Radical Prostatectomy
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Radical
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prostatectomy
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This fact sheet is for men who are thinking about having, or have been recommended,
surgery to treat their prostate cancer. It is one of several fact sheets that have been
written to help you decide which treatment is best for you. It describes the operation to
remove the prostate gland (radical prostatectomy), which can be done as open surgery
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through the abdomen (retropubic) or through the area between the testicles and the
back passage (perineal). It also describes the keyhole operation which can be done by
hand (laparoscopic) or with the help of a robot (robot-assisted).
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Who can have radical
When you discuss possible treatments
prostatectomy?
with your specialist team, they will take
into account your individual medical history
Radical prostatectomy is a treatment option
and personal wishes. You should have an
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for fit, healthy men with cancer that is
opportunity to discuss all of your treatment
thought to be contained within the prostate
options with several specialists before
gland (localised prostate cancer). It may not
making your final choice. A key worker or
be suitable for you if you have other health
specialist nurse may give you their contact
problems, such as significant heart disease,
details so that you can ask questions about
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as these increase the risks of surgery.
your treatment at any time.
Alternative treatments for localised prostate
How does radical prostatectomy
cancer include:
treat prostate cancer?
• active surveillance
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The aim of surgery is to take out the cancer,
• external beam radiotherapy
as long as it is contained within the prostate
• brachytherapy
gland, and stop it spreading to other parts of
• watchful waiting.
the body. This is done by removing the whole
prostate gland and the seminal vesicles,
Other treatment options include High
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which make some of the fluid of semen.
Intensity Focused Ultrasound (HIFU) and
cryotherapy, which may be available as
Your surgeon may also remove the lymph
part of a clinical trial or national study.
nodes if there is a risk the cancer has
These treatments are newer than the
spread there. The lymph nodes are part of
ones listed above and we do not yet know
the immune system and help the body fight
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how they affect quality of life and long
disease and infection. However, surgeons no
term survival. You can find out more about
longer routinely remove them because many
all of the treatments mentioned here
cancers are detected early when the risk of
by reading our other Tool Kit fact sheets
spread into the lymph nodes is very low.
or by calling our free and confidential
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Helpline on 0800 074 8383.
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Your surgeon should discuss this with you
What are the advantages and
before your operation.
disadvantages?
The advantages and disadvantages of all
The surgeon removes the prostate,
types of prostate surgery depend on your
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age, health and stage of disease. Your
the seminal vesicles and possibly the
surgeon should discuss your individual
lymph nodes
situation and options with you.
lymph
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Advantages
nodes
• If no cancer cells have escaped from the
prostate gland, surgery can completely
bladder
seminal
remove the cancer.
vesicle
• You and your doctor will find out exactly
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how aggressive the cancer is (Gleason
prostate
grade) and how far it has spread (stage).
urethra
• It will also treat BPH (non-cancerous
enlargement of the prostate) and its
symptoms.
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• It is easy to measure the success of the
surgery by monitoring the PSA level. If the
There are several ways of removing the
surgery is successful, the PSA should drop
prostate gland:
to less than 0.1 ng/ml within four weeks of
the operation.
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Open prostatectomy
• If the PSA starts to rise after surgery,
This is the most common method. There are
further treatment with radiotherapy
two types of open surgery:
may be possible. However, if the PSA rises
• Retropubic prostatectomy
after treatment with radiotherapy, further
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This is done through an opening in the
treatment with surgery is not
abdomen. Most open prostatectomies are
usually possible.
done this way.
Disadvantages
• Perineal prostatectomy
This is done through the area between the
• Prostate surgery carries the same risks as
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testicles and back passage. This method
any major operation such as:
is less common than the retropubic
- bleeding and the need for a
operation.
blood transfusion
- injury to nearby tissues and nerves
Keyhole prostatectomy
- blood clots in the lower leg that could
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This is also called a laparoscopic
travel to the lung
prostatectomy. This involves accessing
- wound infection
the prostate gland through five or six
• Treatment involves a stay in hospital and a
small openings, rather than one large one.
period of recovery afterwards.
• If the cancer has broken out of the prostate
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There are two ways of doing this type
of operation:
gland, the surgeon may not be able to
remove all of it and some cancer cells
• By hand
may be left behind. These can be treated
• With the help of a robot.
at a later date with radiotherapy, hormone
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The robot-assisted operation is relatively
therapy or a combination of both if the PSA
new and is only available in a few centres
starts to rise.
in the UK.
• There is a risk of erectile dysfunction
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and stress incontinence – read page 7
for more details.
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Advantages and disadvantages of different types of surgery
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Type of
Advantages
Disadvantages
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surgery
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Open
• Widely available across the UK
• Can be more difficult to access
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prostatectomy • Lymph nodes can be removed if
the prostate gland than in the
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- retropubic
necessary
perineal operation
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• You are more likely to need a
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blood transfusion than in the
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other methods
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Open
• Easier to access the prostate gland
• Less common than retropubic
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prostatectomy
than in the retropubic method
method
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- perineal
• You are less likely to need a
• Not possible to remove the
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blood transfusion than in the
lymph nodes
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retropubic method
• Not suitable for removing large
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prostate glands
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Keyhole
• Less time spent in hospital and
• Not yet widely available
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(laparoscopic)
quicker recovery than open surgery
• Needs to be done by a specially
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prostatectomy • The wounds are smaller so you
trained surgeon
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may have less pain than after open
• Is a new method so surgeons
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retropubic surgery
will need time to gain
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• Is as effective as open prostatectomy
experience and improve their
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at treating prostate cancer
technique, although some
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• Lymph nodes can be removed if
surgeons have already gained
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necessary
a lot of experience
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• You are less likely to need a blood
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transfusion and less likely to get
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a wound infection than in the
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retropubic method
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Robot-
• Recovery is quicker than after open
• Not widely available as there
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assisted
surgery
are only a few robots in the UK
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prostatectomy • Is as effective as open and
• Needs to be done by a specially
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laparoscopic prostatectomy at
trained surgeon
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treating prostate cancer
• Is a new method, so surgeons
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• Lymph nodes can be removed if
will need time to gain
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necessary
experience and improve their
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• You are less likely to need a
technique, although some
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blood transfusion than in the
surgeons have already gained
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retropubic method
a lot of experience
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There are some specific advantages
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What does treatment involve?
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and disadvantages to the different types
Before the operation
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of surgery. These are described in the
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To make sure you are fit for the anaesthetic
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table above.
you may have blood tests, a heart tracing
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(ECG), chest X-ray and physical examination.
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This is called a pre-assessment visit and is
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a good time to ask any remaining questions
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you may have about the operation.
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You wil be admitted to the hospital ward on the you have wil depend on your surgeon’s
day of your operation, or the day before. The
preference. Speak to your specialist team
nurses and doctors wil introduce themselves
about which operation they recommend.
and answer any questions you may have. The
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specialist who is responsible for your pain relief Keyhole prostatectomy
during and after the operation (anaesthetist)
The operation wil normal y take between
wil explain how your pain relief wil work.
two and three hours. You wil have a general
Your doctor or nurse will ask you to sign a
anaesthetic so you wil be asleep during the
consent form to state that you have been ful y
whole operation. You may need to have a
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informed of al your treatment options, that you
blood transfusion but this is less likely than
understand the advantages and disadvantages with retropubic prostatectomy because there
of surgery and that you wish to go ahead with
is usual y less blood loss.
the operation.
The surgeon wil make five smal cuts
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You wil not be able to eat or drink for about six
(less than 1cm or half an inch long) in your
hours before the operation. If you need to take
abdomen. They wil insert a smal camera
regular medication, ask the nursing or medical
through one of the cuts so that they can see
staff for advice. You will have some medication
the prostate gland. The surgeon uses the
to speed up your bowel movements (an enema other four cuts to insert the instruments to
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or laxative) to ensure that your bowels are
carry out the operation. For the robot-assisted
empty before your surgery.
operation, the surgeon makes six smal cuts.
You wil be given some elastic stockings
In rare cases (less than one per cent) the
to wear, which reduce the chance of blood clots surgeon may need to switch to an open
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forming in your legs from inactivity during and
retropubic technique if the operation is
after the operation. You will keep these on until
taking longer than expected or if there is
you are moving around normally again.
a lot of bleeding.
The operation
The robot-assisted operation uses the same
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The surgeon may try to use nerve-sparing
technique as the keyhole operation but the
surgery that avoids damaging the bundles of
surgeon uses two or three robotic arms to
nerves that control your erections. However,
move the surgical instruments. The surgeon
this is not always possible because the nerves sits in the operating theatre, away from the
operating table. He or she moves the surgical
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are attached to the back of the prostate,
which is the most likely place for prostate
instruments by control ing the robotic arms
cancer to grow outside the prostate. You may through a computer.
wish to ask your specialist team about this
After the operation
before you have surgery.
You wil be taken to the recovery room until
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Open prostatectomy
you are ful y awake before going back to
The operation takes two to three hours. You will the ward. You wil have a number of tubes in
have a general anaesthetic so you wil be asleep place when you wake up:
during the whole process and wil not feel
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• You may have a smal tube running through
anything. You may need to be given donated
your nose into your stomach to al ow any
blood (blood transfusion) during the operation.
extra fluid to be drained from your stomach
If you are having a retropubic prostatectomy,
while the anaesthetic is wearing off. This
the surgeon wil make a vertical or horizontal
helps to prevent sickness. This wil be the
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cut in your lower abdomen, below the
first tube to be removed.
bel y button. If you are having a perineal
• A drip, usual y placed in your arm or hand,
prostatectomy, the surgeon wil make a cut
to give you fluid while you are not al owed
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in the area between your testicles and back
to drink. This wil be removed once you are
passage (perineum). The type of operation
eating and drinking normally.
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• A smal tube (drain) in your wound to drain
Keyhole prostatectomy
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away any fluid. This tube wil be removed
For a short time after the operation, you may
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before you go home.
have a patient controlled analgesia (PCA)
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• A catheter to drain urine from your bladder, pump. You may need to take painkil ers for
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through your penis to a bag which hangs
several days after the operation. Your nurse
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on the side of your bed, or which can be
wil find the right type and amount of pain
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carried around with you. Most men go
relief to suit you, so it is important to tel them
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home with the catheter in place, attached
if you are in any pain.
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to a bag that can be worn inside your
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trousers, strapped to your thigh. During
You wil have plasters or a type of glue to
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cover the cuts from the operation. These will
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this time, you may be asked to take a low
be removed after a couple of days. You will
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dose of an antibiotic every day to prevent
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have stitches, which wil either dissolve or will
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infection. The catheter is usual y removed
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after one to two weeks.
be removed by a community nurse once you
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have gone home. You should be able to have
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Open prostatectomy
a shower after two days. Dry the wounds
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For the first few days in hospital after the
by patting gently with a towel. You may
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operation, you will be given a continuous
find that loose clothing is most comfortable
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painkil er either into the spine (epidural),
to wear while the wounds heal. You wil be
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or into a vein in your arm (intravenous).
encouraged to get out of bed as soon as
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Painkil ers given into the vein use a patient
you can after the operation and start to
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control ed analgesia (PCA) pump so that you
move around.
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can top up your pain relief yourself if you
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You wil be able to go home one to three
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need to. You wil be shown how to use this.
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days after the operation, depending on your
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Once you are able to eat and drink normal y
recovery and your doctor’s advice.
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you wil be given painkil ing tablets instead,
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which you can continue to take at home. Let
What happens afterwards?
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your nurse know if you are in any pain so that
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Care of your catheter
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they can find the right type and amount of
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Before you leave hospital, the nurse wil show
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pain relief for you. You may find that it hurts
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you how to look after your catheter.
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when you move around, cough or laugh.
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You may have a smal er bag than you had
Some men find it helps to hold a folded towel
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in hospital, which can be strapped to your
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or pil ow over the wound at these times.
leg so that you can move around easily. It is
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The length of time you spend in hospital
important that the urine drains freely into the
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bag and that the catheter is not closed off with
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depends on your doctor’s advice and your
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a tap or valve. If urine is al owed to build up in
recovery but is usual y between four and
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the bladder, it can put pressure on the wound
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six days.
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and the stitches.
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Your stitches or clips wil be removed after
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You may be referred to a community nurse
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seven to 14 days, usual y by a community
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who wil keep an eye on how your wound
(practice or district) nurse once you have
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is healing and help you to look after your
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gone home. You can safely shower about five
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catheter. Tel the nurse if you notice any urine
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to six days after the operation. After washing,
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leaking from the outside of the catheter.
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dry the wound by patting it gently with a
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towel as the skin may not have healed firmly
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It is important to keep the tip of your penis
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at this stage. You may have swel ing in your
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clean to prevent irritation, infection and redness.
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scrotum and penis but this should go down
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Use plain mild soap and water to remove any
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after a few days. You may find the tighter fit of crusting and make sure the foreskin, if present,
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underpants more supportive and comfortable
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is moved forward again after cleaning.
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than boxer shorts.
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You may notice some bloody fluid seeping
Constipation
out around the catheter when you open your
You may have no bowel movements for
bowels or pass wind. This is normal, but if
several days after surgery, but if this carries on
there is a lot of bleeding you should contact
you may need a laxative. Ask your specialist
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your surgical team at the hospital or your GP.
team or GP for advice. To prevent constipation
eat high fibre foods such as bran, prunes or
Going for a short walk every day with a
apples. Drink at least eight glasses of non-
friend or family member wil help speed up your alcoholic fluid each day until your catheter is
recovery. Try to increase the distance you walk removed to help prevent infection.
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each day. Avoid going up or down stairs more
than a couple of times a day and make sure
Your follow-up appointment
that nothing tugs on the catheter. In the unlikely You wil have a fol ow-up appointment around
event that the catheter gets blocked or falls out six to 12 weeks after your operation. This
once you are home, you should let the hospital is an opportunity for you to discuss any
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ward or your key worker know immediately,
problems you are having, such as continence
and they will contact the surgical team.
problems or erectile dysfunction.
You should get the result of your first PSA
A personal experience
test after the operation at this appointment.
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‘While I had my catheter, I found it more
If the surgery has been successful the PSA
comfortable to sleep with a pillow between
level wil drop to the lowest possible reading
my knees’.
(usual y less than 0.1 ng/ml).
If the results of the surgery show that the
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Before you go home, your specialist team
cancer has spread outside the prostate
wil give you details of where and when your
gland, you may be offered treatment with
catheter will be removed. This is usually
radiotherapy or hormone therapy. You can
at an outpatient appointment one or two
find out more about these treatments by
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weeks after the operation. You may find this
reading our other Tool Kit fact sheets.
uncomfortable but it is not painful. You will
need to visit the hospital for several hours so
You wil have regular appointments every six
that the medical staff can make sure you can
to 12 months to monitor your PSA level and
pass urine without any problems. You may find any side effects.
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that you leak anything from a few drops to a
Your PSA level may start to rise months
larger amount of urine, and this can continue
or years after your surgery. If your PSA
for a few months. You may want to buy some
continues to rise, you may be offered further
continence pads from the chemist and take
treatment such as radiotherapy or hormone
these with you when the catheter is removed,
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therapy. You may also wish to consider taking
along with a clean pair of underpants. Loose
part in a clinical trial. You can find out more
fitting trousers or jogging bottoms may be
about this by reading our Tool Kit fact sheet,
more practical during this time.
called A guide to clinical trials.
Your wound
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Waiting for PSA test results can be stressful
The scar from the operation wil shrink and fade and you may need support from friends
over time. The muscle and tissue inside your
and family. If you would like to speak to a
body also has to heal and this may take several specialist nurse, you can call our free and
months. A healthy diet helps the wound healing confidential Helpline on 0800 074 8383. The
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process. Get plenty of rest in the first couple
Helpline nurses can offer you support and
of weeks. After this time, gentle exercise, such
answer any questions you may have.
as a short walk every day, wil help you recover
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but avoid climbing too many stairs, lifting heavy Going back to work
objects or doing manual work for eight weeks
Most men return to work within six to eight
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after the operation.
weeks if they have had open surgery and
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two to four weeks if they have had keyhole
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What are the side effects?
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surgery. This will depend on how much
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The most common side effects of surgery are
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physical effort your work involves. If you do
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urinary incontinence and erectile dysfunction.
work, ask your doctor for advice on how much
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Your risk of getting side effects depends on
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time you will need to take off.
your overall health, your cancer and your
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Driving
surgeon’s skil and experience. Your risk wil
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also be affected by other treatments that you
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You will be able to sit in a car as a passenger
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may have, such as hormone therapy
while your catheter is still in. You may wish
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or radiotherapy.
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to avoid long journeys for the first two weeks
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after the catheter is removed to give yourself a
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Men who have the keyhole operation are able
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chance to deal with any continence problems
to get back to their normal day to day activities
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with confidence.
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more quickly than men who have open
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surgery. However, the risks of side effects from
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Most men are able to drive a car after four
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al types of prostate surgery are similar.
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weeks. Check with your insurance company
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how soon after surgery you are insured to
You may wish to ask your surgeon for more
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drive and whether you can drive while you are
information on the risk of side effects. He or
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taking pain relieving tablets.
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she should be wil ing to show you their results
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and to put you in touch with other patients. You
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Sexual activity
can also cal our Helpline on 0800 074 8383.
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You wil need to avoid ful sexual intercourse
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for the first six to eight weeks after open
Erectile dysfunction
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surgery while the wound is healing. However,
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About half (50 per cent) of men will have
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masturbation and night-time erections are
problems getting and keeping an erection
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safe during this time.
(erectile dysfunction) after surgery. However,
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the reported rates of erectile dysfunction vary
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If you have had keyhole surgery, you may feel
so ask your surgeon for his or her results.
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like having sex sooner than this. However,
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you may not be able to get an erection while
Your surgeon may try to save the nerves that
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you are recovering from the operation.
control erections but even if this is possible,
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there is no guarantee that it will prevent
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When you are ready, regular sexual activity
erection problems. You may be able to
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may help to improve your erections over
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improve your chance of getting erections back
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time. Treatments are available to help you
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by taking tablets called ‘PDE5 inhibitors’ in
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get an erection and you may find that
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lubricants help.
the first few weeks after surgery. Ask
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your specialist team for more information
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about this.
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Soon after the surgery, your doctor may
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recommend tablets to help you gain erections
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Your erections should improve with time
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even if you are not ready to start any sexual
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activity yet. You may also need other
but this will depend on how strong they
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were before surgery. You are also less likely
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treatment, such as injections or a vacuum
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to regain erections if you have high blood
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device, to help you get a strong enough
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pressure, diabetes or if you smoke. At first,
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erection for intercourse.
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most men find it difficult to get an erection
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strong enough for intercourse and it can take
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You can find out more about regaining sexual
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anything from a few months to a couple of
function and the possible effect on your
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relationships by reading our Tool Kit fact
years for erections to return. Erections are
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a
sheet on Sexuality and prostate cancer.
often not as good as they were before
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Your specialist team can also give you
surgery and some men will never get back
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support and answer any questions you may
the ability to maintain an erection without the
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help of artificial methods such as vacuum
have before or after the surgery.
pumps or tablets.
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You can find out more about erectile
For details of pelvic floor exercises and
dysfunction and its treatment by reading
the devices available to help you manage
our fact sheet on Sexuality and prostate
continence problems, read our Tool Kit fact
cancer and by cal ing the Sexual Dysfunction sheet on Urinary continence and prostate
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Association on 0870 774 3571.
cancer. You can also cal our free and
confidential Helpline on 0800 074 8383 or call
Infertility
Incontact on 0870 770 3246.
The prostate gland and seminal vesicles,
which produce and store some of the fluid
Bladder neck obstruction
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in semen, are removed during the operation.
A small number of men have problems
You wil stil be able to experience orgasm
passing urine after surgery due to the build up
(climax) but you wil not ejaculate any semen. of scar tissue around the neck of the bladder.
This is cal ed a ‘dry’ orgasm and means that
Contact your specialist team if your flow
you wil be infertile after the operation. If you
of urine is not as strong as usual, you have
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are planning to have children, you may be
difficulty starting to pass urine or you need
able to store your sperm before the operation to strain to empty your bladder. The scar
for use in IVF (In Vitro Fertilisation). If this is
tissue can be ‘stretched’, or released under
important to you, ask your surgeon if this
a short general anaesthetic. Occasionally
option is available local y.
this may need to be repeated a few times,
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but is usual y successful in the long term.
Urinary incontinence
Contact your specialist team if you have
Continence problems range from drips of
these symptoms.
urine to leaking larger amounts of urine,
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which can be managed with continence pads. When to call your specialist team
Continence will improve with time and most
You should contact your specialist team as
men will fully recover three to six months after soon as possible if you experience any of the
surgery. A small number of men (less than five fol owing. They may ask you to come into the
per cent) will have long term problems and
department or they may advise you to visit
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may not have any control over their urine flow. the Accident & Emergency (A&E) department
These men may need treatment with further
at your hospital.
surgery to help.
• Urine stops draining out of the catheter and
The risk of urinary incontinence is similar
your bladder feels full
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for both open (retropubic and perineal) and
• Your urine contains blood clots or turns red
keyhole (laparoscopic and robot-assisted)
• Your catheter falls out
surgery.
• Your wound edges become red, swollen or
If you have continence problems, try to avoid
painful. This can be a sign of infection
• You get pain or swelling in your legs
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alcohol and drinks containing caffeine, such
as tea, coffee and cola, as these can irritate
• You have a temperature of more than 38ºC
the bladder.
or 101ºF
• You feel sick (nauseous) or vomit
You may wish to practice pelvic floor
• You get cramps in your stomach that will
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exercises before and after the operation.
not go away
These may improve your chances of regaining
control of your bladder more quickly, but more
research is needed before we can know for
certain. Your doctor will advise you on this.
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Some doctors recommend that pelvic floor
exercises are not done while the catheter is
in place, while others advise that they can be
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done with care. You will need to keep doing
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the exercises for several weeks or months.
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Questions to ask your specialist team
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• What type of surgery do you recommend – retropubic, perineal, laparoscopic
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or robotic?
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• How many of these operations have you done and how many do you do a year?
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(Each treatment centre should do more than 50 a year but these may be done by
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more than one surgeon)
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• Will you try to do nerve-sparing surgery if possible?
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• How many of your patients need extra treatment for cancer after surgery?
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• How many of your patients develop incontinence and erectile dysfunction?
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• How long should I expect to be in hospital?
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• What pain relief will I get after the operation?
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• If I have continence or erectile problems after surgery, who should I contact for help?
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• How soon will we know whether the operation has been a success?
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• How often will my PSA level be checked?
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10
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Notes
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More information
Sexual Dysfunction Association
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www.sda.uk.net
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The Prostate Cancer Charity
Helpline 0870 774 3571
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This fact sheet is part of the Tool Kit. Call our
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Helpline on 0800 074 8383 or visit our website Suite 301, Emblem House, London Bridge
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Hospital, 27 Tooley Street, London SE1 2PR
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at www.prostate-cancer.org.uk for more
For support and information on
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Tool Kit fact sheets, including an A to Z of
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erectile dysfunction.
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medical words which explains some of the
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r
words and phrases used in this sheet.
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National Institute for Health & Clinical
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Excellence (NICE)
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The Bladder and Bowel Foundation (B&BF)
www.nice.org.uk
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(Formerly Incontact and the Continence
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Produce an information leaflet on laparoscopic
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Foundation)
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radical prostatectomy. To order a copy,
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www.bladderandbowelfoundation.org
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call 0870 1555 455 and quote reference
a
Nurse Helpline 0845 345 0165 ~
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SATRA Innovation Park, Rockingham Road,
number N1137.
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Kettering, Northants, NN16 9JH
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For support and information on
continence problems.
11
The Prostate Cancer Charity makes
every effort to make sure that its
services provide up-to-date, unbiased
and accurate facts about prostate
cancer. We hope that these will add to
the medical advice you have had and will
help you to make any decisions you may
face. Please contact your doctor if you
are worried about any medical issues.
The Prostate Cancer Charity funds
research into the causes of, and
treatments for, prostate cancer. We
also provide support and information
to anyone concerned about prostate
cancer. We rely on charitable donations
to continue this work. If you would like
to make a donation, please call us on
020 8222 7666.
The Prostate Cancer Charity
First Floor, Cambridge House,
100 Cambridge Grove, London W6 0LE
Email: info@prostate-cancer.org.uk
Telephone: 020 8222 7622
References to sources of information used in
The Prostate Cancer Charity Scotland
the production of this fact sheet are available on
Unit F22-24 Festival Business Centre,
our website.
150 Brand Street, Glasgow G51 1DH
Reviewed by:
Email: scotland@prostate-cancer.org.uk
• Mr Chris Anderson, Consultant Urologist,
Telephone: 0141 314 0050
St George’s Hospital
Website: www.prostate-cancer.org.uk
• Gillian Basnett, Surgical Practitioner - Urology /
Robotic Surgery, Addenbrooke’s Hospital
• Mr Christopher Eden, Consultant Urologist,
The Royal Surrey County Hospital
• Sarah Henderson, Clinical Nurse Specialist,
St George’s Hospital
• Evelyn Pearson, Urology Nurse Specialist,
Stockport NHS Foundation Trust
Email: helpline@prostate-cancer.org.uk
• The Prostate Cancer Charity Information Volunteers
© The Prostate Cancer Charity 2008
• The Prostate Cancer Charity Support & Information
Reviewed August 2008
Specialist Nurses
To be reviewed August 2010
Written and edited by:
* Cal s are free of charge from UK landlines. Mobile phone
The Prostate Cancer Charity Information Team
charges may vary. Cal s may be monitored for training
purposes. Confidentiality is maintained between cal ers
and The Prostate Cancer Charity.
Y09
A charity registered in England and Wales(1005541) and
in Scotland (SCO39332)
RAD/JUL
