The term radical prostatectomy is used to describe surgery to remove the whole of the prostate as a treatment for cancer.
The operation is medically termed a radical retropubic prostatectomy (RRP) because of the area where the incision is made in the lower abdomen. The surgeon then moves back to the prostate gland which is located behind the arch of pubic bones.
The radical prostatectomy for prostate cancer is a long established, gold standard treatment.
What about incontinence and erectile dysfunction?
The bundles of nerves which produce erections lie adjacent to the prostate; if these are disturbed, damaged or removed during a radical prostatectomy, the patient will experience some degree of erectile dysfunction.
It is also recognised that a radical prostatectomy has an impact upon the urinary continence function, although this is highly variable.
It is very important to emphasise that a radical prostatectomy does NOT automatically lead to long term, permanent incontinence or erectile dysfunction.
The extent of these complications will depend on two key factors:
- Surgical intent. If your assessments indicate this is an appropriate option, we will undertake a nerve-sparing prostatectomy. We explain this approach in more detail here, but essentially, this is an adaption to the traditional radical prostatectomy to intentionally spare nerves as well as achieve full cancer clearance.
- Surgical experience. It is widely recognised that the most important factor in achieving the best surgical outcomes is the experience of your surgeon*. Our Clinical Director, consultant urologist Alan Doherty has undertaken more than 3,000 radical prostatectomies and developed an award-winning online results centre to monitor and evaluate results and has continuously refined his surgical technique.
What about keyhole (laparoscopic) and robotic surgery?
At BPC, we were some of the early exponents of the laparoscopic prostatectomy. This involves entering the surgical area through tiny incisions (in other words, keyhole surgery), rather than opening up the surgical area with a wider incision across the abdomen. The laparoscopic prostatectomy appeared to offer positive outcomes for patients, particularly in terms of having a shorter recovery time following surgery. However, some surgeons believe an open approach is the best way of minimising damage to the erectile nerves and continence function (nerve-sparing prostatectomy).
In an article for the Daily Mail Alan Doherty explains his decision to recommend and deliver the radical prostatectomy as open surgery and not to continue the laparoscopic prostatectomy.
Our consultant urologist John Parkin provides laparoscopic radical prostatectomy surgery. Patients are very welcome to see both Mr Parkin and Mr Doherty to decide which technique may suit them best, taking into account individual priorities and medical considerations. BPC is a large, multi-disciplinary team working closely together: this means patients have a genuine and comprehensive choice of treatments and approaches.
Find out more
If you have a diagnosis of prostate cancer and are assessing different treatment and management approaches, we recognise this is a very important decision and it is good to consider different sources of information and advice. These may be helpful:
- You can read a wide variety of different BPC patients describing their experience of prostate cancer diagnosis, treatment and recovery here
- You can see a short film featuring one of our patients and his wife talking about their choice of a nerve-sparing prostatectomy and recovery here
- Many of our patients travel to BPC from beyond the West Midlands. You may want to book advice and guidance by telephone discussion with Alan Doherty, which is an easy and inexpensive way of answering questions you may have and talking about the options. Find out about booking an advice and guidance telephone call
*A report for the Lancet Oncology (April 2009) assesses 4,702 patients with prostate cancer who had been treated with laparoscopic prostatectomy. It concludes: “Patients treated by surgeons with more experience had less recurrence of disease than those patients treated by less experienced colleagues.”
Lead author Andrew Vickers PhD comments: “We report an 8% difference in recurrence rates between experienced and inexperienced surgeons. Experienced surgeons have lower recurrence rates, so we need to learn what they are doing differently.” The full study can be accessed in The Lancet.
“Having undertaken more than 2,000 prostatectomies, I know the benefits this experience brings to my work in terms of outcomes for patients. I was one of the first surgeons in the UK to carry out keyhole prostatectomy in 2003.”