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Prostate Cancer: Surgery

Radical (total) prostatectomy is surgery to remove the entire prostate. It may be done if diagnostic tests show that the cancer is confined to the prostate. Your surgeon will give you detailed instructions on preparing 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.

Before Surgery

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

  • You may be given a laxative or have an enema 1 day before surgery.

How Surgery Is Performed

  • The surgery may be done through several small incisions in the abdomen. This is called laparoscopy. In many cases, a technique 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 performed through an incision behind the scrotum. This is called the perineal approach.

  • 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 techniques may be used to help preserve erectile function. This is the ability to achieve and maintain an erection.

After Surgery

  • Urine will drain through the catheter into a sterile bag. The urine may be bloody or cloudy at first.

  • You may return home in 1 day to 3 days.

  • Medications to control pain will be prescribed.

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

  • The catheter and stitches will be removed at a follow-up visit. This is often 1 week 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.

Call Your Doctor

Contact your doctor right away if:

  • You have fever or chills.

  • The incision is draining or increasingly painful or red.

  • Your leg or ankle begins to swell.

  • Urine isn’t draining from the catheter.

  • You can’t urinate after the catheter has been removed.

Risks and Complications of Prostatectomy

  • Erectile dysfunction (difficulty achieving or maintaining an erection)

  • Incontinence (loss of bladder control)

  • Infection

  • Excessive bleeding

  • Difficulty urinating

  • Pneumonia

  • Blood clots

  • Bowel perforation

Online Medical Reviewer: Parsons, J Kellogg, MD, MHS
Online Medical Reviewer: Reese, Jeffrey H, MD
Last Review Date: 10/27/2011
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