At present radical prostatectomy is not standard treatment in the UK for locally advanced prostate cancer. Occasionally some men with T3 disease may be treated with radical prostatectomy. Clinical over-staging is well documented in patients with clinical T3 disease who have radical prostatectomy. Pathological staging after surgery may show that some patients have earlier disease than was originally shown by clinical staging.
NICE guidelines suggest that radical prostatectomy should not be carried out by urological multidisciplinary teams who carry out fewer than 50 radical operations (prostatectomies and cystectomies) for prostate or bladder cancers per year.(17)
There is a significant risk of the cancer recurring after prostatectomy. Further treatment with radiotherapy or hormonal therapy is often needed.
Before having prostatectomy patients should be counselled about the risks of impotence and incontinence. Erectile dysfunction occurs commonly. Until recently, radical prostatectomy resulted in impotence in the majority of men and caused varying degrees of incontinence in up to 20%.(18) Nerve sparing surgical technique may help to reduce the risk of erectile dysfunction.