What is Prostatectomy? Purpose, Procedure & Recovery

A prostatectomy is a surgical procedure to remove all or part of the prostate gland. This treatment is most commonly recommended for men with prostate cancer, though it can also help with severe cases of an enlarged prostate that hasn't responded to other treatments.

The prostate is a small, walnut-sized gland that sits below your bladder and surrounds the urethra. When cancer develops or the gland becomes severely enlarged, removing it surgically can be the most effective way to protect your health and improve your quality of life.

What is prostatectomy?

Prostatectomy means surgically removing the prostate gland from your body. There are two main types: radical prostatectomy removes the entire prostate gland and some surrounding tissue, while simple prostatectomy removes only the inner part of the prostate.

Radical prostatectomy is the standard treatment for localized prostate cancer. During this procedure, your surgeon removes the entire prostate gland, the seminal vesicles (small sacs that produce fluid for semen), and sometimes nearby lymph nodes to check for cancer spread.

Simple prostatectomy is less common and typically reserved for men with very large prostates causing severe urinary problems. This approach removes only the enlarged tissue blocking urine flow, leaving the outer shell of the prostate intact.

Why is prostatectomy done?

Prostatectomy is primarily performed to treat prostate cancer that hasn't spread beyond the prostate gland. Your doctor might recommend this surgery if you have early-stage cancer and are healthy enough for major surgery.

The main goal is to completely remove the cancer from your body before it has a chance to spread to other organs. This gives you the best chance of being cancer-free long-term, especially when the cancer is caught early and confined to the prostate.

Less commonly, prostatectomy might be recommended for severe benign prostatic hyperplasia (enlarged prostate) when medications and less invasive treatments haven't helped your symptoms. This situation typically involves men with very large prostates causing serious urinary problems or kidney damage.

What is the procedure for prostatectomy?

The surgical approach depends on your specific situation and your surgeon's expertise. Most prostatectomies today are performed using minimally invasive techniques that result in smaller incisions and faster recovery times.

Robot-assisted laparoscopic prostatectomy is currently the most common approach. Your surgeon operates through small incisions using robotic instruments that provide enhanced precision and 3D visualization. This technique typically results in less blood loss, reduced pain, and quicker healing compared to traditional open surgery.

During the procedure, you'll be under general anesthesia and won't feel anything. Your surgeon carefully separates the prostate from surrounding structures, including the bladder and urethra, then removes the gland completely. The bladder is then reconnected to the urethra.

Open radical prostatectomy involves a larger incision in your lower abdomen. While less common now, this approach might be necessary for very large prostates or when previous surgeries have created scar tissue that makes minimally invasive techniques more challenging.

How to prepare for your prostatectomy?

Your preparation begins several weeks before surgery with comprehensive testing and planning. Your medical team will ensure you're healthy enough for surgery and help you understand what to expect during recovery.

You'll need to stop certain medications that can increase bleeding risk, such as blood thinners, aspirin, and some supplements. Your doctor will give you specific instructions about which medications to stop and when. Never stop prescribed medications without consulting your healthcare team first.

Pre-surgery testing typically includes blood work, imaging scans, and sometimes additional heart or lung function tests. These help your surgical team plan the best approach for your specific anatomy and health situation.

The day before surgery, you'll need to follow special dietary restrictions. Most patients are asked to eat a light meal the evening before and then avoid all food and drink after midnight. Your bowel preparation might include an enema or laxative to ensure your intestines are empty.

How to read your prostatectomy results?

Your pathology report provides detailed information about the cancer found in your removed prostate. This report helps determine if additional treatment is needed and gives insight into your long-term outlook.

The pathologist will examine your entire prostate under a microscope and report several key findings. The Gleason score describes how aggressive the cancer cells look, with lower scores indicating slower-growing cancer. Scores range from 6 to 10, with 6 being the least aggressive.

Surgical margins tell you whether cancer cells were found at the edges of the removed tissue. Clear margins mean the surgeon removed all visible cancer, while positive margins might indicate microscopic cancer cells remain and additional treatment could be beneficial.

The pathological stage describes how far the cancer had spread within the prostate and whether it extended beyond the gland. This information, combined with your pre-surgery tests, helps your medical team determine if you need additional treatments like radiation therapy.

How to optimize your prostatectomy recovery?

Recovery from prostatectomy is a gradual process that typically takes several weeks to months. Following your surgeon's instructions carefully helps ensure the best possible outcome and reduces your risk of complications.

Pain management is important during the first few days after surgery. Your medical team will provide medications to keep you comfortable, and the pain typically decreases significantly within the first week. Most patients find over-the-counter pain relievers sufficient after the first few days.

You'll have a urinary catheter for about one to two weeks after surgery. This thin tube drains urine from your bladder while the connection between your bladder and urethra heals. While inconvenient, the catheter is essential for proper healing and preventing complications.

Physical activity restrictions help protect your healing tissues. You'll need to avoid heavy lifting, strenuous exercise, and driving for several weeks. However, gentle walking is encouraged from the first day after surgery to prevent blood clots and promote healing.

What are the risk factors for prostatectomy complications?

While prostatectomy is generally safe, certain factors can increase your risk of complications. Understanding these helps you and your medical team take appropriate precautions and make informed decisions about your care.

Age and overall health status significantly impact your surgical risk. Men over 70 or those with heart disease, diabetes, or other chronic conditions face higher risks of complications. However, many older men successfully undergo prostatectomy with excellent outcomes.

Previous abdominal surgeries or radiation therapy can make the procedure more technically challenging. Scar tissue from prior treatments can make it harder for surgeons to identify normal tissue planes, potentially increasing operative time and complication risk.

Prostate size and cancer extent also influence risk levels. Very large prostates or cancer that has grown close to surrounding structures may require more complex surgical techniques, potentially increasing the chance of complications.

Smoking and obesity are modifiable risk factors that you can address before surgery. Smoking impairs wound healing and increases infection risk, while excess weight can make surgery more technically difficult and slow recovery.

What are the possible complications of prostatectomy?

Like any major surgery, prostatectomy carries potential risks and complications. Most men experience no serious problems, but understanding possible complications helps you make informed decisions and recognize when to seek medical attention.

The most common complications affect urinary and sexual function. These issues are often temporary but can sometimes be permanent, depending on various factors including your age, overall health, and the extent of surgery required.

Here are the main complications to be aware of:

• Urinary incontinence: Difficulty controlling urine flow affects most men initially but usually improves over time. Complete recovery of bladder control can take several months to a year.
• Erectile dysfunction: Difficulty achieving or maintaining erections is common after surgery. Recovery depends on age, pre-surgery function, and whether nerve-sparing techniques were possible.
• Bleeding: Some bleeding is normal, but excessive bleeding might require additional treatment or rarely, blood transfusion.
• Infection: Surgical site infections or urinary tract infections can occur but are usually treatable with antibiotics.
• Stricture formation: Scar tissue can narrow the connection between the bladder and urethra, potentially requiring additional procedures.

More serious but rare complications include blood clots, heart problems, or bowel injury. Your surgical team monitors carefully for these issues and has protocols to manage them if they occur.

When should I see a doctor after prostatectomy?

Regular follow-up care is essential after prostatectomy to monitor your recovery and watch for any signs of cancer recurrence. Your medical team will schedule specific appointments, but you should also know when to seek immediate medical attention.

Contact your doctor immediately if you experience severe pain that isn't controlled by prescribed medications, signs of infection like fever or chills, or heavy bleeding. These symptoms could indicate complications that need prompt treatment.

Problems with your urinary catheter also require immediate attention. If the catheter stops draining, becomes dislodged, or causes severe pain, contact your medical team right away. Don't attempt to fix catheter problems yourself.

Long-term follow-up typically includes regular PSA blood tests to monitor for cancer recurrence. Your doctor will also assess your recovery of urinary and sexual function and provide treatments or referrals if needed.