Prostate cancer surgery, called radical prostatectomy, is the complete removal of the prostate gland along with some surrounding tissue. It’s one of the primary treatment options for cancer that hasn’t spread beyond the prostate, and it carries a 10-year relative survival rate of 98% for localized disease. The surgery typically requires one night in the hospital and several weeks of recovery at home.
Who Is a Candidate for Surgery
Not everyone diagnosed with prostate cancer needs surgery. Doctors use a combination of factors to determine whether it makes sense: the tumor stage (how far it’s grown), PSA blood levels, the aggressiveness of the cancer cells on biopsy (measured by a grading system called the Gleason score or Grade Group), and how much tumor was found in the biopsy samples.
For lower-risk cancers, active surveillance (monitoring without immediate treatment) is often a reasonable choice. For intermediate-risk cancers, surgery is one of several options discussed alongside radiation therapy and monitoring. For higher-risk cancers in men expected to live at least another 10 years, doctors typically offer a choice between surgery and radiation combined with hormone therapy. The goal is to match the intensity of treatment to the seriousness of the cancer, avoiding unnecessary side effects when the cancer is slow-growing while acting decisively when it’s not.
Open vs. Robotic Surgery
There are two main approaches to removing the prostate. Open surgery uses a single incision running from the belly button down to the pubic bone, giving the surgeon direct access to the prostate. Robotic-assisted surgery, which is now far more common, uses several small keyhole incisions in the abdomen instead. Miniaturized instruments are passed through these incisions and controlled by the surgeon, who sits at a console a few feet from the operating table.
The robotic system provides a magnified, three-dimensional view of the surgical area, which helps the surgeon see the delicate nerves, blood vessels, and muscles surrounding the prostate. The instruments have a range of motion greater than the human wrist, allowing more precise movements in a tight space. Both approaches accomplish the same thing (removing the entire prostate), but the robotic method generally results in less blood loss, smaller scars, and a shorter recovery.
How Nerve-Sparing Surgery Works
Two bundles of nerves run along either side of the prostate. These nerves control erections, so preserving them during surgery is a major priority. In a nerve-sparing prostatectomy, the surgeon carefully separates these bundles from the prostate before removing the gland. The urethra (the tube that carries urine from the bladder out of the body) is also identified and reconnected after the prostate is taken out.
Whether nerve-sparing is possible depends on where the cancer sits. If the tumor is tangled with or pressing against the nerve bundles, the surgeon may need to remove one or both sides to ensure all the cancer is taken out. Preserving both nerve bundles gives the best chance of maintaining erectile function afterward. If one side is removed, some function may remain. If both sides are cut, the ability to have a natural erection is lost, though other treatments can help.
Preparing for Surgery
In the weeks before your operation, you’ll need medical clearance from your primary care doctor. This typically involves blood tests, a urine analysis, imaging exams, and an electrocardiogram to check your heart. Results usually need to be completed within a week of the surgery date.
Your surgical team will ask you to stop certain medications about 30 days beforehand, including aspirin, common anti-inflammatory painkillers, vitamin E, fish oil, flaxseed oil, and most supplements, since these can increase bleeding. Blood thinners like warfarin are usually stopped about seven days before, with your prescribing doctor’s approval.
The day before surgery involves a bowel preparation: a bottle of magnesium citrate in the morning, an enema in the evening, and plenty of clear fluids throughout the day to stay hydrated. You’ll stop eating and drinking by midnight. If you’re not already active, starting a daily walking routine of one to two miles in the weeks before surgery can help your body recover faster afterward.
What Recovery Looks Like
Most men spend one night in the hospital after robotic prostatectomy. You’ll go home with a urinary catheter in place, a thin tube that drains urine from your bladder into a bag while the surgical connection between your bladder and urethra heals. The catheter stays in for seven to 10 days and is removed at a follow-up appointment.
The first few weeks involve limited physical activity. Lifting, strenuous exercise, and driving are typically off-limits initially, with a gradual return to normal activity over four to six weeks. Soreness around the incision sites is common but manageable.
Urinary and Sexual Side Effects
The two side effects men worry about most are urinary leakage and erectile dysfunction, and both are common in the early months after surgery. Urinary incontinence (leaking urine, especially during coughing, sneezing, or physical activity) is nearly universal right after the catheter comes out. For most men, control improves steadily over the following months. Pelvic floor exercises, often called Kegels, can speed this process.
Erectile function recovery is slower and less predictable. Among men who had nerve-sparing surgery, about 40 to 50% return to their pre-surgery level of function within the first year. By two years, that range is 30 to 60%, a wide spread that reflects differences in age, pre-surgery function, and how much nerve tissue the surgeon was able to preserve.
Sexual rehabilitation programs can improve these numbers. Many centers encourage men to begin a rehabilitation protocol within weeks of surgery. This can include daily low-dose oral medications to promote blood flow to the penis, a vacuum erection pump used for 5 to 10 minutes at least twice a week, or other therapies like medicated pellets or injections administered a couple of times per week for several months. About 75% of men who had nerve-sparing surgery report achieving erections after using oral medications for erectile dysfunction.
Tracking Success After Surgery
The main way doctors monitor whether surgery was successful is through PSA blood tests. Because PSA is produced by prostate tissue, and the entire prostate has been removed, your PSA level should drop to a very low or undetectable level within a couple of months after the operation. This is a strong sign that the cancer has been eliminated.
You’ll continue getting PSA tests at regular intervals, typically every few months in the first year and then less frequently. A PSA level that begins rising on consecutive tests can signal that some cancer cells remain or have returned, a situation called biochemical recurrence. If that happens, your doctor will order additional tests to determine the next step, which might include radiation therapy targeted at the area where the prostate used to be.
Long-Term Survival
The overall outlook for men treated for localized prostate cancer is very favorable. Ten years after diagnosis, the average prostate cancer patient is only 2% less likely to be alive than a man of the same age without prostate cancer. At 15 years, that gap widens only slightly, to 5%. These figures cover all stages of prostate cancer, so men with truly localized disease caught early often do even better. For many men, prostate cancer becomes something they were treated for rather than something that defines their health long-term.