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Prostatectomy

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 12, 2022.

Prostate cancer patients have a number of treatment options available, depending on the stage and grade of the cancer, as well as the person’s health and preferences. Prostate cancer is the most common cancer diagnosed in men, aside from skin cancer, according to the American Cancer Society.

One common treatment is a prostatectomy, a type of prostate cancer surgery often used in cases of localized cancer. This guide may help patients learn more about what to expect from the procedure and how to prepare.

Radical prostatectomy surgery

A radical prostatectomy is the main type of surgery used for prostate cancer, when the cancer hasn’t spread outside the prostate. The goal of the surgery is to remove the prostate and, along with it, the tumor. This surgery is performed with general anesthesia by a urologist.

The prostate is removed using either an incision in the wall of the lower abdomen or via a robotic surgical tool. Since the prostate sits close to the bladder and penile nerves, the surgeon makes every attempt to spare the nerves that control erections and the bladder from damage.

Types of radical prostatectomy

Below are the most common prostate cancer surgery types for treating prostate cancer.

Open radical prostatectomy

The surgeon makes an incision, or cut, in the lower abdomen (radical retropubic) or the perineum (radical perineal), which is the area between the anus and scrotum. Through the incision, the prostate is removed. With the perineum approach, it may be harder for the surgeon to spare the nerves or remove nearby lymph nodes.

Radical laparoscopic prostatectomy

To remove the prostate with a radical laparoscopic prostatectomy, several small cuts are made in the lower abdomen. The doctor inserts surgical instruments and a tool called a laparoscope (a thin instrument, similar to a tube, that has a light and lens) through the openings.

Robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy is done via a robotic machine, with the surgeon sitting at a control panel and using robotic arms to control the surgery.

Several small cuts are made, which is used for the machinery to surgically remove the prostate, with a camera providing the visuals.

While laparoscopic procedures tend to result in faster recovery times, less blood loss and shorter hospital stays, the rates of side effects are similar for all the surgery types. A urologist may help the patient decide which type of surgery is best for them.

What to expect during the procedure

Leading up to the surgery, the urologist may walk the patient through the entire procedure, including what to expect during and after. This is a good time to ask questions and find out how to prepare.

General anesthesia means the patient will be asleep for the procedure. The urologist will insert a catheter, which stays for one to two weeks, allowing the patient to urinate during the recovery period.

Prostatectomy recovery

Patients may need to stay in the hospital for several days and then limit their activities for a few weeks once they return home. The recovery process typically involves these steps:

  • The surgeon may administer IV pain medications or prescribe pain management drugs for the patient to take home.
  • Following hospital discharge, which is usually a day or two after surgery, the care team will advise the patient about when to return for a follow-up visit, typically within six weeks following the procedure. Additional doctor visits will be required, often every three months or so, to ensure that the patient is progressing well following the prostatectomy.
  • Most patients get back to their regular activities within a month or two, depending on their progress and the doctor's advice.

If patients have questions or concerns related to their health, it's important to contact the care team right away.

Potential risks and side effects

It’s important to be aware of potential side effects and risks associated with a radical prostatectomy.

Immediately after the surgery, risks may include:

  • Reaction to the anesthesia
  • Bleeding
  • Blood clots
  • Infections at the surgery site
  • Damage to other organs near the prostate

Patients should also ask their doctors about side effects. Some of the most commonly experienced side effects from the surgery include:

  • Impotence or temporary erectile dysfunction 
  • Infection
  • Shortening of the penis
  • Incontinence or urine leakage
  • Inguinal hernia

Not all patients experience side effects, and side effects aren’t always permanent. However, if long-term side effects occur, treatments are available for some of the main issues, such as erectile dysfunction and urinary incontinence.

Long-term side effects

If the patient is still experiencing side effects several weeks or months after prostate cancer surgery, these may be long-lasting. Some long-term side effects of prostatectomy include:

  • Erectile dysfunction
  • Urinary incontinence (stress incontinence, overflow incontinence, urge incontinence, continuous incontinence)
  • Pain

Erectile dysfunction is when the penis cannot become erect enough for penetrative sex. Men who undergo prostatectomies may have trouble having spontaneous erections for a short time. For some, this ability may return slowly, appearing again anywhere from a few months after surgery to up to two years. For others, it may not return.

Long-term erectile dysfunction after prostatectomy may be caused by damage to the nerves on either side of the prostate that create an erection. Doctors often take a nerve-sparing approach to preserve the penis’ erectile function. However, if cancer has infiltrated this area, the surgeon may need to remove these nerves. If the surgeon leaves one or both nerves in place, spontaneous erections are possible, depending on age, general health and whether the patient experienced erectile dysfunction before the operation.

The most common type of urinary incontinence after radical prostatectomy is stress incontinence, the loss of bladder control leading to leaking of urine when laughing, coughing, sneezing or exercising. Most men have some incontinence after prostatectomy, but most cases resolve on their own within a year with exercises to strengthen the pelvic floor muscles.

Other kinds of urinary incontinence include overflow incontinence (difficulty getting the bladder to empty), urge incontinence (immediate urge to urinate) and continuous incontinence (loss of urine control). If surgery for prostate cancer has damaged the valve that releases urine from the bladder or the nerves that control it, long-term incontinence may result.

While surgery typically results in pain during healing, it’s uncommon for prostatectomy to lead to pain that lingers for longer than six months without another underlying cause. Long-term pain after prostatectomy, though, may result from swelling related to lymphedema (a buildup of lymph fluid in the pelvic area) due to removal of lymph nodes.

Treatments are available for some of these side effects, such as erectile dysfunction and urinary incontinence.

Recovery process

The patient's care team may provide specific instructions for how to take care of the wound and when the catheter needs to be removed.

It’s best to follow their instructions and rest after returning home, only easing back into regular life when it’s safe to do so. If anything doesn’t feel right after going home, call the doctor’s office to seek advice.

Sex after prostatectomy

With time, most men eventually regain the sexual function they had before undergoing surgery. It may take anywhere from several months to two years to regain the ability to have spontaneous erections.

Generally, sexual activity may be resumed when the patient feels well enough. Once the patient has healed from surgery, doctors may suggest attempting to develop an erection when patients feel ready. In a technique called penile rehabilitation, the nerves and blood vessels involved in an erection may be stimulated to help regain the ability to have them spontaneously in the future.

In the weeks or months after surgery, doctors may recommend developing an erection through ED medications or other tools at least two to three times per week. They may also prescribe low doses of medication to improve blood flow to the penis.

The ability to have an orgasm and feel sexual pleasure is separate from the physical ability to have an erection. After a prostatectomy, many men are still able to have an orgasm. Orgasm after prostatectomy should come with pleasure, but without the release of semen (what doctors call “dry” orgasm). Orgasms may also feel less intense or go away completely, and a few men may feel pain when having an orgasm or painful ejaculation.

Treatment after a prostatectomy

Most men need additional treatment following surgery. Post-prostatectomy cancer treatment involves several steps, during which the doctor will perform prostate-specific antigen (PSA) tests to make sure PSA levels normalize. If not, further tests and potential treatments may be needed. That's why it's important for every post-prostatectomy patient to see the doctor at regular intervals, depending on the schedule the care team recommends.

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