If you have already looked at my little paragraph about prostate cancer, you will already know that I cannot unreservedly recommend this treatment for all men with prostate cancer, but if after careful thought you have decided to go ahead with surgery, then maybe a few words about the operation may be helpful. Surgery to remove the whole prostate in cases where the cancer appears not to have spread is widely practised, and in the majority of cases is successful.

There are 3 main approaches to carrying out the operation

1. Open surgery through an abdominal incision
2. Open surgery through a perineal incision ( a cut made between the anus and scrotum)
3. Laparoscopic surgery
4. Robotic surgery

All surgery can carry a risk of serious complications, including a very small risk of dying as a direct result of the operation and the need for an anaesthetic, so should not be undertaken lightly, but the overall risk of developing life threatening complications is very small. In my practice, I am only able to directly offer the abdominal approach, but can make the necessary referral if the other approaches are to be considered. I did carry out a number of laparoscopic operations, but did not feel the benefits merited the more complex operation, and indeed have found there to be disadvantages. Similarly, the robotic approach is a very promising refinement, but I remain unconvinced that the benefits are real.

The surgery is carried out under general anaesthetic, and usually takes between less than 2 hours. The main problems that can be encountered during the operation are bleeding, for which a blood transfusion may occasionally be required – please make sure that you tell your surgeon if you have any serious misgivings about this (I personally am happy to operate on Jehovah’s Witnesses). Secondly, and fortunately very rarely, it is possible to injure the rectum, and whilst this is usually easily dealt with, on very rare occasions a colostomy becomes necessary, and whilst this would always be a temporary solution, it obviously could have ramifications. After the operation, recovery is usually fairly straightforward, although a catheter is required to help the bladder to heal. Most patients will go home after about 4 days if they have had the abdominal operation, and the catheter is removed a week or so later, and can expect to be back at work (or on the golf course!) after a further 4 to 6 weeks.

When the catheter is first removed many patients do experience difficulties with urinary control, but with gentle exercises, and a certain amount of patience, control gradually returns in the majority, but a few unfortunate men will never regain complete control, and in these circumstances, further surgery may be required, but fortunately this is again fairly unusual. Erectile function may also take some time (up to a year) to return, and may never be satisfactory – this is unfortunately rather more common, and may affect about 50% of those men undergoing this type if surgery. It is a problem that affects people in different ways, but almost always can be helped to some degree, so don’t be embarrassed to ask for help if you need it. The final problem that may be encountered in the months following surgery, is that the join up between the bladder and urethra can become scarred and narrow, a condition known as bladder neck stenosis. This will slow the urinary stream down, and may hinder return of continence, but fortunately it is very easily treated, although will probably require a further anaesthetic.

After the operation, the whole prostate, and any lymph nodes removed, are sent for analysis, and thus a lot more information is gained regarding the cancer; it may be more or less extensive than previously thought but this does not mean that the biopsy that had previously been taken was wrongly read. On the basis of the information gained from the lab, further treatment in the form of radiotherapy and/or hormone treatment may be considered necessary, but in most people, it is simply sufficient to monitor the PSA levels every few months over the following years, as these are a good indicator of the success of the treatment in dealing with the cancer – it is worth pointing out that the level of PSA never goes down to absolutely nothing, and a low level is entirely acceptable.