Open Surgery for Prostate Cancer

What is Classical Open Surgery?

Open surgery, also known as open radical prostatectomy, is the classical surgical approach in which the surgeon accesses the prostate by means of incision.

In this operation, the aim is to extract the whole prostate gland and some of the adjacent tissue. In some situations, the lymphatic glands in the pelvic area are also removed.

Classical surgery involves longer recovery time, but the procedure itself is usually quicker in comparison with laparoscopic prostate surgery.
This significant urological operation is important and difficult to perform given its potential aggressivity, delicacy and the dexterity required to perform it correctly.

Surgery is indicated for patients with clinically localised tumours (≤ T2c TMN classification) and, in some cases, locally advanced tumours (T3 TMN classification).

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What is the Procedure?

The operation lasts around 2 hours, depending on the complexity of the case.

Since the prostate is located deep in the pelvis and is surrounded by blood vessels, there is considerable risk of haemorrhage.

There are two types of classical open surgery: radical retropubic prostatectomy and radical perineal prostatectomy.

Radical Retropubic Prostatectomy

In this operation, the surgeon performs an incision in the lower abdomen in the region between the navel and the pubic bone.

The procedure is performed under general or spinal anaesthetic in which the lower part of the body – the legs and abdomen – are anaesthetised.

If it is suspected that the tumour may have affected the lymph nodes near the prostate, the surgeon may also decide to remove them via a process called lymphadenectomy.

In specific cases, the nerves in contact with the prostate are preserved to:

Minimise the patient’s recovery time;
Preserve or minimise the impact on erectile function;
Reduce the risk of post-operative incontinence.

At the end of the operation, a catheter is inserted into the urethra to help the patient urinate. This step is performed while the patient is still under the effect of the anaesthetic, so they do not feel anything. The thin, malleable tube is removed after 1–2 weeks to ensure the wound heals, particularly the join between the bladder and the urethra.

Radical Perineal Prostatectomy

This operation, which is very seldom used today, involves making an incision between the anus and the scrotum.
The method has fallen out of fashion and is rare nowadays, as it does not safeguard the nerves, can lead to loss of erectile capacity and because the lymph glands near the prostate cannot be removed.

The recovery time after radical perineal prostatectomy is normally shorter and less painful. If performed by experienced surgeons, it can be as effective as the retropubic method.

After surgery, the procedure is similar.

The catheter inserted in the urethra to help the patient to urinate is removed after 1–2 weeks. It is usual for patients to remain in hospital before being discharged.

Want to know more about classical open surgery?

Classical open surgery has good results, but it is major and complex surgery. It is indicated for cases where the tumour has not spread to other parts of the body, such as bones and the lymphatic system.

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What is the Post-Treatment?

At home after discharge, the patient must keep the wound clean and dry.

It is normal for the site of the incision to feel tender or for the skin to feel tight for the first few days. The doctor may prescribe medication to relieve this inconvenience.

When the catheter is removed, some urine leakage is normal but generally temporary.

Within a month of the surgery, the patient will have a follow-up consultation at the clinic.

Normally within the first year, consultations are held every three months, gradually becoming further apart with time.

The aim is to assess the treatment’s effectiveness and to help patients deal with any side effects.

All patients undergoing a radical prostatectomy must have follow-up consultations for at least 15 years.

If PSA levels rise (above all if gradual rises occur in three consecutive tests), the patient may have a relapse, i.e. there may be a recurrence of the illness. In these cases, supplementary tests must be performed to better assess and ascertain the situation so that the appropriate therapy can be administered.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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