Radical Prostatectomy

Open radical prostatectomy is a surgical procedure to treat prostate cancer and involves the removal of the whole prostate gland, seminal vesicles and the surrounding tissues through an incision in the lower abdomen. Surgery may increase life expectancy by at least 10 years.

Indications for Radical Prostatectomy

Radical prostatectomy is appropriate for the following patients:

• Those who are physically fit for major surgery
• Diagnosed with fast growing tumour
• Diagnosed with localised cancer of the prostate gland
• Those who can follow the available treatment protocols

Procedure for Radical Prostatectomy

The goal of prostatectomy is to get rid of all the cancer cells. Open radical prostatectomy is performed under general anaesthesia. In this procedure, your surgeon may use one of two approaches to access the prostate gland: an incision made in the lower abdomen or perineum (area between the anus and scrotum).

If the incision is approached through the lower abdomen, it is called retro pubic approach and this procedure is commonly used for removal of lymph nodes along with the prostate. The procedure allows your surgeon to examine the prostate and lymph nodes. It helps preserve the surrounding nerves that are required for unassisted erections, reducing your risk of impotency.

An incision in the perineum is known as perineal approach and the procedure is used when only the prostate gland needs to be removed. If there is no involvement of lymph nodes, the surgeon uses the perineal approach. In this procedure, your surgeon makes an incision over the area between the scrotum and anus and removes the prostate for examination. If removal of lymph nodes is required for further examination, a small separate abdominal incision or laparoscopic procedure can be performed. This procedure allows your surgeon to use the nerve-sparing approach if required.

The surgery requires 2 to 4 days of hospitalisation. Usually after the surgery, a thin flexible tube called a catheter is inserted into your bladder to drain urine for 1 to 3 weeks. Your doctor will instruct you about the usage and care of the catheter.

Recovery After Radical Prostatectomy

Immediately after surgery, you are advised to drink fluids and can later continue with solid foods. Pain medications may be recommended to reduce pain and inflammation. To prevent certain complications, such as pneumonia or blood clots, you are usually recommended to practice walking, leg exercises and use an incentive spirometer, a small disposable device that assists in deep breathing. Before discharge, you may schedule the next follow-up visit for a physical examination, prostate-specific antigen (PSA) test to check the speed of changes of the tissues, digital rectal examination and biopsies if required.

Risks Associated with Radical Prostatectomy

As with all surgeries, radical prostatectomy may also carry some general complications such as heart problems, blood loss or blood clots, pneumonia, allergic reaction to anaesthesia and infection. Specific complications, such as urinary incontinence, erectile problems and damage of the urethra or rectum, are rare, but can also occur following the surgery. These complications would require additional treatment for complete recovery.