Different surgical methods may be used to remove the prostate:

• open radical prostatectomy – usually done through one long cut in the lower abdomen (belly)
• laparoscopic radical prostatectomy (keyhole surgery) – small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen as a guide 
• robotic-assisted radical prostatectomy – laparoscopic surgery performed with help from a robotic system. The surgeon uses a 3D picture and control panel to move robotic arms holding instruments.

Talk to your surgeon about the methods and other treatment options available to you, and the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital.

You may want to consider getting a second opinion. The surgeon’s experience and skill are more important than the type of surgery offered.

Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery.

Current evidence suggests that the different approaches have a similar risk of side effects. Take the time you need to make the right decision for you.

• Recovery time – whichever surgical method is used, a radical prostatectomy is major surgery and you will need time to recover. You can expect to return to your usual activities within about six weeks. Usually you can start driving again in a couple of weeks, but heavy lifting should be avoided for six weeks.
• Pain and discomfort – it’s common to have pain after the surgery, so you may need pain relief for a few days.
• Having a catheter – you will have a thin, flexible tube (catheter) in your bladder to drain your urine into a bag. The catheter will be removed after 1–2 weeks once the wound has healed.

You may experience some or all of the following side effects:

• Nerve damage – the nerves needed for erections and the muscle that controls the flow of urine (sphincter) are both close to the prostate. It may be very difficult to avoid these during surgery, and any damage can cause problems with erections and bladder control. Sometimes the nerves will need to be removed to try to ensure all cancer is removed.
• Loss of bladder control – you can expect to have some light dribbling or trouble controlling your bladder (urinary incontinence or urinary leakage) for some weeks to months, which can be managed by using continence pads. Bladder control usually improves in a few weeks and will continue to improve for up to a year after the surgery. In the long term, some people will continue to have some light dribbling. Some people may consider having an operation to fix urinary incontinence. In rare cases, people have no control over their bladder.
• Changes in erections (erectile dysfunction or impotence) – problems getting and keeping erections after prostate surgery are common. Erections may improve over months to a few years. It’s more likely you won’t get strong erections again if they were already difficult before the operation. 
• Changes in ejaculation – during a radical prostatectomy, the tubes from the testicles (vas deferens) are sealed and the prostate and seminal vesicles are removed. This means semen is no longer ejaculated during orgasm (a dry orgasm). Your orgasm may feel different – it may be uncomfortable or, rarely, painful. A small amount of urine may leak during orgasm (which isn't harmful to your partner).
• Infertility – a radical prostatectomy will cause infertility, so you won't be able to conceive a child without medical assistance. If you wish to have children, talk to your doctor before treatment about sperm banking or other options.
• Changes in penis size – you may notice that your penis gradually becomes a little shorter after surgery. Talk to your doctor about whether vacuum erection devices and prescription medicines may help. A change to the size of your penis can be difficult to deal with, see side effects for ways to get support.

In EBRT, a machine precisely directs radiation beams to the prostate. Each treatment session takes about 15 minutes. You will lie on the treatment table under the radiation machine.

The machine doesn’t touch you but may rotate around you. You can’t see or feel the radiation.

There are different types of EBRT. Your radiation oncologist will talk to you about the most suitable type for your situation.

Usually, EBRT for prostate cancer is given Monday to Friday for 4–9 weeks. Some newer forms of EBRT are given in 5–7 treatments over two weeks.

EBRT does not make you radioactive and there is no danger to people near you. Most people feel well enough to work and do their normal activities, though fatigue may increase as your treatment continues.

Brachytherapy is a type of targeted internal radiation therapy where the radiation source is placed inside the body near the prostate.

Giving doses of radiation directly into the prostate can lower the amount of unwanted radiation going into areas such as the rectum and bladder.

There are two different types of brachytherapy: permanent and temporary. If you already have significant urinary symptoms or a large prostate, brachytherapy may not be suitable

If you have permanent brachytherapy your body may give off some radiation for a period of time. The levels will gradually fall over a number of months. This radiation only travels a short distance, which means there is little radiation outside your body.

You will still need to take care spending time in close contact with pregnant women and young children for a few weeks or months after the seeds (see next page) are inserted. Your treatment team will explain the precautions to you.

You should use a condom during sex (intercourse and oral) for this precaution time in case a seed comes out (this is rare).

If you have temporary brachytherapy, you will not be radioactive once the wires are removed after treatment, and there is no risk to other people and no special precautions are needed during sex.

The side effects you experience will vary depending on the type and dose of radiation, and the areas treated. Most side effects are temporary and tend to improve gradually in the weeks after treatment ends. Short-term side effects may include:

• fatigue
• urinary problems
• bowel changes, and
• ejaculation changes.

Some side effects may not show up until many months or years after treatment. These are known as late effects and may include:

• infertility
• urinary problems
• bowel changes, and
• erection problems.

To help prevent bowel side effects, the radiation oncologist may suggest a spacer to move the bowel away from the prostate. Before the treatment course begins, a temporary gel or balloon is injected into the space between the prostate and bowel.

This procedure is usually done as a day procedure under a light anaesthetic. The cost is not subsidised by Medicare. Ask your doctors what you will have to pay and the benefits for your situation.

There are different types of ADT:

• ADT injections (most common form of ADT) – involves injecting medicine to block the production of testosterone and can help slow the cancer’s growth for years. The injections can be given by your GP or specialist. How often you have injections depends on the drug – they may be given monthly, every three months or every six months. ADT injections may also be used before, during and after radiation therapy to increase the chance of getting rid of the cancer, and are sometimes combined with chemotherapy.
• Intermittent ADT – occasionally ADT injections are given in cycles and continue until your PSA level is low. Injections can be restarted if your PSA rises again. This is known as intermittent ADT. In some cases, this can reduce side effects. It is not suitable for everyone.
• Anti-androgen tablets – often called hormone tablets, anti-androgen tablets may be given in combination with ADT injections.
• Removing the testicle/s (orchidectomy) – this surgery is not a common way to lower testosterone production. If you have advanced prostate cancer, you may choose to have surgery rather than regular ADT injections or tablets. Surgery to remove both testicles is called a bilateral orchidectomy. It is possible to have a silicone prosthesis put into the scrotum to keep its shape. Removing only the inner part of the testicles (subcapsular orchidectomy) also lowers testosterone and does not need a prosthesis.

ADT may cause side effects because of the lower levels of testosterone in the body. Side effects may include: 

• tiredness that doesn’t go away with rest (fatigue)
• reduced sex drive (low libido)
• erection problems (impotence)
• shrinking of the testicles and penis
• loss of muscle strength
• hot flushes and sweating
• weight gain, especially around the middle
• breast swelling and tenderness
• mood swings, depression, trouble with thinking and memory
• loss of bone density (osteoporosis) – calcium and vitamin D supplements and regular exercise help reduce this risk
• higher risk of diabetes, high cholesterol and heart disease – more likely the longer you have ADT. Ask your doctor about these risks.

For ways to manage side effects, talk to your treatment team or visit the Prostate Cancer Foundation of Australia for more information and support. For information about erectile and other sexual health issues, visit Healthy Male.