What Is Prostate Cancer Surgery (Prostatectomy)? Types and Recovery

Prostate surgery is also called a prostatectomy. During a prostatectomy, a surgeon removes the prostate and the seminal vesicles. If your surgeon is worried that cancer cells have already spread, they may also remove lymph nodes. 

If you’ve been diagnosed with prostate cancer, facing surgery can be overwhelming. But you’re not alone. There are great resources to guide you through your options. This guide goes over your surgical options for prostate cancer treatment and what to expect in recovery, so you can feel ready to talk with your healthcare team. 

What are the types of prostate cancer surgery?

There are several important structures around your prostate that control how you urinate, have a bowel movement, and get or keep an erection. These structures, along with the prostate, are deep inside your pelvis, which makes them hard to reach.

A prostatectomy is a difficult surgery. So, it’s important to have a surgeon that has the right training and experience. The best place to find an experienced surgeon is at a comprehensive cancer center.

There are two ways to do a prostatectomy: open approach or laparoscopic approach. Right now, there’s no evidence that one approach has better outcomes than the other. Depending on your medical history, one option may be better for you. 

Open (radical) prostatectomy

An open prostatectomy lets your surgeon remove your prostate and perform a staging lymphadenectomy through one incision. This means you’ll have a single, larger surgical scar.

Open surgery is a better option if you’ve had surgery in your abdomen before. It helps the surgeon avoid scar tissue from past surgeries, making it easier to get to your prostate. 

There are two different types of radical prostatectomies:

• Radical retropubic prostatectomy: In this procedure, an incision is made in your lower abdomen, behind the pubic bone. This allows your surgeon to remove the entire prostate, the seminal vesicles (surrounding glands), and lymph nodes. This procedure can help to minimize damage to the nerves that control penile erection and bladder function. 

• Radical perineal prostatectomy: With this procedure, an incision is made in your perineum, which is the space between your scrotum and anus. The entire prostate, seminal vesicles, and lymph nodes can also be removed during this procedure. 

Laparoscopic prostatectomy

The laparoscopic prostatectomy uses several small incisions instead of one large one. These smaller incisions are less painful than a single large incision and usually heal faster. Laparoscopic surgeries are less invasive and sometimes cause less bleeding. 

EXPERT PICKS: WHAT TO READ NEXT

• Getting started: Our prostate cancer guide can help you get the answers you need. 

• Early signs of prostate cancer: Take a look at the most common symptoms of prostate cancer. 

• Prostate cancer staging: Prostate cancer staging is the first step to cancer treatment. Here’s how to decode your prostate cancer stage.

A robot-assisted prostatectomy is a type of laparoscopic surgery where the surgeon uses miniaturized robotic instruments to perform a detailed removal of the prostate. The robotic arms are inserted into the small incisions, and the surgeon directs them with controls inside of the operating room. 

What are the risks of prostate cancer surgery?

Prostate cancer surgery is a generally safe procedure. But like all surgeries, it does carry some risks.

Bleeding 

Bleeding can happen after any surgery, including prostate surgery. Severe bleeding is uncommon after prostate cancer surgery. But make sure to review your medical history and medications with your surgery team. They can take steps to lower your risk for bleeding during and after surgery. 

Infection

Infections can happen after any type of surgery. Some people develop urinary tract infections (UTIs) after a prostatectomy. Your surgery team will take steps to lower your risk of infection during surgery. They may also ask you to take antibiotics before and after surgery to lower your risk of infection.

What side effects can you expect after prostate cancer surgery?

Like all surgeries, prostate cancer surgery can cause side effects. Some common ones include:

• Urinary changes: Some people leak urine after surgery. But this usually goes away. Only a small percentage of people have symptoms that last longer than a few months after surgery.

• Erectile Dysfunction: It’s normal to have trouble with achieving and maintaining erections after prostate surgery. But many people recover. Recovery usually takes between 6 and 18 months.

How do you prepare for prostate cancer surgery?

If you and your treatment team decide surgery is the right choice, here’s what you can expect leading up to the surgery. 

1 to 2 months before surgery

In the months before surgery, you’ll get:

• Presurgery evaluation: You’ll need a presurgery evaluation. This can include a physical, blood work, a chest X-ray, and an electrocardiogram (EKG). This evaluation is important to show that your body is ready for surgery. 

• Male Kegel exercises: You’ll start practicing these exercises to help strengthen your pelvic floor muscles. These muscles help with holding urine in your bladder and decrease urinary leakage. 

1 week before surgery

You’ll be asked to stop taking certain medications, like: 

• Aspirin

• NSAIDs (nonsteroidal anti-inflammatory drugs)

• Herbal supplements that may affect bleeding 

• Vitamin E 

• Warfarin or Coumadin 

Make sure you stop medication under the supervision of your healthcare team. 

1 to 2 days before surgery

You’ll be asked to start a liquid diet 1 or 2 days before your surgery. Once you start your liquid diet, don’t eat solid food until after your surgery. 

The night before your surgery, you’ll be asked to do a bowel cleanse. This involves taking medication that’ll make you move your bowels. It’s the same cleanse used before a colonoscopy. 

You’ll be in the hospital for at least 24 hours after your surgery. Pack a hospital bag with things you may need during your stay:

• Toiletries

• Eyeglasses or contact lenses

• Electronics and chargers

• Medical cards and identification

• Comfortable clothes for the ride home

• A donut cushion or soft perineal/buttock cushion to sit on after surgery (these help reduce pressure on your rectal and pelvic areas)

Also, make sure to find someone to drive you to and from the hospital. After surgery, you’ll have a urinary catheter in place, so you won’t be able to drive yourself home. 

Day of surgery

You won’t be able to eat or drink anything for several hours before surgery because you’ll need anesthesia. 

When you arrive, you’ll get checked in and taken to the preoperative area. There, you’ll meet with the team members caring for you during your surgery. This includes the anesthesiologist, surgeons, and other team members.

A team member will start an intravenous (IV) line in your arm so you can receive anesthesia medication. Then you’ll go to the operating room. Prostatectomies usually last about 2 hours. 

After surgery, you’ll recover in the postoperative area before going to your hospital room. You’ll be carefully monitored to make sure the anesthesia medications wear off. Your healthcare team will meet with you and your loved ones to go over how your surgery went. 

Recovery from prostate cancer surgery

A prostatectomy is a major surgical procedure, and it takes time to recover from it. Full recovery can take about 6 weeks. Here’s what you can expect.

First 24 hours after surgery

You can expect to stay in the hospital for about 24 hours after the surgery. You’ll have a urinary catheter in place to drain your bladder. You’ll be allowed to eat and drink after surgery, but you may feel nauseous after anesthesia — so take things slowly. Don’t forget to take your pain medication so you stay comfortable. 

First few days at home

Urinary catheter care is an important part of your first few days at home. You’ll need to leave the catheter in place for 7 to 10 days after surgery. The catheter is an important part of the healing process. It lets your bladder and urethra recover from surgery. 

Here are some helpful catheter care tips:

• Don’t remove your catheter. If it accidentally comes out, call your surgeon’s office right away. 

• Use your “stat-lock,” a plastic clip that secures the catheter to your inner thigh. It’ll keep your catheter from pulling out as you move around. 

• Use larger urine collection bags at night and smaller ones during the day. Empty and change the bags as needed. You can remove the bag during showers.

• If your surgeon prescribed an antibiotic ointment, you can use it to lubricate the outside of your penis. This can help decrease irritation.

• Don’t submerge yourself in water while the catheter is in. This means no bathtubs, hot tubs, or swimming pools until the catheter is removed. 

• Call your surgeon if the catheter isn’t draining well or you have redness or swelling around the tip of your penis. 

Caring for your surgical incision is another important part of healing. You’ll have dissolvable stitches in place when you leave the hospital. You can shower with stitches, but make sure to just gently dab them during washing — don’t rub or tug at them. You don’t need to put creams or ointments on your stitches. These things can actually make it harder for your skin to heal. 

It’s normal to have a small amount of redness along the edges of your incision. But if the redness gets worse, the area becomes more painful, or you notice draining from the incision, call your surgeon right away. These can be signs of an infection.

1 month after surgery

After a month, your incision should be healing well, and pain from the surgery should be fading or gone. You’ll probably be able to get back to your usual exercise routine. 

You may still have trouble with urinary control for a few more months. Keep some adult urinary pads at home. Stay positive and keep practicing your pelvic floor exercises. It may even help to see a pelvic floor physical therapist for more individualized treatment. And talk to your healthcare team about options to help with urinary dysfunction — there are medications that can help you stay dry.

It’s common and normal to have trouble with erections at this point after the surgery. There are treatment options to help, including medications like Viagra (sildenafil) and Cialis (tadalafil), or medical devices like pumps. Talk with your healthcare team about options.

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Written by:

Meredith Grace Merkley, DO, FAAP

Dr. Merkley is a licensed, board-certified pediatrician who has over a decade of experience working in community health. She is currently a National Health Services Corp scholar, and is serving as the medical director of a school-based health clinic at a federally funded health center.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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