Radical prostatectomy


Definition

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.

Alternative Names

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

Description

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 health care provider may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Or, your provider 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. Radical prostatectomy is often done on healthy men who are expected to live for 10 or more years after the procedure.

Risks

Risks of this procedure are:

Before the Procedure

You may have several visits with your 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 under control.

If you smoke, you should stop several weeks before the surgery. Your provider can help.

Always tell your provider what medicines, 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 called an incentive spirometer to keep your lungs clear.

After your surgery, you may:

Outlook (Prognosis)

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.

References

Costello AJ. Considering the role of radical prostatectomy in 21st century prostate cancer care. Nat Rev Urol. 2020;17(3):177-188. PMID: 32086498 pubmed.ncbi.nlm.nih.gov/32086498/.

Li-Ming S, Otto BJ, Costello AJ. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 156.

National Cancer Institute website. Prostate cancer treatment (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated March 11, 2024. Accessed March 27, 2024.

Schaeffer EM, Partin AW, Lepor H. Open radical prostatectomy. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 155.

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