24 January 2020: Part of what I like about my surgeon is that he can explain so clearly what my options are and how it all works. Once I made my choice of Radical Robotic-Assisted laparoscopic Prostatectomy (RARP), he also backed that up with a comprehensive written treatment plan with prostate surgery details.

My surgeon sent me a leaflet from the British Association of Urological Surgeons where you can read how radical prostatectomy surgery works in plain English.  There are also some risk assessment numbers that sound OK (and I later find probably overly optimistic):

  • Urine still leaking after a year, they say less than 1 in 20 men
  • “A high chance of erectile dysfunction if a nerve sparing operation is not possible or nerve damage is unavoidable”

I just presume that I will be one of the lucky ones. My surgery plan includes nerve sparing so I kind of hope and trust I am going to dodge the bullet of erectile dysfunction*. Subsequently I learn that most men going any form of prostate cancer treatment, whether radiation or surgery, whether nerve sparing or not, do experience erectile dysfunction for varying periods.

It’s amazing how many acquaintances turn out to have had prostate cancer – I just didn’t realise. I ask them about the outcomes. The degree of detail I feel able to ask, and they are willing to share, varies widely. The more intimate the details, the hard they are to discuss. Most tell me that either their sexual function has recovered OK, or they had already given up on that before surgery. Early outcomes of my more private online research.

The gory details of prostate surgery

At this stage it is just dawning on me how gory the process might be. My referring urologist said that prostate cancer and breast cancer are genetically related. Two differences are that breast cancer tends to be more aggressive, while surgical access to the prostate is a lot more complicated.

The photo linked to this post comes from my actual surgery at the end of February, 2020. I am glad I hadn’t dug into too many of the gory details at this stage. However, if you are definitely not squeamish, you can also watch a video – the surgeon’s inside view of prostate surgery in progress, taken by the robot, This was not something I was ready to watch pre-surgery – I preferred the one of a da Vinci machine peeling a grape.

*Editor’s note: The post-op report said “Left sided inter-fascial approach. Right sided intra-fascial approach with preservation of endopelvic fascia and pubo-prostatic ligament.” Based on post-op experience I think this might translate into plain English as “partial nerve-sparing approach.”