When your prostate is removed, your body loses the gland responsible for producing most of your semen, and the surgery changes how your urinary and sexual systems function. Most men undergo this procedure (called a radical prostatectomy) to treat prostate cancer, and while it’s effective at removing the disease, it comes with a recovery process that unfolds over months to years. Here’s what to expect at each stage.
The First Days After Surgery
If you have a robotic-assisted procedure, which is now the most common approach, you’ll typically spend one night in the hospital and go home the next day. An open surgery, where the surgeon makes a larger incision in the abdomen, usually means two days in the hospital and a longer recovery of roughly two months.
You’ll go home with a urinary catheter in place. This thin tube drains urine from your bladder into a collection bag because the area where your bladder was reconnected to your urethra needs time to heal. The catheter stays in for about six to nine days before a medical team removes it. Most men describe the catheter as uncomfortable but manageable. During this time, you’ll be walking around and eating normally, but lifting anything heavy or vigorous exercise is off-limits for several weeks.
Urinary Control Takes Time to Return
Once the catheter comes out, expect some degree of urinary leakage. This is nearly universal in the first weeks because the surgery disrupts the muscles and nerves that control the flow of urine. The prostate sits directly below the bladder and wraps around the urethra, so removing it forces your body to rely on different muscles to hold urine in.
Recovery follows a predictable curve. About 30% of men have regained full continence by three months after surgery. That number climbs to roughly 58% at six months and 79% by one year. For most men, leakage steadily improves throughout the first year, though some experience minor stress incontinence (a small leak when coughing, sneezing, or exercising) that can linger longer.
Pelvic floor exercises, sometimes called Kegels, are the single most effective thing you can do to speed this up. You can start within 48 hours of having the catheter removed. The recommended routine is 8 to 12 repetitions, done one to three times a day. These exercises strengthen the muscles that act as a backup valve for urinary control now that the prostate is no longer there to provide structural support.
How Erectile Function Is Affected
The nerves responsible for erections run along both sides of the prostate like two thin cables. In a nerve-sparing surgery, the surgeon carefully preserves one or both of these nerve bundles. Even with the best technique, those nerves are temporarily stunned from the surgery, and erections don’t come back right away.
According to Johns Hopkins Medicine, within one year of nerve-sparing surgery, about 40 to 50% of men return to their pre-surgery erectile function. By two years, that range is 30 to 60%, with wide variation depending on the surgeon’s skill, how much nerve tissue could be preserved, and the man’s baseline function before surgery. Age matters too: a 55-year-old with strong erections before surgery has better odds than a 70-year-old who was already experiencing some difficulty.
If the cancer has grown into or very close to the nerve bundles, the surgeon may need to remove one or both sides to get clear margins. When both nerve bundles are removed, natural erections are unlikely to return. Medications, vacuum devices, and penile implants are all options men use to restore sexual activity, and most urologists will discuss a rehabilitation plan starting a few weeks after surgery.
Changes to Orgasm and Fertility
Your prostate and the attached seminal vesicles produce nearly all of your semen. Without them, you will have “dry” orgasms, meaning you can still reach climax, but nothing comes out. This change is permanent. It also means natural conception is no longer possible, so men who want biological children in the future should discuss sperm banking before surgery.
The sensation of orgasm itself varies from person to person. Most men still feel pleasure, though some report it feels weaker or shorter than before. Others actually describe it as stronger. Over time, many men adjust to the different sensation, and it becomes less noticeable. The physical feeling of climax comes from rhythmic muscle contractions in the pelvic floor, which still function after surgery, so the capacity for pleasure remains even without ejaculation.
Monitoring for Cancer Recurrence
One major advantage of prostate removal is that it gives your medical team a very precise way to track whether the cancer is truly gone. After surgery, your PSA (prostate-specific antigen) level should drop to essentially zero, because PSA is produced by prostate tissue, and that tissue has been removed. Any detectable PSA after surgery signals that some prostate cells, potentially cancerous ones, remain in your body.
The threshold that triggers further action is a PSA reading of 0.2 ng/mL. At that level, guidelines recommend seeing a radiation oncologist and potentially getting genomic testing on the original tissue to understand the risk of aggressive recurrence. If salvage radiation is needed, it’s most effective when PSA is still at 0.5 or below.
The standard follow-up schedule is a PSA blood test every six months for the first three years, then annually after that. These appointments are quick, but they’re essential. Most men find the regular testing reassuring once they settle into the routine.
Possible Long-Term Complications
Beyond incontinence and erectile changes, a small percentage of men develop a narrowing at the site where the bladder was reconnected to the urethra. This is called a bladder neck contracture or urethral stricture, and it happens in roughly 5% of cases, though some studies report rates as high as 25% depending on the surgical approach. Symptoms include a weakening urine stream, straining to urinate, or feeling like your bladder doesn’t empty completely. Most of these develop within the first two years after surgery, and they can usually be treated with a minor outpatient procedure to widen the narrowed area.
Some men also notice a slight shortening of the penis over time, which is thought to result from changes in blood flow and the absence of regular erections during the recovery period. Early use of erectile rehabilitation (medications or devices to encourage blood flow) may help reduce this effect.
What the Recovery Timeline Looks Like
The first six weeks are about basic healing: managing the catheter, easing back into light activity, and starting pelvic floor exercises. Most men return to desk work within two to four weeks after robotic surgery, though physically demanding jobs may require six weeks or more.
From months one through six, the focus shifts to regaining urinary control and beginning erectile rehabilitation. This is the period where progress is most noticeable week to week, and it’s also when many men feel the most frustration, because improvement is real but incomplete. Wearing a light pad for leakage is common and nothing to be embarrassed about.
By the one-year mark, most men have a clear picture of their “new normal.” Continence has returned for the majority, erectile function is still improving for some, and PSA monitoring has become routine. The adjustments are real, but most men report that the trade-off for removing the cancer feels worthwhile once they’ve moved through the recovery process.