Prostate cancer 3
Radical prostatectomy [M6180/M6182]
A radical prostatectomy is a major operation to remove your prostate and any cancer that it contains. At the beginning of the operation lymph glands next to the prostate are removed and immediately checked to ensure that the cancer has not spread. If they are clear your prostate will be removed completely. Your PSA should fall to a low level following the operation and, unless it rises again, it is generally considered that you are free of the cancer.
Unfortunately, in 3-4 out of every 10 men having a radical prostatectomy the cancer will have spread to surrounding tissue.
Radical prostatectomy is usually recommended for men with a life expectancy of 10 years or more who are fit enough to cope with a major operation. The years around 70 are a grey area as, on average, you would expect to live about 10 years, the same amount of time it would take the cancer to grow and cause problems. Your decision may depend upon what the adverse side-effects of each treatment may mean for your quality of life.
Side-effects
1. 3 out of 10 men will suffer mild urinary incontinence. You may, for example, leak when you cough or laugh
2. 2-5 in 100 men will suffer permanent severe incontinence (a continuous leakage)
3. Almost all men will have some difficulty in achieving an erection (impotence)
4. All men will be infertile
5. 1 in 10 men will have bladder problems caused by scarring and will need another operation
There are treatments to help you with any side-effects. For example some men may be offered Viagra (Sildenafil) for impotence but this is not suitable for all men. There are other treatments available for both impotence and incontinence, but most men will not regain their full sexual or urinary functions.
If you feel that your life expectancy may be less than 10 years, the adverse side-effects may not be worth the gain in extra years. Even if your life expectancy is more than 10 years you may be more concerned about your quality of life. This is a decision only you can make, although your consultant is available to discuss all the options and other treatments available to you at any point.
The operation and its risks
There are risks and complications attached to any surgery. In particular there is a risk of:
- Blood loss as some of the large veins next to the prostate are cut in order to remove it
- 1 in 100 risk of death as a result of anaesthesia, blood clot or infection.
You should make your consultant and the hospital aware of any medication you may be taking and also about any allergies that you know about.
You may be asked to attend the hospital before the operation for preadmission checks. Otherwise these will be done on the day of your admission.
These may include:
- Blood pressure and pulse
- Urine test
- ECG
- Blood tests
- Chest Xray
You will be in hospital for approximately 6 days.
Before the operation you will be visited by your anaesthetist. He/she will ask you questions about:
- Previous operations and anaesthetics you may have had - to check that you have had no problems before
- Medicines - it is important that the anaesthetist knows what medication you may be taking
- Dental problems - a tube will be passed through your mouth during the operation and it is important to know about caps and crowns. If you have false teeth they will be left in your room
- Chest problems and smoking – as these may cause complications with the anaesthetic. You are advised to give up smoking at least a week before you are admitted. All hospitals are now non-smoking zones.
Precautions will also be taken to stop you developing a blood clot. You may be asked to wear elastic stockings and may be given drugs to thin your blood.
Consenting to the treatment
Your consultant will also visit you to discuss the operation and ask you to sign the consent form. This is a formal agreement between you, the surgeon and the hospital and says that you are willing to undergo the planned procedures. You should read the consent form before signing it.
After the operation
After the operation you will be taken to the recovery ward where your blood pressure and pulse will be monitored. You will usually be bought back to your room in about an hour.
You will have to wait about 4 hours before you can have a drink as the anaesthetic may make you sick. Within 24 hours you should be able to eat and drink normally. If you feel sick tell the nurse who will be able to give you something to help.
You should also tell the nurse if you feel any pain. It helps your recovery if you are pain-free and the nurse will be able to give you painkillers.
You will see a large bag of clear fluid above your bed which runs through a needle into your arm. This is called a drip (for intravenous fluids) and will help to stop you becoming dehydrated. This will probably be removed 24 hours after the operation. You will also have a catheter in place. This is a plastic tube inserted into the penis to drain the urine from your bladder.
While you are in hospital
You will be encouraged to walk around after the operation as this helps to prevent blood clots forming in your legs. You may feel some pain so ask the nurse for painkillers if you need them. Your catheter will remain in place for about 2 weeks and walking around in the hospital should help you to get used to it being in place.
You must keep the catheter clean to help prevent infection. If you notice any discharge or pain round the tip of your penis you should tell the nurse. It is very common to find some blood clots in the catheter as a result of the operation. You will feel an intense need to empty your bladder but the urine will not flow. This will be painful and you should tell a nurse or doctor if this happens and they will be able to flush it out for you. You should try to drink 2-3 litres of fluids each day.
At home
You should take it easy for a month following the operation but at the same time take gentle exercise like walking as this will help prevent blood clots in your legs. Paracetamol should be enough to deal with any pain.
You will be given a drainage bag for your catheter which can be strapped to your leg. After 2-3 weeks you will return to hospital to have the catheter removed, which can cause some discomfort but should not be painful.
You can return to work after a month but you should expect to feel more tired than usual.
Please go on to Prostate cancer 4 for more information
Go back to Prostate cancer 2
See also Prostate Cancer Diet Guidelines
Relevant links
Cancer BACUP 0808 800 1234
MacMillan CancerLine 0808 808 2020
Cancer Research UK 0800 226 237
Prostate Cancer Support Organisation 0845 650 2555
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