About this page. This is a plain English summary of the three ways the prostate can be removed for prostate cancer. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
The three surgical approaches
If you and your specialist decide that surgery is right for you, the prostate can be removed in three different ways. Dr Kooner is trained in all three and will talk through the pros and cons of each.
1. Open surgery
This is the traditional approach. A cut is made in the lower tummy, between the belly button and the pubic bone. The surgeon removes the prostate directly through this opening.
- The operation usually takes about 2 to 2.5 hours.
- Hospital stay is usually around 7 to 10 days.
- Recovery at home is usually 1 to 2 months, sometimes longer.
Dr Kooner did a fellowship in prostate cancer surgery and was happy with his open surgery results, but the approach has some limits. The prostate sits deep in the pelvis, and bleeding can be unpredictable, which can make nerve preservation harder.
2. Keyhole (laparoscopic) surgery
Several small cuts are made in the tummy. Long thin instruments and a camera go through these small openings. Gas is put into the abdomen to give the surgeon room to work.
Advantages compared with open surgery:
- Less bleeding, because the gas pressure is higher than the pressure in small veins.
- A magnified view through the camera.
- Better access to the deep, narrow space around the prostate.
Drawbacks:
- The instruments do not bend.
- Movements are mirrored: to move the tip left, the surgeon has to move the handle right.
- The most delicate part, the join between the bladder and the urethra, is technically demanding.
Dr Kooner was personally trained by some of the world pioneers of laparoscopic prostate surgery and was one of the first surgeons in Australia to perform it, including running an early Australian workshop.
3. Robot-assisted surgery
This is keyhole surgery, but with a robot in between. The surgeon sits at a console and the robot's instruments move inside the patient. The robot does not operate by itself.
What the robot adds:
- Instruments that bend and rotate inside the body.
- A high-magnification 3D view.
- Tremor filtering, so small hand movements are smoother.
- A more precise join between the bladder and urethra.
Dr Kooner was chosen to lead the robotic urology program at his hospital and pioneered the use of the robot in urology in Australia. Robot-assisted surgery is now the most common approach in his practice, and is supported by multiple studies.
Making the choice
All three approaches aim to remove the cancer. The differences are in recovery, blood loss, and how technically demanding the procedure is for the surgeon. Surgeon experience matters more than the approach by itself.
Important things to know
- All three approaches carry the same general risks of prostate cancer surgery: bleeding, infection, blood clots, anaesthetic risks, urinary leakage, and effects on erections.
- Robot-assisted surgery is not always the right answer for every man. The best approach depends on the cancer, the man's anatomy, his other health problems, and surgeon experience.
- Surgery is not the only treatment for prostate cancer. Active surveillance, radiotherapy, and hormone therapy may be better in some situations.
- Asking how many of each procedure your surgeon does each year, and what their personal results are, is a fair and reasonable question.
What you can do next
- Read the full detailed page with references and patient brochures.
- Short version: robotic prostatectomy.
- Short version overview of treatment options.
- Short version: recovery of erections after surgery.
- Request a second opinion before deciding.
- Call 02 8382 6980 to make an appointment.