Surgery for prostate cancer

Prostate removal surgery has a high success rate for early stage prostate cancer. 

The success rates are lower for later stage prostate cancer, although the chances of recovery can be further improved through the use of other treatment options like radiation therapy or drugs.

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

• whether you have been under anesthesia before
• whether you have any other conditions
• whether you have taken cancer medicine before
• whether you have had radiation treatment before
• whether you have any allergies
• whether you smoke
• whether you drink alcohol
• what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process. 

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Prostate removal may cause (often temporary) urinary incontinence. You may experience issues with your surgical wounds. If your lymph nodes were removed together with the prostate, you may experience lymph fluid buildup in the abdomen.
Depending on the amount of nerve tissue that was removed, you may experience erectile dysfunction. Nerves surrounding the prostate regulate your erection. If these nerves are damaged, achieving an erection may be harder for you. 

You will be unable to ejaculate after prostate removal. This may cause problems for you and your partner. Our Sexuology department can help you with any questions regarding sexuality and intimacy. 

Urinary incontinence and changes in sexuality are the two main problems you may be dealing with after your surgery. For other short and long term effects, please see the frequently asked questions on this page.

Most people recover quickly and smoothly from prostate removal surgery and leave the hospital after a day or two. We will follow up with you through scheduled phone consultations, and you can always contact us. 

Your first follow-up screening will take place at the Netherlands Cancer Institute and will involve a blood test and a PSA screening. Later consultations can be handled by your referring urologist or general practitioner.

Men who underwent prostate surgery will not be able to father children in the regular way. We do offer the option to freeze-bank your sperm.

This feeling is caused by irritation of the bladder caused by the catheter inserted directly after surgery. 

Please contact us if the irritation gets too bothersome. We may be able to prescribe medicine to counter the symptoms.

If the flow of urine stops, your catheter or bag may be clogged. One possible solution is to adjust your own position.

There are several steps you can take: 

1. Check for kinks in the catheter tubing or drainage bag;
2. Change your posture, or go for a walk;
3. Move the catheter around;
4. Turn the catheter a couple of times;
5. Squeeze in the plastic tubing.

Please contact us if the urine still won’t flow into the drainage bag.

You may experience blood in your urine after your surgery. A little bit of blood can change the color of your urine significantly. This does not have to be a problem. 

If blood clots appear in the drainage bag, they will also occur in the tubing. Please remember to drink at least 1.5 liters of water throughout the day in order to properly clean your bladder and ensure all blood clots flow towards the drainage bag.

If your lymph nodes were removed together with your prostate, there is a chance that lymph fluid builds up in the body. The fluid will collect in the lower regions of the body, such as the penis and scrotum, causing them to swell. This can last a week or two. 

To alleviate some of the symptoms, we recommend wearing tight underwear and placing a rolled up towel under the scrotum when sitting down. The swelling will go down as you heal and regain your activity levels.

If your lymph nodes were removed together with your prostate, there is a chance that lymph fluid will build up around the groin or upper legs.

We recommend raising the legs when lying down or resting. The fluid buildup is temporary.

Surgery in the pelvis may affect the nerve pathways running to and from the legs. This may cause changes in skin sensitivity (tingling or numbness) or trouble raising the legs. The affected nerves will eventually recover, although this process may take several weeks. 

Wound drainage, or exudate, after surgery is normal. This will be temporary and stop once scabbing forms on the wounds.

If your lymph nodes were removed together with your prostate, there is a chance that lymph fluid builds up in the abdomen. This may leak through the wounds. If the amount of fluids is manageable, you can use gauze to absorb the liquid. 

Please contact us if the amount of fluids is unmanageable and we will look for an alternative solution.

You will receive a prescription for a laxative when leaving the hospital. Try not to push.

We recommend:

1. Drinking at least 1.5 liters a day;
2. Taking walks;
3. Eating a high-fiber diet;
4. Eating fruits like kiwis, prunes or oranges.

Please contact us if it takes longer than three days before your first bowel movement.

Some pain after surgery is normal. Please use the painkillers we prescribed you, and slowly reduce your dosage over the week following your surgery.

Your temperature may be high as a result of the surgery. This is normal. Please contact the hospital if your body temperature is higher than 98.6F or 37.5C and you feel ill.

We will schedule an appointment for catheter removal with you before you leave the hospital. This will be approximately ten days after your surgery.

Your surgeon may want to scan the area before the removal to check whether the bladder and urethra are properly attached. If the scan shows that everything is normal, your catheter can be removed. 

If this scan is not necessary, your catheter will be removed during your visit to the hospital.

We will give you your prostate tissue (and lymph node, if applicable) test results during your catheter removal consultation. 

We recommend bringing someone with you to the appointment.

The hospital will provide you with a kit with incontinence products and urinary collection material after your surgery. These products are provided by Medireva. Please contact them in case you need more products. We will make sure that you are authorized to request further products. 

Please contact a pelvic physical therapist on your own account before your surgery in order to receive further instructions on how to promote urinary continence. The effects of intense pelvic training before surgery have never been proven. Keep in mind that you may have to cover the costs for this therapy yourself. Discontinue the exercises once the catheter is placed after your surgery. Once the catheter has been removed, you can continue your exercises. You will receive further instructions during your catheter removal consultation at the hospital. 

Please try not to drink when taking medication (such as painkillers). Once your catheter has been removed and you stopped taking specific types of medication, you can drink (small amounts of) alcohol. Please consider the national alcohol guidelines as provided by the ministry of health.

The penis may appear smaller after prostate surgery, as the corpora cavernosa stops functioning. Please discuss this issue with your practicing physician if this is a problem for you.