What is it?
An open radical retropubic prostatectomy is a surgical procedure to remove the entire prostate gland and surrounding tissues (including the seminal vesicles) to treat prostate cancer. The operation is done through an incision in the lower abdomen, behind the pubic bone (“retropubic”).
It has been a standard treatment for localised prostate cancer for decades.
Why is it done?
- To cure prostate cancer that is confined to the prostate or has only locally spread
- For men who are otherwise fit for surgery and want definitive treatment
- Sometimes recommended if other treatment options (e.g. radiotherapy) are unsuitable
The Procedure:
- Performed under general or spinal anaesthesia
- A cut is made in the lower abdomen to access the prostate
- The surgeon removes the prostate, seminal vesicles, and sometimes nearby lymph nodes
- The bladder is reconnected to the urethra so urine can flow normally
- A catheter is left in place for 1–2 weeks to allow healing
Benefits:
- Proven, long-term treatment for localised prostate cancer
- Provides complete pathology (microscopic examination of the removed prostate) to guide further treatment
- In suitable cases, can achieve cancer cure
Risks & Considerations:
- Bleeding and infection (as with any major surgery)
- Urinary incontinence (leakage of urine, may improve over months, sometimes persistent)
- Erectile dysfunction (common, due to nerve damage near the prostate; nerve-sparing techniques may help)
- Narrowing (stricture) at the join between bladder and urethra
- General risks of open abdominal surgery (blood clots, anaesthetic risks, longer recovery compared with minimally invasive options)
Recovery:
- Hospital stay: typically 3–5 days
- Catheter: left in for 1–2 weeks
- Return to light activities in 4–6 weeks; full recovery may take several months
- Pelvic floor exercises and rehabilitation are important for continence and sexual recovery
Why seek advice?
Open radical retropubic prostatectomy remains a safe and effective treatment for prostate cancer, though many centres now also offer laparoscopic or robotic-assisted surgery with smaller incisions.
The best approach depends on cancer stage, surgeon expertise, and patient preference.