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Prostate Cancer

Radical prostatectomy

During this operation the entire prostate gland is removed surgically in an attempt to cure the disease. It is only done when the cancer has not spread from the prostate, and usually in men under 70. It is a common operation for prostate cancer. An incision is made in the abdomen or in the perineum, the area between the legs between the scrotum and the anus. The operation is usually carried out under general anaesthetic. Most men remain in hospital for three to seven days. Some of the men who had this operation describe their hospital experiences (also see section on 'Side effects of treatments').

 

Richard's surgery seemed to go well though he was in the operating theatre for six hours. He...

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Age at interview: 53
Sex: Male
Age at diagnosis: 47
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Well the operation, it was a very long operation, I think, I was told by my consultant that it would be, maybe two to three hours, but as it turned out it was a much longer operation than, I think it was maybe about five or six hours, but obviously I wasn’t (brief laugh) I wasn’t conscious for the operation so I don’t know if there was any complications, but I know from my wife, I mean she was waiting for me when I came out, she was waiting a long time, and obviously thought something might have gone wrong, but yeah, the operation seemed pretty straight forward, and yeah, it was a little bit of discomfort, not really a lot of pain, so I think that was the easy part of the treatment, was the operation, yeah you don’t think it at the time because you haven’t experienced the recovery, but to me, that was the easiest part, I think the recovery period and things you have to go through after that, was much more difficult.

 
So, the immediate recovery, what was it like then?
 
The immediate recovery, because you have a catheter, you’ve got a catheter to pass urine, so you have to, you’ve got this bag strapped to your leg all the time, and then when you’re released from the hospital you’ve still got that, and you have to change the bag and keep it clean, you’re not able to lie down and sleep initially because the cut is a, sort of, where your abdominal muscles are, so you’re not able to lie down flat, so for the first, maybe three, three weeks or so, I was having to sleep in the front room sitting up, because you just can’t lie down, so that was uncomfortable, having to keep changing the bag, that was uncomfortable, just having the catheter in, full stop, was uncomfortable, showering with it, very uncomfortable, and then you have to go back and they do a test to see if they’re able to remove it, if the surgery with your bladder, if that had been healed, and then they’ll remove the catheter. Once it was removed, then you have to learn to sort of pass water yourself, which you don’t, you don’t even think about, so you have to do that and there’s a lot of leakage, a lot of incontinence, so you have to wear a pad, which again, very uncomfortable for a guy, you can’t travel long distances because sometimes, you don’t even realise, you know, the pad is getting wet, because you don’t realise that you’re leaking, because you can go to, you’ll got to the toilet and you finish, and then you’ll be sitting down and you don’t realise you’re still leaking, so you have to do like pelvic floor exercises like pregnant women do, to get control of your bladder back, so that was very uncomfortable and that must have taken about two to three weeks to get control of my bladder back so that I could pass urine and then stop passing urine and for it to, no leakage, and not wear pads anymore, so that was a very hard part of the process, and then after that, I think the erectile dysfunction was the, yeah, was the biggest problem, after that.
 
 

 

 

Describes his experience of the Radical Prostatectomy.

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Age at interview: 56
Sex: Male
Age at diagnosis: 55
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Going into the operation, I just wanted to get on with it, I just did not want to waste another hour really, just get down on that operating table and get it done. I think that was 4 o clock ish I can't remember, the next thing I knew, I think I had a total of 10 tubes going in or coming out or doing something useful, 10 tubes in me and I was in what they call the high dependency unit for 2 days where I really had very close one to one monitoring indeed which was very reassuring and I was sufficiently doped up, but I wasn't in any pain at all, uncomfortable at times yes but not in any pain.

So that wasn't a difficult time and I think 2 days, on the second morning, not the first morning after the op the night before but the next one after that I was offered did I want a bed bath. And I think the nurse, she was a middle aged nurse who had been an army nurse and she said 'Do you want a really strong bed bath?' I said 'Oh yes I feel filthy,' and at 5 o clock in the morning just a few days before Christmas I had the best wash I've ever had in my life (laughs) it felt wonderful, absolutely marvellous. So she sorted me out and a few hours after that I was out of the high dependency and into a room where a nurse was designated to look after me for the next day. And as the days went on the tubes came out and life became a bit more comfortable. And by the time, I was in hospital one week, came Christmas Eve, I was down to, from 10 tubes on the first night down to just the catheter and a tube coming out of a, to a waste bag, I forget what they call them.

A drain?

Yes a drain, taking the rubbish from where the wound, where the operation, that's right a drain, so I had the drain in just taking a bit of rubbish out from the op.

So the experience in hospital was good?

Yes it was, everybody was so, and especially of course when the surgeon came in on the 5th or 6th night and said 'The prostate is, we've caught it in time, it's been,' he said they carve it up and it hasn't reached the outer zone so you're not even in the margin area, it was all central. So that of course made you, you didn't mind how much discomfort you were in at that stage you were basically being told that you hadn't got it in your bones, you hadn't got it, they'd taken out the lymph nodes surrounding the prostate it wasn't there, it was contained all within the prostate. So at that stage he was delighted but that it looked as if it had been a complete success and caught in time and no further problems. But of course it was very uncomfortable for the first month, especially with the catheter and I got an infection in the wound and I got a bladder infection and those were quite uncomfortable but you don't mind that, once you've been told that it's all, you're in the clear. But it was pretty uncomfortable the month, as you no longer had an epidural which I'd had very, very good monitoring by the anaesthetist and the epidural certainly kept me very comfortable in hospital.

So you had an epidural before the operation?

No I think, I don't think I had, no I think that went in whilst I was under the general anaesthetic, I believe that I went in for the operation and the first things they did were fix up things like the epidural and a few tubes here and there and then I was into the surgeon. I was shaved by him, often I think before the nurse or someone else shaves you but he actually wanted to do his own shaving, get it absolutely where he wanted it (laughs) and the scar now 9 months on or so is rather disappointingly fading so I haven't got anything to show off. But it was the first month was quite uncomfy but we had very good, the nurse, the Distric
 

Describes his experiences of the hospital and discomfort afterwards.

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Age at interview: 57
Sex: Male
Age at diagnosis: 54
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I went into, I went into hospital for the operation, of course I was anaesthetised, and I went down to the theatre. They make an incision from the naval down to the bottom of your stomach to operate and they remove the prostate and also they remove the seminal gland which is part of the prostate and I was in the operating theatre for about 5 hours I believe. I woke up in intensive care,I didn't know much about it but I felt fine, I had no problems at all but I had a lot of tubes sticking out of my arms. I had epidurals for the pain, I had a catheter fitted so I had tubes down there. I had quite a few tubes, I was on a drip and I was in intensive care for the night. The nurse - and I shall never forget because I was quite awake - kept calling in every hour to check up on me and I kept smiling at her and then they took me back to the ward the next day.

The first person that came into the ward was the physiotherapist and she said "Right let's be having you out of bed", and at this stage after having major surgery I was frightened to get out of bed. There were tubes everywhere and I was frightened to do any damage to those. Anyway,she said "Come on let's be having you." So I rolled out of bed,and she said, "I want you to sit in that chair," so I sat in the chair and she reassured me "You'll be alright," and went. So I sat in the chair for about 10, 15 minutes, felt a bit shaky, got back into bed and I thought well that's not bad. And then nurse brought me soap and water, I freshened myself up and then I just progressed from there. I must add at this stage I was still on liquids only, nil by mouth, I wasn't allowed to eat and I wasn't allowed to eat for a four days because of the operation.

Food never worried me at all, I was just happy to be where I was happy knowing that I'd had the operation so that's how they explained it to me. There's probably a more technical term but they said the stomach goes to sleep, as soon as you touch it and we get no response out of your stomach for 3 or 4 days.

I had no problems at all with the catheter. I was aware of it - I was aware of them changing the bag every now and again, but there was no discomfort. The biggest discomfort after the operation is going to the toilet, but this was after 3 or 4 days later, after which the bowel or the stomach wakes up. I had a bit of a fright then when I went to the toilet and the nurse explained to me "You shouldn't have tried to go to the toilet, you should have left it". But when you haven't been to the toilet you've just got it in your mind "Well I should have to go now". And she was saying "There's nothing there for you to go", and all I did was I make it worse really because I caused bleeding. I thought "Oh what have I done?" But it was nothing, it was just I should have listened, I shouldn't have gone really.

The strain made me bleed and of course with the catheter there I thought something had happened with the tube and I got a little bit of a panic. But when it was explained to me again I was alright. They told me this catheter was really my lifeline and they had it taped to me and they said "Whatever you do don't pull that out, that is your lifeline because that's replacing the tubes inside your body until such times as they heal up."

I was supposed to have been in hospital for 14 days, that's what they told me, after 7 days I think they were glad to get rid of me. My stomach started rumbling and that was, that went on the nurse's report "I've had a rumble, I've had a rumble, my stomach's waking up," so they started me after the fourth day on food. And it was at this stage, once I went onto solids I just had it into my mind that I should have to go to the toilet. I think I just thought well if I've eaten so
 

Comments that he found the operation straight forward but had some discomfort afterwards.

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Age at interview: 70
Sex: Male
Age at diagnosis: 67
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As far as the operation itself was concerned I was in hospital 6 days. It was pretty straight forward, I obviously had some discomfort. If I had been in severe pain then they gave you a morphine facility which is self regulated in so far as if you feel that you're in too much pain then you press a button and you get a small injection automatically, a small injection of morphine, obviously it is controlled so that you can't give yourself an overdose. Er but the other awkward thing I think initially was the catheter which is really a device to keep draining your bladder until your prostate recovers, till the area round where the surgery has taken place begins to recover. You get used to that within a day, especially if you're in a ward where there are only prostate cancer patients, they're all walking around with catheters, it's just the norm, there are quite a few jokes about which I probably won't repeat on this (laughs). 

 

Describes his experiences on the ward after a major operation to remove a tumour in his abdomen.

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The operation itself was... I had it done through the abdomen, radical prostatectomy is now carried out and I'm bound to get the word wrong but I can't think of the word perennial, no not perennial no that's the wrong word.

Perineum?

Perineum correct thank you, through the perineum area and I can't speak on that because I have no experience at all, as I say my operation was done through the abdomen. And you were told quite clearly that you would be 2 days in intensive care on leaving the theatre and that you would probably be in hospital for something like 6 to 7 days. The anaesthetist was absolutely excellent, following the operation he guaranteed that I would feel no pain and he was absolutely right. He implanted an epidural pretty soon after I came round from the anaesthetic and I can honestly say I had no physical pain at all. There's a certain amount of discomfort of course that you are again fitted with catheters and you've got drips going into your back of your hand and also, or into your wrist and also blood transfusions. These are just a nuisance more than a painful thing. You're pumped fill of antibiotics because they do not wish you to have any infection in the area of the wound because it is a fairly large cut that is made through that abdomen and it was done across the abdomen not as I believe some cases up and down. On leaving hospital I came home, this time I'm absolutely certain with a catheter in and I was incontinent which of course would be the case with the catheter anyway. But after 3 weeks you had to go back and have the catheter removed and I remained incontinent with the catheter out. Now this is the most difficult period of the operation, some people I am informed are lucky the catheter is removed and they're immediately functioning properly, others I'm informed can go on for a year still being incontinent.

 
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The prostatectomy was not as painful as he had expected it to be.

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I found that you know, the hospital staff, the nursing staff, everybody was very kind and considerate and I felt extremely well and I had no worries about it. But people went out of their way to give me information which they, nothing was hidden, everything. I met the anaesthetist who gave a large number of anaesthetics for prostate surgery and I think, probably, at that time was giving more anaesthetics for prostate surgery than any other anaesthetist in the country. So we had a very friendly talk about it and you know, the problems with anaesthesia in prostate surgery, such as they were, and so I felt very reassured. Well, there was no pre-med, which I hadn't realised, so there were little things that slipped passed, I didn't realise that so far as he was concerned he didn't like his cases to have pre-med so I went down to the theatre quite wide awake. Then had the induction and the anaesthetist said to me, 'Well, this is just like champagne which you'll have drunk rather too much of it, it's a very pleasant feeling.' And I didn't altogether care for the feeling induced, of the feeling brought on by the induction, and I said, 'That champagne is bloody awful champagne' and if I hadn't come round those would have been my last words.

But was that with an injection?

That's right, yes. And then I woke up in intensive care.

And how was that?

Well, I found it much better than I expected. Everybody had talked to me about pain when you wake up and there wasn't a nurse who hadn't come in and sat down and said to me, 'Now I do want to warn you of that' and my surgeon had warned me of this and the anaesthetist. So when I went to sleep I was fully expecting to wake up in considerable pain but I woke up in discomfort, no more. And I had my, I could regulate the amount of analgesic I was getting so that if I had wanted more I could have had more but I didn't want any more. And then there were a massive number of drips going, of course, and oxygen, just the usual intensive care procedure. And a very, very pleasant male nurse was specialing me; he couldn't have been better and very efficient, I thought, forever regulating this and that and putting things into my line, what it was I have no idea.

So how long did it take for you to move back to a regular [ward], were you in a private room or regular ward?

I was in a private room and I was just over 24 hours in the intensive care and then went upstairs. I was still having problems with blood pressure and blood oxygenation because I'd bled during the surgery and I had a fair number of units of blood. But even when I got back to the ward, to my room, my haemoglobin was 7 so I had obviously had quite a biggish bleed.

 
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Haq explains why surgeons found it impossible to remove all of his prostate.

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But only thing I wish, I think, okay it’s too late now, I had the perineal prostatectomy, which they call it, from the back like you know, should I have had it from the front? Probably it would have been a bit different, but I decided to go from the back like you know, which was a keyhole sort of thing, and the surgeon who did the operation, suggested that, “Okay you’ll be alright it’s no different from the open surgery from the front”, but unfortunately when they opened me up and they found difficulty, it was not so easy, and for some reason or other my prostate gland was stuck just under the bladder, so they couldn’t remove it completely, that was it, so now I am, what I’m thinking probably it would have been better if I had have gone the other way like you know, maybe, or not, this had to happen like you know (brief laugh).

 

After the operation John developed a MRSA (Methicillin-resistant Staphylococcus aureus) infection.

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Age at interview: 62
Sex: Male
Age at diagnosis: 57
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There’s not much else I can say about the operation itself, per se or the follow up except that I had a little bit of difficulty in the outcome, in that the doctor came round one day and as it happened I was lying on the bed, with the blanket over me, he was quite startled by the fact that within days of the operation I was wandering around the hospital, albeit quite painfully, but I couldn’t sit still, didn’t want to sit still, couldn’t lie on a bed, didn’t want to sit on a chair, I was happy enough just wandering, but this particular day, I was, I had a blanket over me, which he didn’t actually react to initially, until a nurse went past and I said, “Nurse can I have that extra blanket please, I’m freezing”, he reacted immediately, and it turned out I had MRSA, so I did, so, we had a few problems clearing that up as well. I hadn’t a particularly virulent form, it just made it a little bit more difficult for things to clear up per se. Recovery, no particular problems with the recovery and the usual problems that you have post-operative, incontinence and all the rest of it, all cleared up as quickly as can be expected.

 

The latest way of performing radical prostatectomy is laparoscopic (keyhole surgery), either standard or robot assisted. These are minimally invasive with the advantages of reduced blood loss, postoperative pain and a shorter hospital stay. For more information see Robot-assisted laparoscopic radical prostatectomy.
 

Last reviewed July 2017.
Last updated July 2017.
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