Procedure of Radical Prostatectomy

Radical prostatectomy is a surgical procedure performed to treat prostate cancer by removing the entire prostate gland and some surrounding tissues. This treatment option is most commonly recommended for men with localized prostate cancer meaning the cancer has not spread beyond the prostate.

Radical prostatectomy is often recommended when the cancer is confined to the prostate and has not spread to distant parts of the body. The primary goal is to eliminate the cancer entirely while attempting to preserve urinary and sexual function as much as possible. The procedure can be performed through different techniques open surgery, laparoscopic surgery, or robot-assisted laparoscopic surgery depending on the patient’s condition, the surgeon’s expertise, and available medical infrastructure.

What is Radical Prostatectomy?

Radical prostatectomy is a curative treatment option aimed at removing cancerous tissues entirely. It involves the surgical removal of the prostate gland, seminal vesicles, and sometimes nearby lymph nodes. The goal is to eliminate prostate cancer while preserving urinary and sexual function as much as possible.

This procedure is generally offered to men under the age of 75 who are in good health and have a life expectancy of at least 10 years. It is often recommended when the cancer is confined to the prostate and hasn’t spread to other organs.

Types of Radical Prostatectomy

There are three primary techniques used to perform a radical prostatectomy

1. Open Radical Prostatectomy :- This traditional method involves making a single long incision in the lower abdomen to access and remove the prostate. While effective, it may involve longer recovery time and higher chances of blood loss compared to newer techniques.
2. Laparoscopic Radical Prostatectomy :- This minimally invasive method involves making several small incisions through which surgical instruments and a camera are inserted. It offers quicker recovery, reduced blood loss, and smaller scars.
3. Robot Assisted Laparoscopic Prostatectomy :- A technologically advanced version of laparoscopic surgery, this method uses robotic arms controlled by the surgeon from a console. It provides high precision and is currently the most preferred technique due to its accuracy and improved outcomes.

Procedure of Radical Prostatectomy

Before undergoing radical prostatectomy, your healthcare provider will carry out several evaluations. These may include

1. Blood tests, including PSA (Prostate-Specific Antigen) levels

2. Imaging studies such as MRI or CT scans

3. A biopsy confirmation of prostate cancer

4. Anesthesia clearance and general health check-up

You may be advised to stop certain medications, including blood thinners, and to follow a clear liquid diet a day before surgery. Some patients may also undergo bowel preparation.

Your doctor will discuss the type of surgery best suited for your condition, along with potential benefits and risks.

The Surgical Procedure: What Happens During Radical Prostatectomy

On the day of the surgery, you will be administered general anesthesia to ensure you are asleep and pain-free during the procedure. Depending on the type of prostatectomy planned, the surgical technique varies slightly, but the main steps include

1. Accessing the Prostate :- For open surgery, a single incision is made in the lower abdomen. In laparoscopic or robotic surgery, 4–6 small incisions are made to insert surgical instruments.

2. Removing the Prostate Gland :- The surgeon carefully separates the prostate gland from the bladder and urethra. The seminal vesicles are also removed in most cases.

3. Reconnecting the Urinary Tract :- After the prostate is removed, the bladder is directly connected to the urethra using sutures. A catheter is placed to allow urine drainage during healing.

4. Closure :- Incisions are closed with sutures or staples, and a surgical drain may be placed to remove any fluid accumulation.

The surgery typically lasts between 2 to 4 hours and requires hospital stay for 1–3 days, depending on the surgical method and individual recovery.

Recovery After Radical Prostatectomy

Recovery from radical prostatectomy involves both short term and long-term healing processes. Immediately after surgery, you will be monitored for vital signs and pain management. A urinary catheter will remain in place for 7–10 days to allow healing of the bladder-urethra connection.

Most patients are encouraged to start walking within a day after surgery to promote circulation and prevent blood clots. Pain and discomfort are common but manageable with prescribed medications.

Full recovery can take several weeks. Patients are usually able to return to light daily activities within 2–4 weeks and resume full activities, including work and exercise, within 6–8 weeks.

Possible Side Effects and Risks

Like any major surgery, radical prostatectomy carries some risks and side effects. While the surgery aims to remove cancer completely, it may affect certain bodily functions.

1. Urinary Incontinence :- Leakage of urine may occur, especially in the initial weeks. Most men regain bladder control within a few months, but some may experience long-term issues.
2. Erectile Dysfunction :- Nerve damage during surgery can lead to difficulty in achieving or maintaining erections. Nerve sparing techniques aim to reduce this risk, and medications or therapies are often used in rehabilitation.
3. Infection and Bleeding :- There is a small risk of post surgical infection or internal bleeding. These are typically managed with antibiotics or surgical intervention if required.
4. Scarring or Strictures :- Scar tissue formation can sometimes cause narrowing in the urinary tract, which may require further treatment.

Discussing these risks with your surgeon before the procedure is essential for setting realistic expectations.

Follow Up and Long Term Outlook

After radical prostatectomy, regular follow-up visits will be scheduled to monitor your PSA levels, which should ideally become undetectable after the prostate is removed. A rising PSA after surgery may suggest cancer recurrence and require additional treatment such as radiation therapy or hormone therapy.

Many men live long, healthy lives after radical prostatectomy, especially when the cancer is detected early and managed appropriately. The success rate is high for localized prostate cancer, making this procedure a cornerstone in prostate cancer management.

Conclusion

Radical prostatectomy is a proven and effective surgical treatment for localized prostate cancer. With advances in minimally invasive and robotic techniques, the procedure has become safer and more precise, offering better outcomes in terms of cancer control and quality of life. Understanding the procedure from preparation to recovery can help you make confident, informed decisions about your prostate cancer treatment.