Prostatectomy: Learn what you need to know

A prostatectomy is a surgical procedure to remove all or part of the prostate gland. The prostate is a small, walnut-shaped gland located below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine out of the body. The prostate plays an important role in male reproduction; fluid that helps nourish and transport sperm.

In most cases, this refers to radical prostatectomy, which involves removing the entire prostate gland and sometimes nearby tissues. In other situations, only part of the prostate may be removed to relieve urinary symptoms.

Prostatectomy is most commonly performed to treat prostate cancer, but it may also be used for severe noncancerous prostate conditions.

Why is a prostatectomy done?

The most common reason for a prostatectomy is prostate cancer. Prostate cancer is one of the most frequently diagnosed cancers in men, especially as they age. When cancer is confined to the prostate or nearby tissues, surgery may want to remove the cancer and prevent it from spreading.

Other reasons a prostatectomy may be done include:

• Localized prostate cancer that has not spread to distant parts of the body
• Cancer that is growing but still considered treatable with surgery
• Benign prostatic hyperplasia (BPH) that causes severe urinary problems and has not responded to other treatments
• Chronic urinary obstruction or issues related to prostate enlargement

Your healthcare provider will consider many factors before recommending surgery, including age, health, cancer stage, prostate specific antigen (PSA) levels, and personal preferences.

There are different types of prostatectomy, depending on how much of the prostate is removed and the reason for surgery.

Radical Prostatectomy

This removes the entire prostate gland along with the seminal vesicles. In some cases, nearby lymph nodes are also removed to check for cancer spread.

This type is most often used to treat prostate cancer.

Simple Prostatectomy

This** prostatectomy** removes only the part of the prostate that is blocking urine flow. The outer portion of the gland is left in place. This procedure is usually done for severe BPH, not cancer.

Nerve-Sparing Prostatectomy

During a nerve-sparing prostatectomy, the surgeon tries to preserve the nerves that control erections. This approach may reduce the risk of erectile dysfunction, but it depends on the location and extent of the disease.

Not every patient is a candidate for nerve-sparing surgery.

Risks of Prostatectomy

Like any major surgery, a prostatectomy carries risks. While many men recover well, it is important to understand possible issues.

Common Risks

• Bleeding during or after surgery
• Infection at the surgical site or in the urinary tract
• Blood clots, especially in the legs or lungs
• Pain or discomfort during recovery

Urinary Side Effects

• Urinary incontinence, or leaking urine, especially in the weeks or months after surgery
• Difficulty controlling urine when coughing, sneezing, or exercising

Many men regain bladder control over time, but recovery varies.

Sexual Side Effects

• Erectile dysfunction, due to nerve damage during surgery
• Changes in orgasm or ejaculation (dry orgasm is common after radical prostatectomy)

Nerve-sparing techniques and rehabilitation therapies may help improve sexual function over time.

Other Possible Risks

• Narrowing of the urethra or bladder neck
• Changes in fertility
• Emotional effects, such as anxiety or depression

Your surgeon will discuss your individual risk level before surgery.

Preparing for a prostatectomy involves both physical and mental preparation. Your healthcare team will guide you through each step.

Medical Evaluation

Before surgery, you may undergo:

• A physical exam
• Blood tests
• Urine tests
• Imaging studies, such as MRI or CT scans
• Heart or lung testing, if needed

These tests help ensure you are healthy enough for surgery.

Medications

Your doctor may ask you to:

• Stop blood-thinning medications, such as aspirin or warfarin
• Adjust certain supplements or herbal products
• Take antibiotics before surgery to reduce infection risk

Always follow medication instructions carefully.

Lifestyle Preparation

• Stop smoking, as it can slow healing
• Eat a healthy diet and stay hydrated
• Arrange help at home for the first few days after surgery
• Plan time off work and limit physical activity during recovery

Day Before Surgery

Most patients are instructed to:

• Avoid eating or drinking after midnight
• Shower with a special antibacterial soap
• Follow bowel preparation instructions, if given

Types of Surgery

There are several ways a prostatectomy can be performed. Your surgeon will suggest the best approach based on your condition and overall health.

Open Prostatectomy

In an open prostatectomy, the surgeon makes one larger incision in the lower abdomen to remove the prostate.

Pros:

• Long history of use
• Effective for many patients

Cons:

• Larger incision
• Longer hospital stay
• More blood loss compared to newer techniques

Laparoscopic Prostatectomy

A laparoscopic prostatectomy uses several small incisions and a camera to guide the surgery.

Pros:

• Smaller incisions
• Less pain
• Shorter recovery time

Cons:

• Requires specialized surgical expertise

Robotic-Assisted Prostatectomy

This is the most common approach today. A robotic-assisted prostatectomy uses robotic arms controlled by the surgeon.

Pros:

• Greater precision
• Less blood loss
• Shorter hospital stay
• Faster recovery

Cons:

• Availability may vary
• Slightly longer operating time

Despite the name, the robot does not operate on its own. The surgeon is in full control at all times.

Recovery after prostatectomy takes time and patience. While many men feel better within weeks, full recovery may take several months.

Hospital Stay

• Most patients stay 1–2 days in the hospital
• A urinary catheter is placed to help drain urine while healing
• Pain is managed with medication

At Home Recovery

During the first few weeks:

• Expect fatigue and mild discomfort
• Avoid heavy lifting and strenuous activity
• Walk daily to promote circulation
• Drink plenty of fluids

The catheter is usually removed after 7–14 days.

Managing Urinary Changes

Urinary leakage is common early on. Pelvic floor exercises, such as Kegel exercises, can help strengthen bladder control.

Improvement often occurs gradually over weeks to months.

Sexual Recovery

Erectile function may take time to return, sometimes up to a year or longer. Recovery depends on:

• Age
• Nerve-sparing technique
• Overall health

Medications, devices, and therapy may help support recovery.

Follow-Up Care

Regular follow-up visits are important. Your doctor will:

• Monitor PSA levels
• Check healing progress
• Address side effects or concerns