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Prostate Cancer: Radical Prostatectomy

Cross section of prostate showing urethra, seminal vesicles, and nerve.
The prostate, seminal vesicles, and a portion of the urethra are removed.

Radical prostatectomy is surgery to remove the entire prostate. It may be done if tests show that the cancer is only found in the prostate and you are healthy enough to have surgery.

Your surgeon will give you detailed instructions on getting ready for surgery. After surgery, you’ll be told how to care for yourself at home as you recover. Ask any questions you have about the procedure and recovery. Also ask about possible side effects and what can be done to help prevent them or treat them.

Risks and possible complications

All surgeries have risks. The risks of this surgery include:

  • Blood clots in your legs or lungs

  • Excess bleeding

  • Damage to nearby organs

  • Hole (perforation) in the bowel (This is rare.)

  • Infection

  • Reactions to the medicines used to make you sleep during surgery (anesthesia)

Side effects of prostate surgery include:

  • Loss of bladder control (incontinence)

  • Lung infection (pneumonia)

  • Trouble getting or keeping an erection (erectile dysfunction)

  • Trouble urinating

  • Infertility

  • Orgasm changes

  • Shorter penis

  • Swelling in the legs or groin (lymphedema)

  • Risk for hernia

Talk with your treatment team about the risks of surgery and what can be done about them. Know what to expect and what to watch for after surgery.

Getting ready for your surgery

Follow all instructions from your healthcare team. Here are some of the things you might be asked to do:

  • Tell your healthcare provider about all medicines you take. This includes all prescription and over-the-counter medicines as well as herbs, vitamins, and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before the surgery.

  • You may be told to use a laxative, enemas, or both before the surgery. This is to empty the colon and rectum of stool. Follow the instructions you are given.

  • Don’t eat or drink after midnight the night before surgery.

How the surgery is done

There are different ways to do prostate surgery and different ways to reach the prostate to do it. Your treatment team will talk with you about the plan they think is best for you.

The surgery may be done through many small cuts (incisions) made in the belly (abdomen). This is called laparoscopic surgery. Long, thin tools are put into these incisions to take out the prostate. A method called robotic-assisted laparoscopy might be used. This system uses robotic arms that the surgeon controls to do the surgery. It also gives a close-up 3-D view inside the body.  

Sometimes the surgery is done through a larger incision in the lower abdomen. This is called the retropubic approach. Or the surgery m be done through an incision behind the scrotum. This is called the perineal approach.

During the surgery:

  • The surgeon may remove and check the lymph nodes near the prostate. This is to see if cancer has spread. If the cancer has spread, the surgeon may decide not to remove the prostate.

  • The prostate, seminal vesicles, and part of urethra will be taken out.

  • Nerve-sparing methods may be used to try to save erectile function.

After surgery

A catheter will be put through your penis and into your bladder during the surgery. It's used to drain urine from your bladder into a bag. The urine may be bloody or cloudy at first. It'll stay in for a few weeks while you heal.

Cross section of bladder showing balloon catheter.
The urethra is reattached to the bladder. A catheter is inserted to drain urine while you heal. A balloon holds the catheter in place.

Recovering at home

You may go home 1 to 3 days after surgery. The catheter will be left in. You'll be taught how to manage it at home.

You’ll be given medicines to control pain. Your team will also teach you things like how to use your pain medicines, how to take care of your incision, what you can and can't do, and when you should call them. They'll schedule your next appointment, too.

Make sure you know when you can drive and when you can go back to work. Plan to give yourself time to rest and heal for the first few weeks.

Follow-up care

The catheter and stitches will be removed at a follow-up visit. This is often 1 to 2 weeks after surgery. Bladder control often takes a few weeks to several months to return. It can continue to get better for up to a year.

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

  • Chills

  • Fever of 100.4°F (38°C) or higher, or as directed by your provider

  • Fluid leaking from your incision

  • Redness or pain in the incision that gets worse

  • Your incision opens

  • New swelling in your groin or leg

  • Pain that's not controlled or is getting worse

  • Swelling, warmth, redness, or pain in your leg

  • Trouble moving your bowels

  • Urine not draining from the catheter

  • Trouble passing urine after the catheter has been removed

Be sure you know what other problems you should watch for. Also know how to get help any time, including after office hours, on weekends, and on holidays.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham RN BSN
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 7/1/2019
© 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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