Preparing for Your Prostatectomy: What You Need to Know

The most commonly relied upon surgery for prostate cancer is radical prostatectomy. This procedure involves removing your prostate, seminal vesicles and their connecting sperm ducts.

At the turn of the century, robot-assisted laparoscopic prostatectomy (also known as robotic prostatectomy) was introduced, providing a new minimally invasive approach that brought about shorter recovery times. In the US, this is currently used for 80 to 90% of prostate removal procedures. If you are offered this option, rest assured that while robotic systems help improve accuracy, your surgeon will still be in full control. However, due to the high operational costs, not all hospitals may offer this option.

During your pre-surgery assessment, your doctor will review your PSA levels, prostate size and tumor staging with you. Your existing bladder and sexual function will also be reviewed. This will help your doctor to advise your expected recovery post-surgery and inform you of any potential complications. You should also keep your doctor informed of any prior pelvic or abdominal surgery or radiotherapy you have had.

Some preparations you may need include:

• Stopping medications that increase the risk of bleeding and interfere with blood clotting (e.g. aspirin, non-steroidal anti-inflammatory drugs).
• Continuing to do moderate exercise before your surgery. This will help build your strength and promote a faster recovery.
• Considering sperm banking. If you intend to father children in the future, you should consider this option, as the surgery will remove your ability to ejaculate.
• Taking preparatory antibiotics, to reduce the risk of infection post-surgery.

The day before your surgery:

• You should be given a laxative to take in the morning, followed by an enema to complete at night to fully cleanse your bowels.
• You should follow a light diet (e.g. crackers or soup) and stop eating after midnight.
• You should drink lots of water to avoid dehydration during this preparation process.
• You may need to use antibacterial soap to shower.

Two hours before your surgery, you should stop consuming any liquid or food.

Your surgery will be performed under general anesthesia. You will be lying on your back with your lower body likely placed on an adjustable platform. Your upper body may also be tilted downwards, in what’s called the Trendelenburg position, so that your head is lower than your feet. This will help improve your surgeon’s access to the pelvis.

The aim of prostatectomy is to remove your entire prostate without leaving any cancerous cells behind, all while mitigating the chances of blood loss, incontinence and erectile dysfunction. To do this, your surgeon will focus on:

• Controlling the blood vessels surrounding the prostate

During your surgery, your doctor may tie or seal off your blood vessels to prevent significant blood loss. Here, the Trendelenburg position also helps. It reduces blood flow to the operation site by keeping your head lower than your legs.

• Nerve-sparing to help retain sexual function

If possible, dissections will be planned to spare critical nerves used in your bodily functions. Unfortunately, this comes at the risk of missing some cancerous tissue, so it would be up to your doctor’s discretion to decide whether this is possible for you.

• Ensuring your ability to urinate

To facilitate healing, a temporary catheter will be placed in your bladder to drain urine as you recover. Your doctor will also try their best to restore the connection between the urethra and the bladder and to preserve the urinary sphincter during your surgery.

If deemed necessary, your surgeon may also insert a drain from your pelvis, to reduce the chances of complications from a collection of blood, pus or other infective fluids. If kept post-surgery, you would need to empty this drain regularly, under the guidance given by your care team.

The surgery may take up to two to four hours, depending on other necessary procedures decided during your surgery (e.g. nerve-sparing or removal of surrounding lymph nodes, if necessary based on your PSA level, type of tumor, and magnetic resonance imaging (MRI) and/or positron emission tomography (PET) results). For the general open prostatectomy, the incision on your lower abdomen would be less than six inches, while the laparoscopic approach may only need incisions of just over an inch.

Finally, you may need around two to three days of hospitalization, depending on your recovery rate.

After you wake up, it will be important to move as soon as possible to keep your blood circulation up. You should try to get out of bed at least three times daily, to ward against infections and blood clots, which could impede your recovery.

Your incision will likely radiate some pain, but this can be managed with pain medication. Due to the insertion of the new catheter, you may also encounter bladder spasms, which are sporadic episodes of pain. You can take some comfort in knowing it should resolve once your catheter is removed. Flatulence may be painful, but this can be eased by frequent walking to help ease the movement of gas through your bowels.

After recovering from your surgery, you can rest easy. Determining if your prostatectomy was successful will be quick. A simple blood test can help monitor if your PSA level has dropped to the point of being undetectable.

Learn more: PSA After Prostatectomy

You will still be able to consider follow-up treatments with radiation or chemotherapy, especially if recurrence does happen. These are good options to have, especially as combination treatments are important for survival in higher-risk cases.

All in all, prostatectomy is a serious surgery, and may have long-lasting effects on your lifestyle after. Your fertility, sexual and urinary functions may be affected, alongside other potential complications. However, if successful, it will provide a reassuring peace of mind that you can rely on. While your recovery may take a few weeks, the actual procedure will take a day to carry out, rather than the months required for some chemotherapy and radiotherapy courses.

Taking your time to consolidate all you can about this surgery and other available options will help you make your next decision with confidence.

Learn more: Life After Prostatectomy