What is Open Radical Prostatectomy?
An open radical prostatectomy is a surgical procedure in which the surgeon removes the entire prostate gland through an incision in the lower abdomen. The seminal vesicles, which contribute to semen production, are also removed. In some cases, nearby pelvic lymph nodes may be taken for evaluation.
This operation is considered major pelvic surgery and is usually performed with curative intent, aiming to remove all cancer when the disease appears confined to the prostate region.
Why is this surgery performed?
Open radical prostatectomy may be recommended for individuals with localized prostate cancer, and in selected situations where the cancer is locally advanced but remains potentially operable. The main goal is to achieve long term control of the disease.
The decision to proceed with surgery is individualized. It involves a thorough discussion of available alternatives such as radiation therapy, along with consideration of overall health, medical conditions, and personal preferences regarding recovery and possible side effects.
Treatment options for localized prostate cancer
If prostate cancer is confined to the prostate, treatment options may include surgery or radiation therapy. The best approach depends on the features of the cancer, a person’s general health, and personal priorities.
This short educational video by Professor Jack Baniel provides a general overview comparing surgery and radiation therapy for localized prostate cancer.
What happens before surgery?
Before surgery, several evaluations are completed to confirm that the operation is appropriate and to prepare safely for anesthesia. This process often includes:
- PSA (prostate specific antigen) testing.
- Imaging studies, such as MRI or other scans, to evaluate disease extent.
- Review of prior biopsy results.
- Staging tests to assess whether there is evidence the cancer has spread.
- Discussion about possible effects on urinary and sexual function.
- Pre anesthesia consultation to evaluate overall health.
- Review of current medications and possible adjustments.
- Instructions for fasting before the procedure.
What happens during surgery?
The procedure begins with an incision in the lower abdomen. The surgeon removes the prostate gland and seminal vesicles, and in some situations, pelvic lymph nodes may also be taken for analysis.
When suitable, a nerve sparing technique may be used to help preserve erectile function. After removal of the prostate, the bladder is reconnected to the urethra to allow urine to flow normally again.
A urinary catheter is placed through the penis into the bladder to enable healing at the reconnection site. The entire surgery typically lasts several hours, though duration varies among individuals.
What to expect after surgery
In hospital
- Continuous monitoring of recovery and vital signs.
- Pain control with prescribed medications.
- Early movement to reduce the risk of complications.
- The urinary catheter remains in place, usually around one to two weeks, though this may vary.
- Hospital stays generally last several days, depending on recovery progress.
At home
- Caring for the catheter until removal at follow up.
- Following instructions on lifting and activity restrictions.
- Gradual return to normal daily activity as approved.
- Performing pelvic floor exercises to support urinary control.
- Attending scheduled follow up appointments to review recovery and pathology results.
Risks and Possible Complications
All surgeries carry potential risks. While many people recover smoothly, both general and procedure specific complications may occur.
General surgical risks
- Bleeding or need for blood transfusion.
- Infection at the incision site or internally.
- Blood clots in the legs or lungs.
Specific risks related to prostate surgery
- Urinary incontinence, which may be temporary or, in some cases, longer term.
- Erectile dysfunction, varying by individual and depending on nerve preservation and pre surgery function.
- Loss of ejaculation and resulting infertility.
- Urine leakage at the reconnection site between the bladder and urethra.
- Need for additional treatments, such as radiation or medication, based on final pathology results.
Individual recovery experiences differ, and ongoing follow up helps identify and manage any issues early.
Results and Follow up
After successful surgery, the PSA level typically becomes very low or undetectable, as the prostate gland has been removed. Final pathology reports determine the cancer stage and whether further treatment may be needed.
Some patients may require additional therapy, such as radiation or systemic treatment, if microscopic disease is found near the surgical margins or in lymph nodes.
Regular PSA testing is essential for long term monitoring, as changes over time can help detect any recurrence early.
Recovery of urinary and sexual function varies among individuals and can continue to improve for months or years after the operation.
When to Seek Urgent Help
Seek urgent medical attention if you experience:
- Fever or chills.
- Severe or increasing pain not relieved by medication.
- Heavy or persistent bleeding from the incision or catheter site.
- Catheter blockage or sudden inability to drain urine.
- Swelling, warmth, or pain in one or both legs.
- Inability to urinate after catheter removal.
Disclaimer
This information provides a general overview of Open Radical Prostatectomy. It is not a substitute for medical advice, diagnosis, or treatment. Your individual care plan may differ. Always follow the recommendations of your treating clinician.