Surgery may be a treatment option for you. Before any operation, make sure that you have discussed it fully with your doctor. It is important that you understand what it involves, the chances of success, the likely side effects, and whether there are other treatment options that may be more appropriate to your particular circumstances. Your doctor may suggest that you have hormonal therapy before or after your surgery.

There are three types of surgery used to treat locally-advanced prostate cancer:

A radical prostatectomy is carried out by specialist surgeons. The whole prostate gland is surgically removed either through a cut made in the tummy area (abdomen) or through a cut made between the scrotum and the back passage. This aims to get rid of all of the cancer cells. This operation is only suitable for a small number of men with locally-advanced prostate cancer. You can discuss with your specialist whether a prostatectomy would be suitable for you.

The operation often causes impotence - the inability to have and maintain an erection. In a few men it can also cause problems with control of passing urine (urinary incontinence). Sometimes it is possible to do a special type of operation, called a nerve-sparing prostatectomy, which can reduce the risk of erection problems.

As doctors cannot predict which men will be affected by these side effects it is important that you are fully aware of these risks beforehand. Your doctor will discuss the operation, its possible side effects and other possible treatment options with you.

Although prostatectomy can get rid of the cancer cells completely for some men, the cancer cells may come back in the area of the prostate a while after the operation. If this happens, external radiotherapy may be given to the prostate area. The treatment is given over a larger area, which can cause more side effects.

Laparoscopic prostatectomy

With a laparoscopic prostatectomy your surgeon doesn’t need to make a large opening but can take out your prostate gland using only four or five small cuts (about 1cm each) in your tummy area (abdomen). The surgeon uses specially designed instruments that can be put through these small cuts. This type of surgery is also known as keyhole surgery.

After making the small cuts the surgeon uses carbon dioxide gas to fill (inflate) the abdomen. A tiny video camera gives a magnified view of the prostate gland onto a video screen. The prostate gland is then cut away from surrounding tissues and removed through one of the cuts in the abdomen.

Most studies have shown that laparoscopic surgery is as successful at treating prostate cancer as open surgery. Your surgeon can discuss with you the potential risks and benefits. This type of surgery is only carried out by surgeons with specialised training and experience in the technique.

After your operation

After prostatectomy you will have a drip (intravenous infusion) into a vein in your arm and a tube (catheter) to drain urine from the bladder. If the operation is done through the abdomen you will also have an abdominal wound. You may have a small tube in the wound to drain any excess fluid that is produced. After your operation you may have some pain or discomfort which may continue for a few weeks, particularly when you walk. Regular painkillers should help to ease this, so let the staff on the ward know if you are still in pain.

You will probably be ready to go home a week to ten days after your operation. Your catheter will probably stay in for one to three weeks to allow the urethra to heal. Arrangements can be made for a district nurse to visit you at home, and if you have any problems you should contact your doctor as soon as possible.

Side effects of radical prostatectomy

Surgery to the prostate can cause problems in getting an erection (sexual impotence) and in controlling the bladder (incontinence). Erection problems are caused by a reduction in the blood flow to the penis due to damage to the arteries or nerves. Often the need to remove all of the cancer cells makes it impossible to avoid nerve damage. In men aged under 60 who have had nerve-sparing prostatectomy, the risk of erection problems after total prostatectomy may be 1 in 2 (50%) or higher. The risk increases to about 4 in 5 (80%) or more in men over the age of 70 and may be higher if nerve-sparing techniques are not used. Our section on side effects discuss ways of coping with erection problems.

Problems with controlling the bladder as a result of radical prostatectomy are less common. Most men have some incontinence when the catheter is first removed, but this usually improves with time. About one year after the operation up to one in five (20%) of men will leak an occasional drop of urine. Some men may need to wear an incontinence pad, but it is very rare to be completely incontinent and need to have a permanent catheter. Another less common effect of surgery is scarring of the bladder which can make it difficult to pass urine. This is fairly easily treated with minor surgery (known as a bladder neck dilation).

Some men may find that they have diarrhoea or constipation for a few months after prostatectomy.

A TURP is carried out if it is necessary to remove the part of the tumour that is blocking the urethra (the tube that drains urine from the bladder). A tube which contains a miniature camera is passed through the urethra, into the prostate. A cutting instrument attached to the tube is then used to shave off the inner area of the prostate to remove the blockage.

This can be done under a general anaesthetic or an epidural. With an epidural, the lower body is numbed temporarily by injecting an anaesthetic into the spine so that you can’t feel anything even though you are awake.

A TURP can’t remove all of the cancer cells. It is used to relieve problems with passing urine.

After your TURP

After your operation you will probably be up and about the next morning. You will usually have a drip, giving fluid into your vein. This will be taken out as soon as you are drinking normally. A tube (catheter) will drain fluid from your bladder into a collecting bag. It is usual for the urine to contain blood.

To stop blood clots from blocking the catheter, bladder irrigation may be used. This means that fluid is passed into the bladder and drained out through the catheter. The blood will gradually clear from your urine and the catheter can be taken out. At first you may find it difficult to pass urine without the catheter, but this should improve. Some men find that they have some urinary incontinence following this procedure. It can also cause some long-term difficulty in passing urine.

Most men are able to go home after three or four days. Occasionally it is necessary to keep the catheter in for a while after you go home. Before you leave hospital the nurse will show you how to look after your catheter and arrangements can be made for a district nurse to visit you at home to help with any problems.

You may have pain and discomfort for a few days after your operation, for which you will be given painkillers. These are usually very effective, but if you continue to have pain it is important to let the doctor or nurse looking after you know as soon as possible so that a more effective painkiller can be found.

Following a TURP about 1 in 5 (20%) men may have retrograde ejaculation. This means that, during ejaculation, semen goes backward into the bladder instead of through the urethra, so your urine may look cloudy after sex. This is harmless.

Although this is an operation, the aim of removing the testicles is to reduce the levels of testosterone (male hormone) in the body, so it is discussed in the section about hormonal therapies. As there are many hormonal therapy drugs available now, orchidectomy is not used very often.

If you think that you might have any difficulties coping at home after your surgery, let your nurse or social worker know when you are admitted to hospital so that help can be arranged.

As well as being able to offer practical advice, many social workers are also trained counsellors who can offer valuable support to you and your family, both in hospital and at home. If you would like to talk to a social worker, ask your nurse or doctor to arrange it for you.

Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check-up. This is a good time to discuss any problems you may have.