What Happens If You Have Your Prostate Removed?

Removing the prostate, a surgery called radical prostatectomy, eliminates the gland itself along with the seminal vesicles and some surrounding tissue, and in doing so it disrupts several systems that were running through or alongside that small organ. The immediate consequences touch urinary control, sexual function, and fertility, while subtler effects on penile anatomy, psychological health, and even hernia risk can unfold over months or years. Most of these changes are temporary or treatable, but the degree and timeline of recovery vary widely from person to person.

Why the Prostate’s Location Matters So Much

The prostate sits just below the bladder and wraps around the urethra, the tube that carries urine out of the body. Nerve bundles responsible for erections run along its outer surface. The gland contributes fluid to semen that helps sperm function properly after ejaculation.
¹ When a surgeon removes the prostate, the urethra has to be reconnected directly to the bladder neck, the nerve bundles may be stretched or cut, and the pathway semen once traveled through is permanently severed. Understanding this anatomy explains why the side effects of prostatectomy cluster around urination, erections, and reproduction rather than being random.

Urinary Leakage and How It Recovers

Nearly every man experiences some degree of urinary incontinence immediately after the catheter comes out, typically one to two weeks after surgery. The leaking happens because the internal sphincter that sat at the bladder neck is removed along with the prostate, leaving the external urethral sphincter as the sole gatekeeper. That remaining sphincter was never designed to do the job alone, and it needs time to strengthen and adapt. Several anatomical factors influence how quickly control returns: the length of the remaining urethral stump, whether the nerve bundles were preserved, and how much scarring develops around the surgical connection point.²

One MRI-based study tracked what happens physically after surgery and found that the membranous urethra shifts upward by about 4 mm in the first ten days, then gradually drifts back to its original position over twelve months. The length of the remaining urethral stump predicted how much leakage men experienced, and the return of the urethra to its original position tracked closely with the return of continence.³ In practical terms, this means the body has a built-in recovery process, but it takes time to play out.

Pelvic floor exercises speed things up considerably. A meta-analysis pooling data from multiple trials found that men who did guided pelvic floor muscle training were roughly two to four times more likely to be continent at each follow-up point compared with men who received standard care alone, and the benefit persisted at one year after surgery.⁴ Starting these exercises before surgery may help even more. One randomized trial found that men who began preoperative pelvic floor training had roughly double the continence rate at one month (about 44% vs. 20%) and maintained that advantage at three months.⁵ Another trial combining preoperative biofeedback with monthly assisted sessions after surgery showed even more dramatic differences, with ten out of fifteen men in the treatment group regaining continence by six months compared with just one of fifteen in the control group.⁶

Erectile Function After Surgery

Erections depend on the cavernous nerve bundles that hug the prostate. If those bundles are preserved during surgery, a technique called nerve-sparing prostatectomy, erections can eventually return, but it takes months. A pooled analysis of studies on an especially careful nerve-sparing approach found that about 42% of men had erections sufficient for intercourse at three months, rising to about 54% at six months and roughly 72% at twelve months.⁷ Those numbers come from the best-case scenario, where surgeons preserved the nerve tissue as completely as possible. When nerves cannot be fully spared because of cancer location, recovery rates are lower.

Among the three main treatment approaches for localized prostate cancer, surgery has the greatest initial impact on sexual function. A large trial comparing surgery, radiotherapy, and active monitoring found that prostatectomy produced the worst sexual function scores, and while there was partial recovery, the surgery group remained behind the other groups throughout the study period.⁸

Penile rehabilitation programs aim to preserve erectile tissue during the months it takes for nerves to heal. A common approach combines a daily low-dose PDE5 inhibitor (the same class of drug as sildenafil or tadalafil) with a vacuum erection device, which draws blood into the penis mechanically. One prospective trial found that daily tadalafil combined with a vacuum device improved erectile function scores and successful penetration rates at twelve months compared with either treatment alone.⁹ For men who don’t respond to pills or vacuum devices, penile injections are another step up. These programs require patience and consistent use; the goal is to keep the erectile tissue oxygenated and elastic while the nerves regenerate.

Changes to Penile Length

Many men notice their penis looks shorter after surgery, and this is not imagined. When the urethra is reconnected to the bladder, it gets pulled slightly upward into the pelvis, and the penis follows. An MRI study showed the membranous urethra displaced about 4 mm proximally in the first ten days, which corresponded to an average measured shortening of roughly 20 mm in stretched penile length.¹⁰ The encouraging finding is that the urethra drifted back to its original position by twelve months, and the measured penile length was no longer significantly different from baseline at that point.

A longer-term prospective study tracked penile length for up to five years and confirmed an average shortening of about 1 cm in the first year. The length gradually recovered starting around two years, and by four to five years the difference from baseline was no longer significant. Men who maintained erectile function recovered their penile length faster.¹¹ A separate survey-based study found that about 4% of surgery patients complained of a reduced penile size, a rate similar to men who had radiation therapy combined with hormone treatment and higher than men who had radiation alone.¹² The subjective distress this causes is real, even though objective measurements suggest the change is temporary for most men.

Fertility Is Eliminated, but Biological Fatherhood Is Still Possible

Prostate removal causes complete obstructive infertility because the surgical connections between the testes, seminal vesicles, and urethra are severed.¹³ No semen can leave the body through the normal route. The testes themselves typically continue producing sperm, but that sperm has nowhere to go.¹⁴

For men who want biological children after surgery, the main option is sperm banking before the operation. If sperm was not banked beforehand, surgical sperm retrieval directly from the testes can sometimes be used in conjunction with assisted reproduction. These conversations ideally happen before surgery, especially for younger men, but the reality is that prostate cancer is overwhelmingly diagnosed in men over 60, and fertility counseling is often skipped because it seems irrelevant. Men diagnosed younger should raise the topic explicitly.

Orgasm Still Happens, but It Feels Different

One of the most common surprises is that orgasm is still possible after prostatectomy, even without an erection and even without any fluid coming out. The sensation usually changes, though. Many men describe it as less intense or different in character, and it may take longer to reach. There is no ejaculate because the prostate and seminal vesicles that produced it are gone. What men experience is sometimes called a “dry orgasm.”

A more troubling variation is climacturia, or urine leakage at the moment of orgasm. The muscular contractions of orgasm can push urine through the weakened sphincter. This is common enough that it has attracted its own body of research, though many men never mention it to their doctors because of embarrassment.¹⁵ Pelvic floor exercises help with climacturia for the same reason they help with general leakage: a stronger external sphincter can resist the pressure spike during orgasm. Some men find that emptying the bladder before sexual activity and wearing a constriction band at the base of the penis reduce episodes.

Psychological Effects That Often Go Unaddressed

The physical side effects get most of the attention, but the psychological toll is substantial and often worsens over time rather than improving. A study following prostate cancer patients after radical prostatectomy found anxiety in about 45% and depression in about 34% shortly after surgery. Over three years of follow-up, both anxiety and depression rates increased rather than decreasing.¹⁶ That trajectory runs counter to what many men expect: they assume things will get better as they heal physically.

Fear of cancer recurrence is a persistent thread running through the post-surgery years. Research on long-term survivors found that cancer-related anxiety remained relevant years after prostatectomy, with younger age, lower overall quality of life, higher depression scores, rising PSA values, and shorter time since surgery all predicting greater anxiety.¹⁷ Another study found that fear of recurrence independently predicted worse mental health quality of life, even after accounting for age, education, other health conditions, and cancer severity.¹⁸ Men who felt more satisfied with their treatment decision had some protection against these fears, which is one argument for taking time with the treatment decision rather than rushing into surgery.

Impact on Partners and Relationships

The sexual consequences of prostatectomy don’t land on one person alone. A longitudinal study that tracked intimate partners found that by six months, about half reported a negative impact on their sexual relationship. By twelve months, that number had climbed to over 70%, with nearly a third describing the impact as “very negative.” Partners were almost ten times more likely to report a worsened sexual relationship when the patient had surgery compared with other treatments.¹⁹

Arousal incontinence, the leakage of urine during sexual arousal or activity, adds another layer. A study found that 87% of men with arousal incontinence were bothered by it to some degree, and 41% actively avoided sexual activity because of it. About 64% perceived that their partner was also bothered.²⁰ Open communication between partners about what to expect and how to adapt sexually can make a real difference, but many couples avoid the topic. Programs that include the partner in rehabilitation discussions tend to produce better outcomes than those that treat recovery as a solo endeavor.

PSA Monitoring After Surgery

Once the prostate is gone, your PSA level should drop to essentially zero because the prostate is the main source of PSA in the blood. If PSA starts rising again, it signals that prostate cancer cells survived somewhere. The threshold that most oncologists use to define biochemical recurrence is a PSA reaching at least 0.4 ng/mL followed by another rise, a definition chosen because it best predicts which men will eventually develop detectable metastases.²¹ Different centers sometimes use slightly different cutoffs, and there is no universal consensus, but the 0.4 ng/mL mark followed by confirmation is the most widely studied.²²

A rising PSA does not automatically mean the cancer has spread to distant organs. Many men with biochemical recurrence are treated successfully with salvage radiation therapy aimed at the area where the prostate used to sit, sometimes combined with hormone therapy. For men at higher risk, newer approaches add androgen receptor pathway inhibitors to the mix, though these more aggressive combinations come with additional side effects including metabolic and cardiovascular risks.²³ The PSA blood test becomes a lifelong companion after prostatectomy, usually checked every few months in the early years and less frequently later.

The Inguinal Hernia Connection

A side effect that surprises many men is a significantly higher risk of inguinal hernia after prostatectomy. A systematic review and meta-analysis found the incidence was about 14% after open surgery, about 8% after laparoscopic or robotic surgery, and only about 3% in men who had not had prostate surgery. The vast majority of these hernias were the indirect type, suggesting that the surgery itself disrupts the tissues of the inguinal canal.²⁴ A population-based study confirmed the pattern, finding that men who had prostatectomy were about 42% more likely to need hernia repair than men who received radiation therapy instead.²⁵ This is rarely mentioned in pre-surgical counseling but is worth knowing about so a new groin bulge doesn’t trigger cancer anxiety.

Exercise as Part of Recovery

Structured exercise helps recovery on multiple fronts. A trial comparing exercise before surgery (prehabilitation) with exercise starting six weeks after surgery found that men who exercised before the operation gained strength and fitness that buffered them against the physical decline that typically follows surgery. The post-surgery group experienced drops in strength and walking speed that later recovered, but by twelve weeks both groups were in a similar place.²⁶ The takeaway is that exercising before surgery is ideal, but starting afterward still helps.

A longer supervised exercise program lasting fifteen months after prostatectomy produced improvements not just in physical fitness but also in urinary continence, emotional functioning, social functioning, and disease-related symptoms like fatigue and bowel irregularity.²⁷ Exercise doesn’t replace pelvic floor training or penile rehabilitation, but it complements both and addresses the general deconditioning and mood disruption that surgery causes.

Bowel Function After Surgery Alone Versus Surgery Plus Radiation

Prostatectomy by itself has relatively little impact on bowel function. The rectum sits behind the prostate and can be irritated during surgery, but lasting bowel problems from surgery alone are uncommon. The picture changes if radiation is added afterward. A study comparing men who had surgery alone with those who had surgery followed by radiation found that 53% of the radiation group had stool urgency and 13% had fecal incontinence at four months, compared with about 2% and 0% in the surgery-only group. By one year, the radiation group’s bowel symptoms had improved and the difference between the groups was no longer significant.²⁸ A large population-level analysis confirmed that radiation therapy is associated with a higher rate of rectal and anal procedures over five years compared with surgery.²⁹ Men who need both surgery and radiation should be counseled about this cumulative effect.

Open, Laparoscopic, and Robotic Approaches

Prostatectomy can be done through a large abdominal incision (open surgery), through small keyhole incisions with long instruments (laparoscopic), or with a robotic console assisting those small-incision instruments. A Cochrane systematic review found that robotic and laparoscopic approaches probably reduce hospital stays by roughly one to two days and lower the need for blood transfusions. Differences in major complication rates were small and uncertain, and postoperative pain was similar across methods by twelve weeks.³⁰ In the long term, the functional outcomes like continence and erectile recovery appear to depend more on surgeon experience and nerve-sparing technique than on which platform is used. Robotic surgery has become the dominant approach in many countries largely because of the shorter recovery and less blood loss, but it has not been convincingly shown to produce better cancer control or better long-term quality of life than a skilled open procedure.

The Early Postoperative Days

Immediately after surgery, you wake up with a urinary catheter in place, typically for one to two weeks. The catheter keeps the new connection between the bladder and urethra from being stressed while it heals. A study of patients after robotic prostatectomy found that about 10% experienced a complication related to the surgery, with the most common serious complication being narrowing (stricture) at the reconnection site, sometimes requiring a minor procedure to open it up.³¹ Most men go home within one to three days after robotic surgery and within three to five days after open surgery. The first few weeks involve restricted lifting, graduated walking, and waiting for the catheter removal, which is usually the milestone men look forward to most.