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Prostate Cancer: Radical Prostatectomy

Radical (total) prostatectomy is surgery to remove the entire prostate. It may be done if tests show that the cancer is confined to the prostate. 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. Be sure to ask any questions you have about the procedure and recovery.

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

Illustration showing a balloon holding the catheter in place as part of prostate cancer surgery.
The urethra is reattached to the bladder. A catheter is inserted to drain urine while you heal. A balloon holds the catheter in place.

Risks and possible complications

All procedures have risks. The risks of this procedure include:

  • Trouble getting or keeping an erection (erectile dysfunction)

  • Loss of bladder control (incontinence)

  • Infection

  • Excess bleeding

  • Trouble urinating

  • Lung infection (pneumonia)

  • Blood clots

  • Hole (perforation) in the bowel

Getting ready for your surgery

Follow all instructions from your health care team. In addition:

  • Tell your health care provider about all medicines you take. This includes herbs 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 procedure.

  • 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

The surgery may be done through several small incisions in the abdomen. This is called laparoscopy. In many cases, a method called robotic-assisted laparoscopy is used. The robotic system helps during the surgery. It gives a 3D view of inside the body. It also assists the surgeon’s hand movements. 

In some cases, the surgery may be performed through a larger incision in the abdomen. This is called the retropubic approach. Or surgery may 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, the seminal vesicles, and a portion of urethra will then be removed.

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

After surgery

You will have a catheter in place to drain urine from your bladder. Urine will flow through the catheter into a sterile bag. The urine may be bloody or cloudy at first. You may go home in 1 to 3 days.

Recovering at home

You’ll be given medicines to control pain. The catheter will be left in place when you go home. You’ll be given instructions on how to manage it.

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. Improvement can continue for up to a year.

When to call your health care provider

Contact your health care provider right away if you have any of the following:

  • A fever of 100.4°F (38°C) or higher

  • Chills

  • Fluid leaking from the incision

  • Redness or pain in the incision that gets worse

  • Swelling of your leg or ankle

  • Urine not draining from the catheter

  • Trouble urinating after the catheter has been removed

Online Medical Reviewer: Alteri, Rick, MD
Online Medical Reviewer: Cunningham, Louise, RN
Last Review Date: 3/24/2015
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