Introduction
If you or someone you love has been diagnosed with prostate cancer, you may be considering radical prostatectomy as a treatment option. This major surgery removes the entire prostate gland to eliminate cancer. While effective, it’s a big decision with important effects on your body and life.
This guide breaks down what radical prostatectomy is, how it works, what to expect during recovery, and possible side effects. We’ve used straightforward language to help you understand this complex procedure so you can have better conversations with your healthcare team and make informed decisions about your care.
What Is It?
A radical prostatectomy is surgery to remove the prostate gland. Doctors use it to treat prostate cancer. The goal is to remove all cancer while keeping your ability to control urine and have sex.
The prostate is a small gland that sits below your bladder. It makes fluid that helps carry sperm. When cancer grows in this gland, taking it out may cure the disease.
What Gets Removed:
- The whole prostate gland
- Seminal vesicles (glands that make semen)
- Parts of the tubes that carry sperm
- Sometimes nearby lymph nodes (to check if cancer has spread)
Who Needs This Surgery?
You might need a radical prostatectomy if you have:
- Cancer that’s still in your prostate (not spread)
- At least 10 more years of expected life
- Good overall health for surgery
Dr. James Brooks from Stanford says: “We look for patients with cancer just in the prostate. They should be young enough to benefit from cure and healthy enough for surgery.”
Types of Surgery
Open Surgery
Through the Lower Belly
- Cut from belly button to pubic bone
- Lets the doctor see the prostate and lymph nodes
- Better for saving nerves
- More blood loss than other methods
Through the Area Between Scrotum and Rectum
- Shorter surgery time
- Faster recovery
- Harder to reach lymph nodes
- Not done as often today
Less Invasive Surgery
Laparoscopic Surgery
- Small cuts for tools and camera
- Less blood loss and pain
- Takes longer to do
- Hard for surgeons to learn
Robot-Assisted Surgery
- Doctor controls robot arms from a console
- Better 3D view and more precise
- Better chance of saving nerves
- Most common method in the U.S.
- Costs more than other types
A 2021 study shows robot surgery is now used in over 85% of these operations in the U.S.
Getting Ready for Surgery
Tests Before Surgery
- Full physical exam
- Blood tests including PSA level
- Imaging (MRI, bone scan if needed)
- Heart tests if needed
- Talk with the sleep doctor
Instructions Before Surgery
- Changes to your meds (especially blood thinners)
- When to stop eating and drinking
- Bowel prep
- Special soap for showering
The Surgery Step by Step
Sleep and Position
You’ll be fully asleep during surgery. How you’re positioned depends on the surgery type:
- Open surgery: lying flat with slight tilt
- Robot/scope surgery: head down position
What Happens During Surgery
- Making the Cut(s)
- Opening the skin based on surgery type
- Creating space to work
- Checking Lymph Nodes (if needed)
- Taking out nodes to check for cancer spread
- Working Around the Prostate
- Careful cutting around the gland
- Controlling blood flow
- Saving Nerves (when possible)
- Careful work to keep nerve bundles intact
- Key for keeping sexual function
- Removing the Prostate
- Separating the gland from bladder and urethra
- Taking out the whole prostate with attached glands
- Reconnecting Parts
- Joining bladder to remaining urethra
- Making sure the join won’t leak
- Finishing Up
- Placing a drain for extra fluid
- Closing the cuts
Recovery After Surgery
Right After Surgery
- Hospital stay: 1-2 days for robotic/scope surgery; 2-3 days for open surgery
- Pain control with meds
- Walking soon to prevent problems
- Catheter (pee tube) for 1-2 weeks
Common Early Challenges
- Pain: Usually well-controlled with meds
- Catheter Discomfort: Short-term but often the most annoying part
- Limited Activity: Slow return to normal over 4-6 weeks
Recovery Timeline
First 2 Weeks
- Limited physical activity
- Catheter in place
- Focus on healing
2-4 Weeks
- Catheter comes out
- Start pelvic floor exercises (Kegels)
- Light walking and slowly more activity
4-6 Weeks
- Return to most easy activities
- OK to drive
- Can slowly start sex again (full recovery takes longer)
6-12 Weeks
- Return to all physical activity including exercise
- Continued better control of urine
Side Effects and Problems
Short-Term Problems
- Bleeding: Might need blood (less than 5% of cases)
- Infection: In cut, urine tract, or whole body
- Blood Clots: In legs or lungs
- Urine Leak: Where bladder connects to urethra
- Fluid Collection: If lymph nodes were removed
Long-Term Side Effects
Leaking Urine
- Affects 5-30% of men at first
- Gets better over time, most men regain control within a year
- Risk goes up with: older age, prior urine problems, surgery technique
- Help options: pelvic exercises, meds, devices, or fix-it surgery
Erectile Dysfunction
- Affects 30-80% of men at first
- Recovery depends on age, function before surgery, nerve-saving success
- Can take 1.5-2 years for full recovery
- Help options: pills (like Viagra), vacuum devices, shots, implants
Dr. Patrick Walsh, who created nerve-saving methods, says: “Sex function recovery depends on careful nerve saving during surgery, the man’s age and function before, and dedicated rehab work after.”
Other Long-Term Effects
- Penis Shrinkage: About 70% of men notice this
- Leaking During Orgasm: Urine comes out during climax
- Dry Orgasm: No fluid comes out due to removed glands
- Can’t Father Children: Permanent after prostate removal
Cancer Outcomes
The main goal is to beat cancer. Results depend on several things:
What Affects Success
- Cancer Stage and Grade: Higher means more aggressive disease
- Surgery Edges: Finding cancer at the edge of removed tissue
- PSA Level: Higher levels before surgery may mean more spread
- Gleason Score: Higher scores mean more aggressive cancer
Success Rates
- Cancer Just in Prostate: 85-90% cancer-free at 15 years
- Cancer Growing Outside Prostate: 50-75% cancer-free at 15 years
- PSA Coming Back: Happens in 20-40% of men within 10 years
A long-term study in the New England Journal of Medicine found men with low-risk prostate cancer treated with surgery had a 97% cancer-free rate at 15 years.
Follow-Up Care
PSA Checking
- First test 6-8 weeks after surgery
- PSA should be nearly zero (<0.1)
- Rising PSA means cancer might be back
- Regular tests (every 3-6 months at first, then yearly)
More Treatments If Needed
If cancer returns or wasn’t fully removed:
- Radiation: Often used for local return
- Hormone Therapy: For more spread disease
- Watching: For slow-rising PSA in older men
Other Treatment Options
Surgery isn’t the only choice. Consider these options too:
Active Surveillance
- Watching cancer without treating right away
- Good for very low-risk disease
- Avoids side effects of treatment
- Needs regular checks and may need treatment later
Radiation
- External Beam: Radiation aimed from outside the body
- Seed Implants: Tiny radioactive seeds put in the prostate
- Different side effects than surgery
- May be better for older men or those with other health issues
Focused Treatments
- High-Intensity Focused Ultrasound (HIFU)
- Freezing Therapy
- Laser Treatment
- Less proven long-term results
- May keep function with good cancer control in some cases
Making Your Choice
When picking between treatments:
- Talk deeply with your doctors
- Think about your cancer risk level
- Look at your overall health and life span
- Weigh side effects against benefits
- Consider your personal values
Dr. Matthew Cooperberg, a top prostate cancer expert, says: “The best treatment varies—it depends on each man’s unique cancer, health, and personal priorities.”
Life Quality After Surgery
Research shows life quality after surgery varies:
Physical Function
- Most men return to normal physical activity within 3-6 months
- Hard exercise may take longer
Mental Impact
- Anxiety and depression affect 15-25% of men
- Body image concerns are common
- Support groups can really help
Effect on Relationships
- Talking with partners is crucial
- Sex rehab works better with partner help
- Adjusting hopes and finding new ways to be intimate
New Advances in Surgery
Surgical Improvements
- Single-Port Robots: Fewer cuts
- Glow-Guided Surgery: Better views of important structures
- New Approaches: May help men regain urine control faster
Better Recovery Programs
- Multi-type pain control
- Early eating and walking
- Shorter catheter time for some men
- Shorter hospital stays
Common Questions
Q: How do I know if my nerves can be saved during surgery?
A: It depends on where your cancer is. MRI and biopsy results help show if cancer is near nerve bundles. Your surgeon will discuss this based on your case.
Q: How long will I have a catheter after surgery?
A: Usually 7-14 days, depending on surgery type and healing. Your surgeon will remove it once the join between bladder and urethra has healed enough.
Q: When can I go back to work?
A: Most men return to desk jobs in 2-4 weeks and physical jobs in 6-8 weeks. Your surgeon will guide you based on your healing and job type.
Q: Will insurance cover robot surgery?
A: Most insurance plans cover robot surgery if needed, but coverage varies. Check with your insurance about specific coverage and out-of-pocket costs.
Q: How well does surgery cure prostate cancer?
A: For cancer still in the prostate, surgery offers excellent control with over 90% cancer-free rates at 10 years. Success depends on cancer stage, grade, and other factors.
Conclusion
Radical prostatectomy remains a key treatment for prostate cancer. It offers excellent cancer control with better function outcomes than in the past. Advances in technique, especially nerve-saving approaches and robot help, have reduced problems and improved life quality after surgery.
The choice to have surgery should be personal. Consider your cancer details, health, age, and preferences. Working with a team of doctors helps ensure the best outcome.
Side effects like leaking urine and erectile problems remain concerns, but better surgery methods and recovery plans reduce their impact. With good preparation, skilled surgery, and dedicated recovery work, most men achieve good function and cancer outcomes after radical prostatectomy.