Radical Prostatectomy Explained
Radical prostatectomy is an operation to remove the entire prostate gland and seminal vesicles for prostate cancer. Pelvic lymph nodes may also be removed when the predicted risk of nodal spread is high enough. The operation can be performed through an open, laparoscopic or robotic approach. The aim is complete cancer removal while preserving urinary control and, when oncologically safe, the nerves involved in erections. A catheter is left temporarily while the bladder is rejoined to the urethra. Most men recover progressively over weeks, but urinary continence and erectile function can take months to improve. Cancer control depends more on tumour biology, stage and quality of surgery than on whether a robot is used.
Who may benefit from radical prostatectomy?
Surgery is most commonly considered for men with localized prostate cancer and enough life expectancy to benefit from curative treatment. It can also be part of multimodal treatment for selected higher-risk or locally advanced disease. Low-risk cancers suitable for active surveillance do not automatically need surgery.
What exactly is removed?
- Entire prostate gland.
- Seminal vesicles.
- A small segment of vas deferens near the seminal vesicles.
- Pelvic lymph nodes when indicated by cancer-risk assessment.
The bladder neck is then connected to the urethra — called a vesicourethral anastomosis. The external urinary sphincter below the prostate is preserved as carefully as possible because it is central to postoperative continence.
Open, laparoscopic and robotic approaches
| Approach | How it is performed | Practical differences |
|---|---|---|
| Open | Single lower-abdominal incision | Direct open access; usually more blood loss and longer incision than minimally invasive surgery. |
| Laparoscopic | Several small ports using long instruments | Minimally invasive but technically demanding; now less common where robotic systems are available. |
| Robotic-assisted | Several ports with surgeon-controlled robotic instruments | Excellent magnified view and wristed instruments; often less blood loss and shorter early recovery, but the robot does not operate independently. |
What is nerve-sparing?
The neurovascular bundles that support erections run alongside the prostate. If MRI, biopsy and intraoperative findings suggest cancer can be removed safely without sacrificing them, one or both bundles may be preserved. Nerve-sparing is an oncological decision first: preserving nerves is not appropriate if it risks leaving cancer behind.
Even after technically successful bilateral nerve-sparing, erections may take many months to recover and may not return to baseline. Age, preoperative erectile function, diabetes, vascular health and the extent of nerve preservation all matter.
Hospital stay, catheter and early recovery
Hospital stay varies by centre and patient, often around one to a few days. The urinary catheter commonly stays for about 1–2 weeks, depending on the operation and surgeon. Walking starts early to reduce blood-clot and chest risks. Heavy lifting and strenuous exercise are restricted during initial healing.
Main risks and side effects
- Urinary incontinence, usually greatest immediately after catheter removal and improving over time.
- Erectile dysfunction, with recovery depending on age, baseline function and nerve-sparing.
- Bleeding or need for transfusion, less common with modern techniques.
- Infection, blood clots, anaesthetic complications or wound problems.
- Bladder-neck/anastomotic narrowing or urethral stricture in a minority of men.
- Lymphocele or leg swelling after pelvic lymph-node dissection.
- Infertility and dry orgasm because the prostate and seminal vesicles are removed; ejaculation is no longer possible.
Urinary continence after surgery
Most men leak initially. Recovery is usually gradual over weeks to months. Pelvic-floor muscle training before and after surgery can help technique and confidence. Persistent bothersome leakage beyond the expected recovery period should be assessed rather than accepted indefinitely; male sling or artificial urinary sphincter surgery can be effective for selected patients.
Erections and penile rehabilitation
Erectile recovery may continue for 18–24 months or longer. Rehabilitation may include PDE5 inhibitors, vacuum-erection devices, intracavernosal injections and, when other methods fail or are unsuitable, penile prosthesis. The plan should be individualized rather than based on a single fixed protocol.
PSA after radical prostatectomy
PSA should fall to an undetectable or very low level because the PSA-producing organ has been removed. A persistent or later rising PSA can indicate residual or recurrent prostate cancer. Early salvage radiation is more effective when used at low PSA levels in appropriately selected patients, so follow-up should be regular.
Red flags after surgery
- Fever, chills or worsening wound redness.
- Catheter stops draining with increasing lower-abdominal pain.
- Heavy bleeding or large clots.
- New calf swelling, chest pain or breathlessness.
- Persistent vomiting, severe abdominal distension or uncontrolled pain.
What does the final pathology report tell you?
The prostatectomy specimen provides the most complete local assessment of the cancer. Important items include pathological T stage, Grade Group, surgical-margin status, seminal-vesicle invasion and lymph-node findings when nodes were removed. None should be interpreted in isolation. A positive margin does not automatically mean cancer will recur, and an adverse pathological feature does not automatically mean immediate additional treatment is required. Postoperative PSA and the overall recurrence risk guide whether observation, early salvage radiotherapy or other treatment is appropriate.
What radical prostatectomy can and cannot promise
The operation removes the prostate and provides complete pathology, but it cannot guarantee that microscopic cancer has not already escaped the gland. It also cannot guarantee immediate continence or preservation of erections. These outcomes depend on baseline function, age, anatomy, tumour location, nerve-sparing safety and surgical execution.
A strong pre-operative discussion therefore separates three goals: cancer control, urinary function and sexual function. Sometimes the safest cancer operation limits nerve-sparing. Sometimes a wide excision is unnecessary. The final balance should be dictated by the tumour rather than by a promise of a particular functional outcome.
Consultation checklist
- Biopsy report and Grade Group.
- Prostate MRI and staging images.
- PSA trend.
- Baseline urinary continence and erectile function.
- Current medicines and blood thinners.
- Cardiac, lung and anaesthesia history.
- Prior pelvic surgery, radiation or hernia repair history.
- Your priorities regarding nerve-sparing, cancer control and functional outcomes.
FAQs
Does radical prostatectomy cure prostate cancer?
It can cure localized disease, but recurrence risk depends on grade, stage, margins, lymph nodes and tumour biology.
Will I definitely be incontinent?
Temporary leakage is very common after catheter removal. Most men improve substantially, but a minority have persistent leakage requiring treatment.
Will I be able to have sex after prostatectomy?
Orgasm is still possible, but ejaculation becomes dry and erectile function may be impaired. Recovery depends strongly on baseline function and nerve-sparing.
Does robotic surgery eliminate erectile dysfunction or incontinence?
No. Robotic technology can aid precision, but functional outcomes still depend on anatomy, cancer extent, surgeon experience and patient factors.
Do I need radiation immediately if the margin is positive?
Not always. Modern practice often uses close PSA surveillance with early salvage radiation if PSA becomes detectable, although selected very high-risk situations may warrant discussion of additional treatment sooner.
Related reading
- Robotic Prostate Surgery Explained
- Urine Leakage After Prostate Cancer Surgery
- Erectile Dysfunction After Prostate Cancer Treatment
- PSA After Prostate Cancer Treatment
- Prostate Cancer Recurrence Explained
- Radiation vs Surgery for Prostate Cancer
- Bladder Preservation vs Radical Cystectomy
- Urologist in Latur
References
- European Association of Urology (EAU). EAU Guidelines on Prostate Cancer. 2026 edition https://uroweb.org/guidelines/prostate-cancer
- National Cancer Institute. Prostate Cancer Treatment (PDQ®)–Patient Version https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
- British Association of Urological Surgeons (BAUS). Radical prostatectomy patient information https://www.baus.org.uk/
- American Urological Association/ASTRO. Clinically Localized Prostate Cancer Guideline (2022; amended 2026) https://www.auanet.org/guidelines-and-quality/guidelines/clinically-localized-prostate-cancer-aua/astro-guideline-2022