No technique guarantees a particular result.

Nerve-sparing surgery attempts to preserve nerves close to the prostate that are important for erections. Preservation may be possible on one or both sides depending on the cancer.

Sometimes, in carefully selected circumstances. The decision depends on the risk of cancer extending beyond the prostate on each side. Cancer clearance takes priority over nerve preservation.

Not always. Pelvic lymph node dissection may be recommended according to the estimated risk of lymph node involvement and the treatment plan.

The operation commonly takes approximately two to four hours, although more complex procedures may take longer. Anaesthetic preparation and recovery require additional time.

Hospital stay varies with the technique, general health and recovery. Some patients leave hospital within one or two days, while others require a longer admission.

The catheter drains urine while the new connection between the bladder and urethra heals. It is usually removed once your surgical team considers healing satisfactory.

The catheter commonly stays in for approximately one to two weeks. Some patients require longer, depending on the bladder connection and healing.

Pelvic floor exercises are generally paused while the catheter is in place. Restart after removal when instructed by your surgeon or physiotherapist.

Removal is usually brief. Some patients feel temporary discomfort or an unusual sensation as the catheter is withdrawn.

Urinary leakage is common after catheter removal. Some men require continence pads initially. Control often improves over the following months, although persistent incontinence is possible.

Recovery varies. Many men improve substantially within the first few months, with further improvement possible over twelve months or longer. Some men experience persistent leakage requiring specialist treatment.

Persistent bothersome leakage should be assessed. Depending on the severity and type of incontinence, treatment may involve further rehabilitation, a male sling or an artificial urinary sphincter.

Erectile dysfunction is common after surgery. Some men regain erections over months or years, especially when nerve sparing is possible, while others require ongoing treatment. Recovery is not guaranteed.

A rehabilitation plan can be discussed before surgery and reviewed during early postoperative follow-up. Timing depends on healing, nerve-sparing status and individual circumstances. Your specialist may discuss medication, vacuum devices or injection therapy.

These medicines may help some men, particularly when enough nerve function remains. Their response varies and they do not guarantee recovery of natural erections. Suitability depends on your health and other medication.

Treatments may include erectile dysfunction tablets, a vacuum erection device, penile injections or a penile implant in suitable patients. Your specialist can discuss the relative benefits and risks.

Yes. Many men can continue to experience orgasm, although the sensation may feel different. Semen is no longer ejaculated because the prostate and seminal vesicles have been removed.

No. Radical prostatectomy causes permanent loss of semen ejaculation. Orgasm may still be possible, but it is usually a dry orgasm.

Climacturia means urine leakage during orgasm. It can occur after radical prostatectomy. Some men experience improvement over time, and treatments are available for selected patients.

No. Natural fertility is lost because sperm cannot be ejaculated after prostatectomy. Sperm banking should be discussed before surgery if future biological parenthood is important.

Some men notice a reduction in apparent penile length after radical prostatectomy. This can be related to anatomical and erectile changes. Discuss any concerns and possible rehabilitation strategies with your specialist.

Many patients gradually return to desk-based work within two to four weeks. Heavy physical work may require around six weeks or longer. Individual recovery varies.

Driving may be possible after approximately a couple of weeks in selected patients, but timing depends on pain, mobility, medication and your surgeon's instructions. You must be able to perform an emergency stop safely.

Gentle walking is encouraged during recovery. Heavy lifting and vigorous exercise are commonly avoided for approximately six weeks or until your surgical team permits them.

Timing depends on wound healing, catheter removal, comfort and individual instructions. Discuss the appropriate time to resume sexual activity and any erectile rehabilitation with your surgeon.

The report describes the cancer's Grade Group, local extent, surgical margins and whether structures such as seminal vesicles or removed lymph nodes are involved. These results guide ongoing treatment and follow-up.

A positive margin means cancer cells are identified at the cut surface of the removed tissue. It can increase recurrence risk but does not automatically mean further treatment is required. PSA and other findings help guide management.

PSA is expected to become undetectable or very low after complete prostate removal. The first test is commonly taken approximately six to eight weeks after surgery. Your specialist will explain your result.

A confirmed rising PSA may indicate recurrent prostate cancer. Your team considers the PSA pattern, pathology and whether further scans or treatment are appropriate. Salvage radiotherapy may be considered in selected cases.

Not everyone requires radiotherapy. It may be considered if cancer persists or returns, or in selected patients with concerning pathology. The timing and need for additional treatment are individualised.

Both surgery and radiotherapy are established treatments for many localised prostate cancers. The best choice depends on cancer risk, health, urinary and sexual function and personal preferences. They have different side-effect profiles.

Yes. Some men experience biochemical or clinical recurrence despite surgery. Long-term PSA follow-up allows changes to be detected and further treatment to be considered.

Bring your GP referral, prostate biopsy pathology, PSA results, MRI and staging scan reports, medication list and details of existing urinary and erectile symptoms.