NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
4 Overview of cancer treatments
Surgical treatment may be an option if you are
healthy enough to have an operation. The goal of an
operation is to remove all the cancer from your body.
To do so, the tumor will be removed along with some
normal-looking tissue around its rim. The normal-
looking tissue is called the surgical margin. Other
tissue may be removed along with your prostate as
A radical prostatectomy is an operation that removes
the entire prostate, seminal vesicles, and sometimes
other tissue. It is often used when the tumor appears
not to have grown outside the prostate—T1 and T2
tumors. Less often, it is used when the tumor has
grown outside the prostate but not into other organs.
There are four main types of radical prostatectomy.
These types are described in this section.
Results of a prostatectomy may be related to the
experience of the surgeon. Surgeons who are
experienced have better results. When choosing your
surgeon, ask how many of these operations he or she
has done. Going to a surgeon who has and continues
to do many radical prostatectomies may result in
a better outcome. Talk to other men with prostate
cancer about their experiences.
There are a few steps to prepare for an operation.
You may need to stop taking some medications
to reduce the risk of severe bleeding. Eating less,
changing to a liquid diet, or using enemas or laxatives
will empty your bowel. Right before the operation, you
will be given anesthesia. Anesthesia may be general,
spinal, or epidural.
After a radical prostatectomy, a catheter will be
inserted into your urethra to allow your urethra to
heal. It will stay in place for 1 to 2 weeks. You will be
shown how to use it while you’re at home. If removed
too early, you may lose control of your bladder
(urinary incontinence) or be unable to urinate due to
Open radical prostatectomy
Open radical prostatectomy removes the prostate
through one large cut. Your surgeon can make the cut
in one of two places.
Radical retropubic prostatectomy
. This surgery
removes tissue through a cut that runs from your
belly button down to the base of your penis. During
the operation, you will lie on your back on a table with
your legs slightly higher than your head.
Before removing your prostate, some veins and your
urethra will be cut to clear the area. Your seminal
vesicles will be removed along with your prostate.
After removing your prostate, your urethra will be
reattached to your bladder.
Your cavernous nerve bundles are on both sides of
your prostate. They are needed for natural erections.
A nerve-sparing prostatectomy will be done if your
cavernous nerves are likely to be cancer-free.
However, if the cancer involves them, one or both
bundles of nerves will be removed. If removed, good
erections are still possible with aids, and orgasms can
occur with or without these nerves.
It takes between 90 minutes and 3 hours to complete
this operation. You may stay 1 to 2 days in the
hospital. It takes about 2 weeks to feel very well, and
4 to 6 weeks to resume all normal activities.