Radical prostatectomy
Radical prostatectomy - surgical removal of the prostate gland for cancer - is now performed using a robotic method with preservation of nerve bundles, which allows most patients to maintain urinary continence and erectile function. In K+31, the operation is performed using the da Vinci robotic system and the principles of nerve-sparing surgery.
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Who is the operation indicated for?
Indications for radical prostatectomy are determined according to the international D'Amico risk classification and the Gleason/ISUP grading system:
Low risk group (PSA < 10 ng/ml, Gleason index ≤ 6, stage ≤ T2a)
Active oncological surveillance or RP is possible in patients with a life expectancy of more than 10 years.
Intermediate risk group (PSA 10–20 ng/ml, Gleason 7, stage T2b–T2c)
Radical prostatectomy is the recommended standard of care.
High risk group (PSA > 20 ng/ml, Gleason ≥ 8, stage ≥ T3a)
RP is possible and justified in patients with locally advanced disease; up to 30% of all cases of prostate cancer in Russia fall into this group. Clinical studies confirm the oncological effectiveness of robotic prostatectomy at high risk, provided that extended pelvic lymphadenectomy is performed.
The main condition for RP is the absence of distant metastases (stage M0) and a life expectancy of more than 10 years.
Types of radical prostatectomy
Robotic radical prostatectomy (RARP)
The most modern and technologically advanced method. The surgeon controls the da Vinci system manipulators through a three-dimensional console with 10x magnification. The instruments have 7 degrees of freedom of movement - greater than the human hand - which allows you to work in the limited space of the small pelvis with submillimeter precision. The system completely eliminates tremor in the surgeon's hands. In the United States, the vast majority of radical prostatectomies are performed robotically.
Laparoscopic radical prostatectomy (LRP)
Minimally invasive technique through 5–6 punctures of the abdominal wall. In terms of oncological outcomes, it is comparable to robotic surgery, however, systematic reviews and meta-analyses show the advantage of RARP in restoring erectile function and early continence.
Open retropubic prostatectomy
It is performed through an incision in the lower abdomen. Generally accepted standard before the advent of robotic surgery. Characterized by greater blood loss and a long hospital stay compared to minimally invasive methods, but the oncological results are comparable to RARP when performed by an experienced surgeon.
Nerve-saving technique: maintaining quality of life
A key advantage of the robotic approach is the ability to precisely preserve neurovascular bundles (NVBs) running directly along the prostate capsule. It is these structures that are responsible for erectile function and partly for urinary retention.
The nerve-sparing technique is used provided that the nerve bundles are not involved in the tumor process according to mpMRI and biopsy data. With bilateral nerve sparing in patients under 60 years of age with initially preserved potency, the “trifecta” indicator (oncological control + continuity + potency) reaches 53–71% after 12–24 months.
In 2025, the Sechenov Clinic patented a modification - reduced fascia- and nerve-sparing RARP with late ligation of the dorsal venous complex, which significantly reduces the risk of urinary incontinence.
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How is the operation performed?
1. Preoperative preparation (4–6 weeks)
- Biopsy with pathological report (Gleason/ISUP group)
- MPMRI of the pelvis - for nerve-sparing planning
- Standard preoperative screening: CBC, OAM, coagulogram, ECG, chest X-ray/CT
- With BMI > 30 – weight loss speeds up post-operative rehabilitation
- Hospitalization the day before the intervention
2. Progress of the operation (2–3 hours)
The patient is placed under general endotracheal anesthesia in the Trendelenburg position. After 5–6 punctures (5–10 mm), carbon dioxide is injected into the abdominal cavity to create pneumoperitoneum. da Vinci manipulators ensure removal of the prostate gland en bloc with the seminal vesicles; When indicated, extended pelvic lymphadenectomy is performed. The urethrovesical anastomosis is created with absorbable sutures.[29]
3. Early postoperative period
The drainage is removed on days 1–2, the urethral catheter on days 7–14. The inpatient period after RARP is 2–5 days - significantly less than after open surgery (7–10 days).
Why K+31
- The da Vinci Robotic System is the most advanced platform for urological surgery
- Multidisciplinary consultation of a urologist-oncologist, anesthesiologist and rehabilitation specialist before each operation
- Precision mpMRI navigation for nerve-sparing planning
- Personalized rehabilitation program from the first day after surgery
- Managing the patient until complete oncological and functional recovery
Frequently asked questions (FAQ)
How is radical prostatectomy different from surgery for prostate adenoma?
Adenomectomy (or TUR of the prostate) removes only benignly enlarged tissue, preserving the gland itself. Radical prostatectomy involves complete removal of the prostate gland along with the capsule, seminal vesicles and, if necessary, lymph nodes. Performed exclusively for malignant tumors.
How painful is the surgery?
The operation is performed under general anesthesia, so there is no pain during the intervention. In the postoperative period with robotic access, the pain syndrome is much less pronounced than with open surgery - most patients manage with tablet analgesics for 2–3 days.
When can I return to work after surgery?
For sedentary work, most patients return to work within 2–4 weeks after robotic prostatectomy. Physical labor and sports are allowed after 6–8 weeks.
Will I have urinary incontinence after surgery?
Temporary incontinence to one degree or another is observed in almost all patients after removal of the urethral catheter. However, when Using the nerve-sparing technique, up to 83% of patients retain urine without pads by 3 months, and 85–95% by 12 months. Kegel exercises, started before surgery significantly speeds up recovery.
Will potency remain after prostatectomy?
The likelihood of maintaining potency depends on age, initial SHIM score and the availability of technical conditions for nerve sparing. With bilateral nerve sparing in young patients (under 60 years of age) with an initially intact erection, the chances of restoring sexual function exceed 60–70%. It is important to understand that recovery takes from 6 to 24 months and often requires medication support.
Can I become a father after radical prostatectomy?
Traditional RP excludes biological paternity in a natural way, since the removal of the prostate gland disrupts the ejaculation mechanism. If Planned Parenthood is an option, sperm cryopreservation is recommended prior to surgery.
Do I need surgery if I am diagnosed with stage 1 prostate cancer?
For stage T1a–T1b and low risk according to D'Amico (Gleason ≤ 6, PSA < 10) European guidelines (EAU) allow active surveillance. However, when the presence of aggressive cells (ISUP group 2 and higher) or at the request of the patient, surgery is a justified choice. The decision is made jointly with a urologist-oncologist after a complete examination.
How soon after surgery will my PSA level drop?
After radical removal of the gland, the PSA level should drop to undetectable values (< 0.1–0.2 ng/ml) for 4–8 weeks. This confirms the oncological radicality of the operation. Further PSA monitoring is carried out every 6 months.
Are radical prostatectomy and robotic prostatectomy the same thing?
No. Radical prostatectomy is the general name for surgery to remove the prostate for cancer. It can be performed open, laparoscopic or robotically. Robotic prostatectomy is the most modern type of RP performed using the da Vinci system.
What is the risk of recurrence after surgery?
The risk of biochemical relapse (rising PSA) within 5 years ranges from 8–12% in the low-risk group to 21–38% in the high-risk group according to D'Amico. Timely detected recurrence is successfully controlled with salvage radiation therapy or hormonal therapy.
Is it possible to perform an operation under a compulsory medical insurance policy?
In Russia, robotic prostatectomy is available under the VMP quota (high-tech medical care) in a number of government centers. In K+31, check the current financing conditions with the administrator.
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About the service
Radical prostatectomy (RP) is an operation to completely remove the prostate gland along with the seminal vesicles and, if necessary, regional lymph nodes. This is one of the two main methods of radical treatment of prostate cancer, along with radiation therapy, and is the recognized “gold standard” for localized and locally advanced forms of the disease according to the recommendations of the European Association of Urology (EAU).
Prostate cancer is the most frequently diagnosed cancer among Russian men: according to 2023 data, it ranks 1st in the structure of cancer incidence in the male population of the Russian Federation (19.1%) with a recorded increase in prevalence over 10 years by almost 40%. Global statistics are also disappointing: in 2022, about 1.47 million new cases of prostate cancer were registered in the world, by 2040 their number is predicted at the level of 2.4 million. In Russia, 65.2% of all cases are detected today at stages 1 and 2 - this means that the majority of patients are candidates for for radical surgical treatment.