Total surgical removal of the prostate gland, known as radical prostatectomy, is a common choice to cure prostate cancer and remove prostate cancer cells after diagnosis. But, what happens to a man when he has his prostate removed?
When a man has his prostate removed, the entire prostate gland plus some of the prostate tissue around it, including the seminal vesicles, is removed.
The consequences of total removal of the prostate via surgery are profound. And many of them are related to bladder control and sexual function.
However, one of the main consequences that recent research suggests is that, for some instances, you may not need it.
The diagnosis and treatment of prostate cancer have, for many years, been based on a cookie-cutter approach initially triggered by an out-of-range PSA measurement followed up with a prostate biopsy.
The measurement of a man′s PSA is a very imprecise method of determining the presence or absence of prostate cancer.
Plus, recent research suggests most biopsies are overestimating low-level lesions and labeling them as prostate cancer. Therefore, it would seem that a significant overhaul of diagnosing and treating prostate cancer is in order.
In this article, we examine what happens to a man when he has his prostate removed.
We discuss the side effects and consequences of the surgical removal of a man′s prostate gland. We do not discuss the reasons or motivations for this surgery.
Any man facing a recommendation of a prostatectomy should check out the many articles on this and other websites.
Educate yourself on the need for the procedure and seek a second opinion from an unconnected qualified authority.
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The Purpose of Prostate Surgery
Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.
It has been performed for many years and was regarded as the “gold standard” of prostate cancer treatment. However, few studies compare its efficacy to other techniques.
Most men diagnosed with prostate cancer today are typically diagnosed with “Gleason 6” cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:
Misuse of the term “cancer” has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.
The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they don′t really have.
Aggressive treatment, usually a complete surgical removal of the prostate (radical prostatectomy), is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.
Prostate Surgery Risks
A radical prostatectomy is major pelvic surgery. The prostate is deep within the pelvis, and there are many critical structures close to it. These include the urinary bladder and rectum. Damage to these structures during surgery can cause permanent disability.
In addition, the organ and surrounding areas are well-supplied with blood veins and arteries for circulation. Surgical damage to blood circulation can cause lasting disabilities.
In the recent past, several surgeons have promoted nerve sparing surgery such as a nerve sparing prostatectomy and bloodless techniques to eliminate or minimize side effects.
The nerve sparing surgery techniques are an attempt to limit damage to erectile function from surgery.
However, it takes additional skill for the performing surgeon and extra time in surgery to identify and protect critical nerve bundles. As a result, most of this kind of surgery causes the patient erection problems like erectile dysfunction.
Other surgical risks are much like any other pelvic surgery and include excessive bleeding at the surgical site, infection, and damage to ancillary organs.
Known Side Effects of a Radical Prostatectomy
So, what happens to a man when he has his prostate removed? There is a multitude of effects that occur to men after they have had prostate removal surgery.
The procedure is major pelvic surgery, and, as such, it carries along with it many potential risks. In addition to the immediate effects of the surgery, the removal of the prostate causes long-term side effects that are generally permanent.
Until recently, these side effects about what happens to a man when he has his prostate removed have not been relatively well-classified.
Most side effects are those reported by urologists that are performing the surgery. This reporting has been, in past years, rather poorly detailed and sparse; due to the surgeons not anxious to publicize the failures of a procedure, they have attached a “gold standard” label.
The most reported side effects are; erectile dysfunction and urinary incontinence.
Unfortunately, even though doctors have filed reports, the bias of the doctors filing them is questionable.
For example, one report details one of the significant side effects, postoperative erectile dysfunction, occurs between 14 and 90 percent of patients. This is a relatively wide range.
Based on my many years of practice, it is a very optimistic estimate. And it is likely provided by urologists who either do not want to admit their procedure causes such harm or deny the side effects and results.
Long-Term Side Effects
I have found it extremely rare for someone with radical prostatectomy to be satisfied with their postoperative erectile function. Even a year after the surgery.
Similarly, urinary incontinence is a major issue. Most men experience a period of urinary incontinence after the surgery. Fortunately, this side effect tends to minimize with time. But many men experience bladder control problems for a year or more.
Less experienced surgeons may be more inclined to minimize the side effects. However, the less experience the surgeon has, the more the procedure may cause extensive inflammation and nerve damage.
Erectile dysfunction and incontinence are the major factors that most researchers study and document. But nerve damage may also lead to ejaculation or orgasm issues.
Removing the prostate eliminates the ability for a man to ejaculate during sex since the seminal vesicles, (removed during surgery) provide the bulk of the ejaculate volume.
You may not able to have an orgasm after the procedure. But if you do, there will be little to no ejaculate or seminal fluid present. Most males will experience dry orgasms.
Other possible side effects
Anorgasmia is the inability to achieve orgasm regardless of the level of stimulation.
2) Penile shrinkage
Removal of the prostate seems to initiate a phase of penile shrinkage that varies between 2 to 3 cm. For men with large organs, this may have little effect. But a man that starts on the small side might be very dismayed about it.
3) Urine leakage or pain during intercourse
4) Urine leakage at orgasm
5) Pain or discomfort at orgasm
Rehabilitation, if begun early, may help restore some function. PDE5 inhibitors such as sildenafil, vardenafil, and tadalafil have been used in patients with post-surgery erectile dysfunction.
However, there is no guarantee of success. If there is significant trauma or damage to the erectile nerves due to the surgery, it is unlikely that any of the PDE5 inhibitors will have a considerable effect.
How Radical Prostatectomy Affects A Relationship
A 2011 study of 63 men that had undergone a radical prostatectomy found that about 75 percent of them sought treatment for erectile dysfunction. Additionally, more than 50 percent reported having less sexual desire, and roughly an additional 40 percent were unable to have a satisfying orgasm.
The mental health effects of these symptoms were worse in highly sexually motivated participants. 52 percent reported that this had affected their self-esteem, and 36 percent said having performance anxiety.
Additionally, the last three items on the list above can vastly affect your relationship. Few women can tolerate a high degree of urine leakage during sexual activity, and few men can handle the pain during intercourse.
There is no way to accurately predict what happens to a man when he has his prostate removed or which side effects of a radical prostatectomy will affect a specific patient. But research shows that most men have one or more significant and bothersome side effects.
Unfortunately, urologists rarely honestly discuss the severity of these side effects when recommending a radical prostatectomy.
I have heard quotes from my clients like, the doc said, “we just scoop out your prostate, and you′re good to go.” This is so far from the truth.
The radical prostatectomy is routinely recommended by many urologists, even though its value and efficacy have been questioned recently by several key researchers. Especially for those men who have confirmed low-level lesions that may not even be cancerous.
Worldwide, this has resulted in a legion of men that this surgery has sexually crippled.
Research on quality of life and life expectation does not show any great benefit for this debilitating surgery. Yet, healthcare providers still heavily promote it.
Any man who has had a radical prostatectomy recommendation would be wise to thoroughly check his options, especially if his initial diagnosis indicates a Gleason 6 score.
You should only consider a radical prostatectomy for patients with an original Gleason score over 7 who have confirmed their diagnosis using a second unrelated source.
If you have already had a radical prostatectomy and you have erectile dysfunction or other side effects, many research articles can help you overcome or minimize some of these side effects.