Prostate surgery (also called radical prostatectomy) is an operation to take out the prostate gland and the cancer inside the gland. The urethra (tube that carries urine) is surrounded by the prostate gland, so part of it has to be removed as well. The remaining urethra is reattached to the bladder. Other tissues around the prostate gland, like lymph nodes, may also be removed and checked for cancer.
Nerves that are needed for a man to get an erection are next to the prostate gland. These nerves can be damaged during surgery, which causes problems in keeping an erection. If the cancer has not spread near the nerves, they can be left alone and not taken out.
There is more research about prostate surgery than other active treatments.
How does prostate surgery compare with watchful waiting?
In general, men who have prostate surgery are in good health and are younger than men who use watchful waiting or other active treatments. The risks from prostate surgery increase as you get older. Up to 10 out of 100 men 65 years and older have heart and lung problems after surgery.
Men who have prostate surgery are more likely to survive their prostate cancer than men who follow watchful waiting. One research study that compared prostate surgery with watchful waiting found:
- 90 out of 100 men who had prostate surgery survived their cancer for at least 10 years.
- 85 out of 100 men who used watchful waiting survived their cancer for at least 10 years.
This research study started before PSA testing was common.
What about combining hormone treatment with prostate surgery?
Research tells us that using hormone treatment before prostate surgery does not work better than having prostate surgery without the hormone treatment. Hormone treatment used before surgery does not help men live longer and does not stop the cancer from coming back.
More experience means better results
Men who have prostate surgery from a surgeon and a hospital with more experience have fewer problems from the surgery.
- Men treated by surgeons who do more than 10 prostate surgeries a year have a lower chance of long-lasting side effects. They have fewer problems, like dribbling or leaking urine, than men treated by surgeons who do less.
- Men treated in hospitals that do more than 43 prostate surgeries a year have fewer problems from the surgery. They are less likely to have bleeding or heart and lung problems.