A prostatectomy is surgery to remove part or all of the prostate gland. It’s most commonly performed to treat prostate cancer that hasn’t spread beyond the gland, but it can also address severe urinary symptoms caused by a non-cancerous enlarged prostate (benign prostatic hyperplasia, or BPH). The type of prostatectomy, the surgical approach, and the recovery timeline all depend on why the surgery is being done.
Radical vs. Simple Prostatectomy
The two main types differ in how much tissue is removed and why. A radical prostatectomy removes the entire prostate gland along with surrounding tissue and nearby lymph nodes. This is the standard surgical treatment for prostate cancer confined to the gland, and it’s used across cancer stages I through III. In some cases, it’s also an option for cancer that has returned after radiation therapy.
A simple prostatectomy removes only the inner portion of the prostate that’s pressing on the urethra. This is reserved for men with very enlarged prostates causing serious urinary problems, not cancer. A related procedure called transurethral resection of the prostate (TURP) takes a more limited approach, using a thin instrument threaded through the urethra to shave away prostate tissue blocking urine flow. TURP is sometimes used to relieve symptoms caused by a tumor when a radical prostatectomy isn’t an option.
Symptoms That Lead to Surgery
For cancer, the primary qualification is straightforward: the tumor appears confined to the prostate, and the patient is in good overall health. Imaging and biopsy results guide that decision, though there’s no single lab value that automatically qualifies or disqualifies someone.
For BPH, surgery becomes a consideration when urinary symptoms are severe enough to disrupt daily life and haven’t responded to medication. These include an urgent or frequent need to urinate, difficulty starting or maintaining a stream, waking multiple times at night to urinate, feeling like the bladder never fully empties, recurrent urinary tract infections, or complete inability to urinate.
Open, Laparoscopic, and Robotic Approaches
A radical prostatectomy can be performed three ways: through a large incision in the abdomen (open surgery), through several small incisions using long instruments and a camera (laparoscopic), or through small incisions with a surgeon controlling robotic arms (robotic-assisted). Robotic-assisted surgery has become the most common approach in the United States.
Compared to open surgery, robotic-assisted prostatectomy results in less blood loss and shorter hospital stays. Operative time tends to be slightly longer with the robotic approach. A key finding from randomized trials, though, is that functional outcomes after surgery are similar regardless of technique. The robotic approach doesn’t consistently produce better continence or sexual function than open surgery. Newer robotic techniques, such as single-port and Retzius-sparing approaches, may offer incremental improvements, but these are still evolving.
What Recovery Looks Like
Most people spend one night in the hospital after a robotic or laparoscopic prostatectomy. Open surgery may require a longer stay. You’ll go home with a urinary catheter, which stays in place for seven to ten days while the connection between the bladder and urethra heals.
The first few weeks involve significant rest. Most people take three to four weeks off work, though those who work from home may return sooner. Strenuous activity and heavy lifting are off limits for at least a month. Walking is encouraged early and often, as it helps prevent blood clots and promotes healing. By six weeks, most people are resuming normal daily routines, though full recovery of bladder control and sexual function takes considerably longer.
Urinary Incontinence After Surgery
Some degree of urinary leakage after a radical prostatectomy is nearly universal in the first weeks. The prostate sits directly below the bladder and wraps around the urethra, so removing it disrupts the muscles that control urine flow. For most men, control improves steadily over the following months.
At 12 months after surgery, roughly 20% of men still experience incontinence. That rate is similar whether the surgery was performed robotically or through an open incision. Pelvic floor exercises (Kegels) are the primary tool for speeding recovery. Both the European Association of Urology and the American Urological Association recommend learning these exercises three to four weeks before surgery and resuming them immediately after the catheter is removed. The standard protocol involves four sessions a day, ten repetitions per set, practiced in different positions with a focus on standing and sitting.
Erectile Dysfunction and Nerve-Sparing Surgery
Erectile dysfunction is the most common long-term side effect. The nerves responsible for erections run along both sides of the prostate, and even careful surgery can damage them. At 12 months post-surgery, roughly 70 to 75% of men report erectile dysfunction, regardless of whether the procedure was robotic or open.
Nerve-sparing surgery aims to preserve one or both of these nerve bundles when the cancer’s location allows it. The results depend heavily on how many nerves can be saved. Among men who had both nerve bundles preserved (bilateral nerve-sparing), about 63% regained potency. When only one side could be spared (unilateral), that figure dropped to 39%. Age, pre-surgery erectile function, and the extent of cancer all influence individual outcomes. Recovery of erections is gradual, often taking 12 to 24 months, and many men use medications or other aids during that period.
Long-Term Cancer Outcomes
For localized prostate cancer, radical prostatectomy offers strong long-term control. A population-based study from British Columbia found that 79% of men who underwent radical prostatectomy were event-free at 10 years, meaning they had not died of prostate cancer or needed additional treatment like salvage radiation or hormone therapy.
Outcomes varied significantly by how aggressive the cancer was at diagnosis. Men with lower-grade tumors had an 87% event-free survival rate at 10 years. For intermediate-grade cancers, that dropped to 74%, and for high-grade cancers, it was 52%. These numbers underscore why the grade and stage of the cancer matter so much in treatment planning. Men with less aggressive cancers may also be candidates for active surveillance rather than immediate surgery, a decision typically made in consultation with a urologist.