In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team. The major possible side effects of radical prostatectomy are urinary incontinence being unable to control urine and erectile dysfunction impotence; problems getting or keeping erections. These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well.
These are the major types of incontinence:. After surgery for prostate cancer, normal bladder control usually returns within several weeks or months.
This recovery usually occurs slowly over time. In general, older men tend to have more incontinence problems than younger men. Large cancer centers, where prostate surgery is done often and surgeons have a lot of experience, generally report fewer problems with incontinence. Incontinence can be treated. To learn about managing and living with incontinence, see Bladder and Bowel Incontinence. Erections are controlled by 2 tiny bundles of nerves that run on either side of the prostate.
If you can have erections before surgery, the surgeon will try not to injure these nerves during the prostatectomy. This is known as a nerve-sparing approach. But if the cancer is growing into or very close to the nerves, the surgeon will need to remove them. If the nerves on only one side are removed, you might still have erections, but the chance is lower than if neither were removed.
If neither nerve bundle is removed you might have normal erections at some point after surgery. Your ability to have an erection after surgery depends on your age, your ability to get an erection before the operation, and whether the nerves were cut.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem.
Common side effects from radiation treatment include:. For men with higher-risk prostate cancer, radiation treatment may be given along with hormone therapy.
Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease. Men who choose either treatment have a low risk of dying from prostate cancer. One study found that the risk of dying was about the same no matter what treatment men with localized prostate cancer had.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
My doctor told me I have prostate cancer. After I got over the shock, we talked about my treatment choices. My doctor told me the cancer is small, so I have taken some time to think about it. I could have surgery to remove my prostate or use radiation to try to kill the cancer. Except for this cancer, I am in good health and hope to live a good long while, so I have decided on a radical prostatectomy.
I realize the surgery may cause problems with holding my urine or getting an erection, but I do not like the idea of cancer slowly growing in my prostate.
I want to get rid of it and not just try to kill it with radiation. My doctor told me after my last checkup that I have prostate cancer. I've got some heart problems that may make surgery more risky for me. So I'm choosing to have radiation therapy. We are also talking about using hormone therapy to try to increase the effectiveness of the treatment. I'm not that concerned about the side effects. I just want to enjoy a little more time with my family.
I really was not all that surprised when my doctor told me I had prostate cancer. My father had prostate cancer too. My doctor told me there were several treatment options. Since I have a family history, I feel that I need to be as aggressive as possible in my treatment of the cancer. For me, that means having the radical prostatectomy. Lots of men get prostate cancer as they get older.
I guess that makes me a statistic. My doctor told me there are several different ways to treat my cancer. I want to do something, but at my age I'm not keen on having surgery.
I also thought about my age and how long most men live after being diagnosed with prostate cancer. For me, choosing radiation therapy is the best balance between doing something and not doing too much. Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. I am more concerned about the risks of radiation than I am about risks from surgery.
I am more concerned about the risks of surgery than I am about the risks from radiation. It's not important to me for my doctor to know what kind of tumor I have. I'm not worried about the higher risks of erection problems in the first few years after surgery. I don't want to risk having erection problems in the first few years after surgery. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision.
Show which way you are leaning right now. How sure do you feel right now about your decision? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Is surgery always the better treatment for a man who has localized prostate cancer? In the first few years, does surgery have a greater risk of causing bladder control and erection problems than radiation?
Does your surgeon's experience affect your risk of side effects? Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.
Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Updated visitor guidelines. Get the facts. Your options Have radiation treatment to the prostate. Have surgery to remove your prostate. As well as the prostate, your surgeon will also take out the seminal vesicles. These are two glands that are connected to the prostate and sit just behind it. They store some of the fluid in semen the fluid that carries sperm.
There are two bundles of nerves attached to the prostate that help you get erections. This is called nerve-sparing surgery. If your surgeon thinks your cancer may have spread to the nerves, they may need to remove one or both of these bundles.
This will cause problems getting an erection without medical help. Even if the nerves are saved, it can still take some time for your erections to recover. You will wake up in the recovery room. You will have an oxygen mask on, as you will be breathing more slowly than usual while the anaesthetic wears off. You will have a drip in your arm to give you fluids and pain relief, and you will have a catheter in place to drain urine from your bladder.
You may also have a thin tube in your lower abdomen to drain fluid from the area where your prostate used to be. This is usually removed 24 to 48 hours after the operation. It may feel strange or uncomfortable at first and you may feel like you need to urinate all the time.
But the catheter should drain all the urine without you needing to do anything, and this feeling usually passes after a few hours. Most men go home with the catheter in.
Your nurse will show you how to look after it, and it will be removed at the hospital one to three weeks later. You will be given pain-relieving drugs after the operation if you need them. These should control any pain you have, but tell your doctor or nurse if you are in any pain. The drugs are usually given into a vein in your arm or hand through a drip intravenous infusion. You might have a pump so that you can give yourself pain relief without having to wait for someone to bring it to you.
There is a limit on the pump so that you can't give yourself too much medicine by mistake. After keyhole surgery, you may have some pain in the tip of your shoulder for a few days.
This is caused by the carbon dioxide used during surgery. The gas irritates the nerves, and this can cause pain. Your stomach may also feel bloated, and you might feel some cramping and tightness. You may have some bruising and swelling in and around your testicles and penis. This can make it uncomfortable to sit on hard surfaces.
When you go home, you may find underpants briefs give you more support and are more comfortable than loose boxer shorts. You can also buy supportive underwear, such as a jock strap or testicle support. If you had lymph nodes removed during the operation, this can very occasionally cause swelling in the scrotum the skin containing your testicles and one or both legs lymphoedema. You will be given compression stockings to help encourage the fluid to drain from your legs if you need them.
You will usually start with sips of water. You will be encouraged to get out of bed and start moving around as soon as you can to lower the risk of blood clots. You may also be prescribed injections to reduce the risk of blood clots. A district nurse might also visit you during the first few weeks.
Before you go home, your nurse will show you how to look after your catheter. The catheter will be attached to a bag that can be worn inside your trousers, strapped to your leg. The following tips can help prevent urine infections. Your catheter will be removed at the hospital one to three weeks after your surgery.
Your doctor or nurse will make sure you can urinate before you go home. This is quite common and usually stops on its own. Take some absorbent incontinence pads and spare underwear and trousers to the hospital. Close-fitting underwear can help to keep the pads in place and men often find loose trousers most comfortable. Some hospitals will provide a few absorbent pads and your local NHS service may provide some for free. You can buy more from pharmacies, chemists, large supermarkets or online.
You may also be able to order them from a supplier without paying VAT. Our surgery support pack might be helpful. After keyhole surgery, the cuts are usually closed with a special type of glue, clips or stitches.
The cuts heal within a few days and the stitches slowly dissolve and fall out on their own. If you have open surgery, the cut is usually closed with stitches or clips. Some types of stitches need to be removed in hospital or by your GP after one to two weeks.
The muscles and tissues inside your body need time to heal. This may take several months, and can sometimes take up to a year. You will need to take it easy for the first couple of weeks after surgery.
Gentle exercise around the home and a healthy diet will help your recovery. Light exercise such as a short walk every day will help improve your fitness. If you can, avoid climbing lots of stairs, lifting heavy objects or doing manual work for eight weeks. Bowel habits may take a few weeks to return to normal. You may have no bowel movements for several days after surgery. If this carries on or becomes uncomfortable you may need medicine to help empty your bowels called a laxative.
Ask your pharmacist for some as soon as you start having trouble. Eating high fibre foods such as wholegrains and fruit , drinking plenty of fluids, and doing gentle physical activity will help. Some men get fatigue extreme tiredness for a few weeks or months after surgery. This should pass with time. Try to eat healthily and be physically active when you feel able to. Watch Colin's story below for one man's experience of surgery.
He and his wife talk about how he recovered from the operation. You will have regular check-ups after your operation — this is called follow-up. Your check-ups will usually start between six and eight weeks after surgery, and they will usually be every three to six months.
Over time you may have these less often and two to three years after your treatment you may start seeing your GP instead of your hospital doctor. You will have a PSA test a week before your check-up, so the results are available at the appointment.
The PSA test is a good way of checking if your treatment has worked. A rise in your PSA level can suggest some prostate cancer cells were left behind. If this happens, your doctor will talk to you about further treatment.
Your prostate will be sent to a laboratory to be looked at under a microscope. This can give a clearer idea of how aggressive the cancer might be and whether it has spread. If your results suggest some cancer cells may have been left behind or the cancer has come back , you might be offered radiotherapy on its own or with hormone therapy. You may also be able to take part in a clinical trial. The amount of time you take off work will depend on how quickly you recover, how much physical effort your work involves, and whether you feel ready to go back to work.
If you have open surgery, you might need longer to get back to your usual activities than after keyhole surgery. You will be able to sit in a car as a passenger while your catheter is still in. You may want to avoid long journeys for the first two weeks after the catheter is removed until you are more used to dealing with any problems, such as leaking urine. The risk of side effects from HIFU is usually lower than other treatments.
But possible effects can include erectile dysfunction or urinary incontinence. Back passage problems are rare. A fistula, where an abnormal channel forms between the urinary system and the rectum, is also rare.
This is because the treatment targets the cancer area only and not the whole prostate. But HIFU treatment is still going through clinical trials for prostate cancer. In some cases, doctors can carry out HIFU treatment outside of clinical trials. HIFU is not widely available and its long-term effectiveness has not yet been conclusively proven. Cryotherapy is a method of killing cancer cells by freezing them.
It's sometimes used to treat localised prostate cancer that has not spread beyond the prostate gland. Tiny probes called cryoneedles are inserted into the prostate gland through the wall of the rectum.
They freeze the prostate gland and kill the cancer cells, but some normal cells also die. The aim is to kill cancer cells while causing as little damage as possible to healthy cells.
It's rare for cryotherapy to cause a fistula or problems with the back passage. Cryotherapy is still undergoing clinical trials for prostate cancer. In some cases, doctors can carry out cryotherapy treatment outside of clinical trials. It's not widely available and its long-term effectiveness has not yet been conclusively proven.
If the cancer has reached an advanced stage, it's no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms. If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss. Chemotherapy is often used to treat prostate cancer that's spread to other parts of the body metastatic prostate cancer. Chemotherapy destroys cancer cells by interfering with the way they multiply.
It does not cure prostate cancer but can keep it under control to help you live longer. It also aims to reduce symptoms, such as pain, so everyday life is less affected.
The main side effects of chemotherapy come from how it affects healthy cells, such as immune cells. Many of these side effects can be prevented or controlled with other medicines that your doctor can prescribe. Steroid tablets are used when hormone therapy no longer works because the cancer is resistant to it.
This is called castration-resistant prostate cancer CRPC. Steroids can be used to try to shrink the tumour and stop it growing. The most effective steroid treatment is dexamethasone. There are a number of new medicines that could be used if hormones and chemotherapy fail. Your medical team can tell you if these are suitable and available for you. NICE has issued guidance on medicines called abiraterone, darolutamide and radium dichloride.
All of these may be used to treat metastatic prostate cancer that no longer responds to standard hormone therapy.
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