There are several tests that are used to diagnose prostate cancer as you will not always have any symptoms. These can include a physical examination by your GP, a prostate-specific antigen (PSA) blood test, an MRI scan or a biopsy and ultrasound (or a combination of these).
What is the prostate?
The prostate is the organ that makes fluid for semen, which carries sperm. The prostate gland surrounds the tube (urethra) from your bladder. Urine and sperm must pass though this tube to leave your body.
What is a prostatectomy, and why might I need one?
If you have been diagnosed with prostate cancer, then your consultant will talk to you about your treatment options and you may be offered surgery. Removal of your prostate is called a prostatectomy.
How do I get a prostatectomy?
Cancer treatment is free on the NHS. You will have a diagnosis and be under the care of a urologist, a doctor who specialises in the male reproductive system. They will have a consultation with you before your treatment.
If you wish to be treated privately, then you can have a proctectomy in a private hospital or with a consultant of your choice.
The procedure will typically require a two night hospital stay.
Before your procedure prostatectomy
Your doctor will discuss the benefits and risks (e.g. bleeding, pain) before the procedure. They will explain the different types of surgery you can have.
Different types of prostate surgery
Robotic-assisted keyhole surgery
Robotic assisted surgery for proctectomy is common in the independent sector in the UK.
Your surgeon will make five or six small cuts in your abdomen and remove the prostate using special surgical tools. Your surgeon controls the tools via four or five robotic arms. Although it’s called ‘robotic assisted’, it is your surgeon who does the operation. It’s commonly referred to as ‘the da Vinci robot’.
If you want robotic assisted surgery and your hospital doesn’t offer it, your surgeon will be able to refer you to one that does.
Keyhole surgery
As with robotic-assisted surgery, the surgeon makes four or five cuts in your abdomen. However, they hold the surgical tools in their hands, rather than using robotic arms.
Open surgery
This isn’t very common due to the rise of keyhole and robotic surgery. Your surgeon makes a large single cut in your abdomen to reach the prostate. They will do the operation by hand and close your cut with stitches and clips.
What happens on the day of prostate surgery?
For prostatectomies, you will spend two nights in hospital so you should make appropriate preparations. You won’t be allowed to eat for about six hours before the operation, although you may drink water up to two hours before.
Your doctor will explain what will happen, pain relief options and answer any questions. You will be asked to sign a consent.
A nurse may give you an enema or suppository to clear your bowels.
When having the procedure done, you will be given:
- General anaesthetic to make you unconscious, so that you will feel nothing during your operation
The time of procedure can vary but usually two to three hours. During the procedure, your urologist will perform the procedure.
Recovery and what to expect after your prostatectomy
After the operation you will go the recovery area. Once you are fully awake, you will go the ward for recovery time. You will have a catheter in situ while you recover from the operation. You may have a thin tube in your abdomen to drain any fluid from where your prostate used to be. This is usually removed after 24-48 hours.
Week 0
- You will be sent home with pain relief and advice on how to recover.
- You may have some pain in your shoulder due to gas used during surgery.
- Your stomach may feel bloated with cramping.
- You will go home with your catheter in. Your nurse will show you how to look after it, and it will be removed in 1-2 weeks.
- Your testicle and penis might be swollen. It should start to pass within a few days or week.
Weeks 1-6
- Your cuts are usually closed with glue or stitches. These heal within a week and don’t need to be removed.
- The pain around your wounds should improve each day and be gone in four to six weeks.
- Light exercise such as a short walk each day will help improve your fitness.
- You can have sex or be sexually active once your catheter is removed, but most men wait a few weeks. If you receive anal sex, you may have to wait six weeks before having sex.
Week 6+
- Your scars will fade.
- Your muscles and tissues may take a few months to heal.
- Your fatigue from surgery should have passed and you should be able to resume normal activities.
Follow ups
You will usually have calls from your healthcare team and regular blood tests (starting at three-monthly intervals) to confirm the cancer has all been removed.
Potential complications of a prostatectomy
All surgical operations carry a risk of complications. Your risks can increase the older you are, particularly if you have other health problems. Your surgeon will discuss any specific concerns with you before your operation. Following surgery, you will no longer ejaculate, so will not be able to have children.
Side effects can include:
Very common - 7 in 10 people
- Erectile dysfunction/Reduction in sexual function. ‘Nerve sparing surgery’ during your procedure can limit the impact.
Common – 1 in 100 people which is equivalent to one person on your street
- Soreness or pain after the procedure.
- Wound or urinary tract infection
- Mild or severe urinary incontinence which can persist up to a year
- Further treatment of cancer cells if still present
Uncommon - 1 in 100 to 1 in 1,000 which is equivalent to one person in a village
- Bleeding during or after your operation
- Blood clots in your lower legs
Rare – between 1 in 1,000 and 1 in 10,000 people which is equivalent to one person in a town.
- Injury to nearby organs including your bowels, nerves and pelvic floor
- Problems caused by the anaesthetic
Contact the hospital where you had your operation if you develop:
- Unable to urinate
- Fever and/or chills
- Excessive bleeding
- Excessive pain
How much does prostate surgery cost?
Prostate cancer treatment is available free of charge through the NHS. Private healthcare may offer different surgical access or a broader selection of consultants.
Proctectomy is available through private medical insurance. Check with your insurer which hospital or consultant they will cover it.
You can also self-fund a prostectomy. Typically, an initial consultation with the surgeon will cost between £150 and £300. The cost of the operation itself will vary depending on the exact surgery you need will also vary depending on where you live.
If you opt to self-fund you will be offered one of the following:
- An all-inclusive ‘package price’, where you know the full costs before undergoing treatment. Not all consultants and hospitals offer this.
- A ‘fee-per-service’ deal, where you pay for each part of your treatment and the services you use separately. You often will not know the full costs until you receive invoices.
For more information, you can read our guide on self-pay .
What's it like to have a prostatectomy?
Paul underwent robotic prostatectomy surgery and is now living cancer-free. Paul shares his story: Life after robotic prostatectomy – a patient’s story
