Radical Prostatectomy

Long term cure rates are highest if the cancer is organ confined, typically above 90 %. The nearby pelvic lymph nodes may need also to be sampled, if there is a higher grade tumour (greater than Grade Group 4) , or the PSA is above 10. I have now performed more than 1600 radical prostatectomy operations in my career as a urologist. This is now carried out with robotic assisted laparoscopic surgery in the last 10 years.

The surgery involves a 3 hour operation. When the prostate is removed, a small portion of the urethra within the prostate is also taken, and the bladder is then reconstructed and rejoined to the remaining urethra. This join is splinted by a urinary catheter tube, usually in place for 8 days. The catheter may very occasionally need to stay in longer (2 - 3 weeks) if the join is not sufficiently healed. After catheter removal , there may be transient urinary urgency and leakage (incontinence). This may require the patient to wear a small pad in the underwear, and tends to resolve anywhere between a few days to 3 - 12 months post op. Speedy resolution of incontinence depends on the surgical technique, your age, muscular condition, and the strength of the pelvic sling muscles. These can be strengthened by pelvic muscle exercises pre and post operatively.

Erectile dysfunction is a more common side effect of radical surgery. When disease is localised, the erectile nerves and vessels (neurovascular bundle) on either side of the prostate are preserved. In patients under 70, there will be the possibility of regaining erections post operatively with the aid of oral agents such as Viagra or Cialis, or with penile injections. Dr Coombes will advise as to the individual likelihood of this recovery.

The patient will commence drinking oral liquids the day after the operation, and light solid diet on Day 2. Mobilisation is from Day 1, aided by analgesics (PCA , patient controlled analgesia) . Discharge from hospital is typically on day 2 depending on the patient's progress, but the catheter will remain in until Day 8 for proper healing.

You should avoid driving a car in the first week post op. Heavy lifting / straining and long travel should be avoided in the first month. After catheter removal in the office, the next office follow up visit is at 6 weeks, which will be followed by PSA blood test readings each 4 - 6 months in the first year, then 6- monthly in the second year, thence yearly. Successful remission is accompanied by a post op PSA reading of less than 0.2. Higher readings may be the subject of PSMA PET scanning for re-staging.