The surgical procedure

Note - I'm writing this pre-surgery, and will be able to comment on the accuracy of it in a couple of weeks. 

A radical prostatectomy is both relatively simple and absolutely horrifying, Basically what they do is remove your prostate (which sits between your bladder and the base of your penis) entirely. This is different to a non-cancer prostate operation, where they enlarge the hole through the middle of the prostate to allow for greater fluid flow. 

Because the whole prostate is removed the bladder needs to be re-stitched onto the urethra (essentially the base of the penis) so that there is a path for urine to flow. This stitching can take time to heal which leads to the first uncomfortable situation - you will have no bladder control at first. In fact a catheter will be inserted for the first week after surgery so that any urine produced simply flows into a convenient bag strapped to your leg without any interaction on your part. This sounds a bit like drinking in a swim up bar but I don't think that alcohol is recommended at this point.

You also lose a sphincter as part of the deal, and that sphincter is the one that you use to regulate the flow of urine on a day to day basis. Without it you will leak urine for at least a week or two and possibly longer, particularly when getting up, coughing, laughing or exerting yourself. So incontinence pads are apparently a must at first. Building up your pelvic floor with regular 'kegal' type exercises can assist in this process as you can learn to active a second sphincter closer to your bladder which can also help. 

As if that wasn't bad enough, the prostate sits very close to the nerves that are used for erections. Most prostatectomies are 'nerve sparing' which means that they will do what they can to avoid damaging these nerves, but even in the best case there will be some trauma to the nerves. This means that for a few weeks after the surgery you will not be able to get an erection and that there is a chance that it may never happen again. Apparently they sometimes proscribe Viagra to induce bloodflow into the erectile muscles but it still will not have an effect, it just keeps them active. I asked my prostate cancer nurse if it was dangerous to try to exploit an erection post surgery if it should happen and she just sorrowfully shook her head and said 'no, it won't'. So yeah, not fun. 

The removal of the prostate also makes you permanently infertile because there is nothing to channel sperm into your urethra. In fact you will never ejaculate anything again. Despite having no desire to have kids this is still vaguely unsettling. 

In my case I'm having a 'Robotic Assisted Radical Prostatectomy' (RARP to its friends) which is essentially keyhole surgery with thin robotic arms penetrating my abdomen and helping hold the tools in position. This is less invasive than open surgery and has a better chance of sparing nerves and healing quickly. From what I can tell most prostate surgery in Australia is RARP now. I had the option  of getting this done on the public system (surgery date to be assigned by the hospital, surgeon to be whoever is rostered for that day) or the private system (my pick of surgeon and of time & date). I went for the private option because I had heard very good things about my urologist from a physio friend and also I was able to pick a quiet time for my business. It's not going to be cheap but it has the best chance of a positive outcome and as a friend says - 'chuck $2 into a jar every time you get a hard-on and it'll more than cover the cost by the time you're dead'. Seems fair. 

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