Radical prostatectomy (prostate removal) is surgery to remove all of the prostate gland and some of the tissue around it. It is done to treat prostate cancer.
Prostatectomy - radical; Radical retropubic prostatectomy; Radical perineal prostatectomy; Laparoscopic radical prostatectomy; LRP; Robotic-assisted laparoscopic prostatectomy; RALP; Pelvic lymphadenectomy; Prostate cancer - prostatectomy; Prostate removal - radical
There are 4 main types or techniques of radical prostatectomy surgery. These procedures take about 2 to 4 hours:
For these procedures, you may have general anesthesia so that you are asleep and pain free. Or, you will get medicine to numb the lower half of your body (spinal or epidural anesthesia).
Why the Procedure Is Performed
Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer.
Your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your doctor may talk with you about other treatments that could be good for your cancer. These treatments may be used instead of surgery or after surgery has been performed.
Factors to consider when choosing a type of surgery include your age and other medical problems. This surgery is often done on healthy men who are expected to live for 10 or more years after the procedure.
Risks of this procedure are:
Before the Procedure
You may have several visits with your health care provider. You will have a complete physical exam and may have other tests. Your provider will make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being controlled.
If you smoke, you should stop several weeks before the surgery. Your provider can help.
Always tell your provider what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.
During the weeks before your surgery:
On the day of your surgery:
Prepare your home for when you come home after the surgery.
After the Procedure
Most people stay in the hospital for 1 to 4 days. After laparoscopic or robotic surgery, you may go home the day after the procedure.
You may need to stay in bed until the morning after surgery. You will be encouraged to move around as much as possible after that.
Your nurse will help you change positions in bed and show you exercises to keep blood flowing. You will also learn coughing or deep breathing to prevent pneumonia. You should do these steps every 1 to 2 hours. You may need to use a breathing device to keep your lungs clear.
After your surgery, you may:
The surgery should remove all of the cancer cells. However, you will be monitored carefully to make sure the cancer does not come back. You should have regular checkups, including prostate specific antigen (PSA) blood tests.
Depending on the pathology results and PSA test results after prostate removal, your provider may discuss radiation therapy or hormone therapy with you.
Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370(10):932-942. PMID: 24597866 www.ncbi.nlm.nih.gov/pubmed/24597866.
Ellison JS, He C, Wood DP. Early postoperative urinary and sexual function predicts functional recovery 1 year after prostatectomy. J Urol. 2013;190(4):1233-1238. PMID: 23608677 www.ncbi.nlm.nih.gov/pubmed/23608677.
National Cancer Institute website. Prostate cancer treatment (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated January 29, 2020. Accessed February 20, 2020.
Resnick MJ, Koyama T, Fan KH, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368(5):436-445. PMID: 23363497 www.ncbi.nlm.nih.gov/pubmed/23363497.
Schaeffer EM, Partin AW, Lepor H. Open radical prostatectomy. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 114.
Su LM, Gilbert SM, Smith JA. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 115.
Review Date: 1/15/2020
Reviewed By: Sovrin M. Shah, MD, Assistant Professor, Department of Urology, The Icahn School of Medicine at Mount Sinai, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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