Surgery: radical prostatectomy

This page is for anyone thinking of having surgery to treat their prostate cancer.

Prostate cancer surgery, called a radical prostatectomy, aims to remove the whole prostate and the prostate cancer cells inside it - while keeping the chances of side effects as low as possible.

Who can have prostate cancer surgery?

Localised prostate cancer 

You might be offered surgery if your cancer hasn’t spread outside your prostate (localised prostate cancer) and you are generally fit and healthy.

There are other treatments available for localised prostate cancer. Research involving men with localised prostate cancer that had low risk of spreading has shown that men who go on active surveillance, surgery or external beam radiotherapy all have the same chances of living for 10 years or more. Read more about treatments for localised prostate cancer.

Locally advanced prostate cancer

Prostate cancer surgery may also be an option for some men whose cancer has started to break out of the prostate, or has spread to the area just outside the prostate (locally advanced prostate cancer). This will depend on how far the cancer has spread. Read more about treatments for locally advanced prostate cancer. 

Recurrent prostate cancer 

Surgery can sometimes be used to treat cancer that has come back after radiotherapy (recurrent prostate cancer). Surgery after radiotherapy can be more complicated and your risk of having long-term side effects can be higher than if it was your first treatment. Read more about treatments for recurrent prostate cancer.

Advanced prostate cancer 

If your cancer has spread to other parts of your body (advanced prostate cancer), surgery usually won’t be an option. Read more about treatments for Advanced prostate cancer.

A radical prostatectomy is a major operation. It may not be suitable if you have other health problems that would increase the risks involved with surgery, such as heart disease, lung or bowel problems, or previous major surgery to your abdomen (stomach area). Your doctor will discuss whether surgery is suitable for you.

Overweight men are more likely to have problems during and after surgery. If you are overweight, your doctor may advise you to lose weight before your operation

Surgery: radical prostatectomy fact sheet

This fact sheet is for men who are thinking about having surgery to treat their prostate cancer.

Download or order fact sheet

What types of prostate surgery are there?

There are three types of surgery to remove the prostate – keyhole surgery either by hand or robot-assisted, and open surgery.

Studies have shown that all three techniques are as good as each other for treating prostate cancer and have similar rates of side effects such as urinary and erection problems.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal and return to normal activities more quickly than with open surgery.

Keyhole surgery

Keyhole surgery (also called laparoscopy or minimally invasive surgery).

• Robot-assisted keyhole surgery – Your surgeon makes five or six small cuts (about 1 cm long) in your lower abdomen (lower stomach area) and a slightly bigger cut (a few centimetres long) near your belly button, and remove the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what they’re doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although it’s called ‘robot-assisted’, it’s still a surgeon who does the operation. You may hear the equipment called ‘the da Vinci® Robot’.
• Keyhole surgery by hand – As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Some hospitals don’t do robot-assisted surgery, as it needs special equipment. If you particularly want robot-assisted surgery and your hospital doesn’t offer it, your surgeon may be able to refer you to one that does. 

Open surgery

Your surgeon makes a single cut (about 15 to 20 cm long) in your lower abdomen, below your belly button, to reach the prostate. Sometimes the cut is made in the area between the testicles and back passage (the perineum), but this isn’t very common. They will do the operation by hand, before closing the cut with stitches or clips.

Advantages and disadvantages of surgery

Everyone’s experience of prostate cancer is different and what is important for one person may be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.

Advantages

• If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
• The prostate is looked at under a microscope after surgery. This can give your doctor a clearer idea of how aggressive your cancer was and whether it is likely to spread.
• Your PSA level should fall to less than 0.1 ng/ml after surgery, giving health professionals a good idea of whether your cancer was completely removed. 
• If there are signs that your cancer has come back or wasn’t all removed such as your PSA level going up, you may be able to have radiotherapy afterwards.
• Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests such as a PSA test to make sure no cancer cells have spread outside the prostate.   

Disadvantages

• There are risks in having surgery, as with any major operation.
• You might get side effects such as erection and urinary problems.
• You’ll need to stay in hospital – usually between one and five days depending on the type of surgery you are having.
• If the cancer has started to spread outside the prostate, the surgeon may not be able to remove all of the cancer, and you might need further treatment.
• You won’t be able to have children naturally or ejaculate after surgery as you won’t be able to produce semen, but it’s possible to store sperm before surgery for fertility treatment.

Risk of surgery

A radical prostatectomy is a major operation, and as with all major surgery there are some risks involved. These include:

• bleeding during or soon after the operation and possibly needing a blood transfusion - this is very unlikely if you have keyhole surgery (fewer than 1 in every 100 men)
• injury to nearby tissue, including the bowel, blood vessels, nerves and pelvic floor muscles
• blood clots in the lower leg that could travel to the lung (less than 2 out of every 100 men)
• infection such as wound or urinary infections (about 1 to 5 out of every 100 men)
• scars where the surgeon makes the cuts in your abdomen
• problems caused by the anaesthetic, but serious problems are rare.

Things that can affect how your surgery goes, your risk of side effects, and whether or not you will need more treatment include:

• whether your cancer has spread
• how aggressive your cancer is
• your general health such as your weight
• your surgeon’s experience and skill. 

Research suggests that surgeons who do a lot of prostatectomies each year get better results and fewer side effects. If you ask your surgeon, they should be able to tell you how many operations they’ve done, as well as the results of these operations and the rates of side effects. 

If you decide you want a different surgeon, you could ask to be referred to another surgeon or hospital. You don’t have a legal right to this, but most doctors will respect your wishes. It might mean you’ll wait longer to have your surgery though, as some hospitals and surgeons are busier than others.

What does surgery involve?

Before the operation

A week or more before your operation you will have tests at the hospital to make sure you are fit enough for surgery. This is called a pre-op assessment.

Tests can include blood and urine tests, an electrocardiograph (ECG) to check how well your heart is working, a physical examination, and scans such as a chest X-ray.

Your nurse will also ask you about any allergies you have, and you’ll need to bring a list of any medicines you’re taking. You might need to stop taking some drugs known as blood thinners, such as aspirin or warfarin.

Doing pelvic floor muscle exercises for a few weeks before your operation may help you recover more quickly from urinary problems caused by surgery.

Getting organised at home

Before your operation, it helps to get organised at home to make life easier when you leave hospital. You won’t be able to lift heavy things for a while and you will need to rest. You could:

• fill your freezer with food so you don’t need to cook
• do your shopping online
• if you have food or household goods in large heavy bags, put some in small containers 
• if possible, arrange to have a friend or relative with you for the first couple of days after you go home in case you need any help
• arrange for people to help with things like cleaning
• get a list of useful phone numbers ready
• have some absorbent (incontinence) pads ready
• make sure you have some comfortable, loose clothes to wear while any soreness settles down.

On the day of the operation

You will usually go into hospital on the day of your operation. You won’t be allowed to eat for about six hours before the operation, although you may be able to drink water or certain other drinks until two hours before. This will be explained to you.

You may be given an enema (liquid medicine) or a suppository (a pellet) which is put inside your back passage (rectum). These help to clear your bowels.

A nurse will prepare you for your operation. They will put elasticated knee length stockings on your legs - you might hear these called TEDs. They reduce the chance of blood clots forming in your legs. You will keep these on until you are moving around normally again.

During the operation

You will have a general anaesthetic so you’re asleep during the operation and won’t feel anything. You may also have a spinal anaesthetic so you can’t feel anything in your lower body afterwards, to make you more comfortable. The operation usually takes two to four hours but can take longer.

As well as the prostate, your surgeon will also take out the seminal vesicles. These are two glands that are connected to the prostate and sit just behind it. They store some of the fluid in semen (the fluid that carries sperm).

There are two bundles of nerves attached to the prostate that help you get erections. Your surgeon will try to save these nerves if it’s possible, depending on where the cancer is. This is called nerve-sparing surgery.

If your surgeon thinks your cancer may have spread to the nerves, they may need to remove one or both of these bundles. This will cause problems getting an erection without medical help. Even if the nerves are saved, it can still take some time for your erections to recover. Although these nerves are involved in erections, they don’t control feeling in the penis or the surrounding area. So even if they are damaged or removed you won’t lose any feeling, and you should still be able to have orgasms.

After the operation

You will wake up in the recovery room. You may be given oxygen through a mask if you have low levels of oxygen in your blood caused by anaesthetic from surgery. You will have a drip in your arm (intravenous infusion) to give you fluids and pain relief, and you will have a catheter in place to drain urine from your bladder.  

You may also have a thin tube in your lower abdomen to drain fluid from the area where your prostate used to be (prostate bed). This is usually removed 24 to 48 hours after the operation. 

Catheter

You’ll have a thin, flexible tube (called a catheter) passed up your penis to drain urine from your bladder while the area heals. The catheter will be put in place during the operation, while you’re asleep. It may feel strange or uncomfortable at first and you may feel like you need to urinate all the time. This feeling usually passes after a few hours the catheter should drain all the urine without you needing to do anything. 

Most men go home with the catheter in. Your nurse will show you how to look after it, and it will be removed at the hospital one to three weeks later.

Pain

You will be given pain-relieving drugs after the operation if you need them. These should control any pain you have, but tell your doctor or nurse if you are in any pain.

The drugs can be given as tablets by mouth or as a drip that goes into a vein in your arm or hand. You might have a pump so that you can give yourself pain relief, without waiting for someone to give it to you. There is a limit on the pump so that you can’t give yourself too much medicine by mistake. 

After keyhole surgery, you may have some pain in the tip of your shoulder for a few days because of the carbon dioxide used during surgery. This gas irritates the nerves and can cause pain. Your stomach may also feel bloated, with some cramping and tightness. It’s usually mild and goes away over time. 

Swelling

You may have some bruising and swelling in and around your testicles and penis. This might make it uncomfortable to sit on hard surfaces. It shouldn’t last more than a few weeks and may pass much sooner. If you have a lot of swelling, or if it’s getting worse, tell your doctor.

When you go home, you may find underpants (briefs) give you more support and are more comfortable than loose boxer shorts. You can also buy supportive underwear, such as a jock strap or testicle support, to help control any swelling. 

If you had lymph nodes removed during the operation, this might sometimes cause swelling in the scrotum (the skin containing your testicles) and one or both legs (lymphoedema). You will be given compression stockings to help encourage the fluid to drain from your legs if you need them.

Eating and drinking

Your team will let you know when it’s safe to start eating and drinking. You will usually start with sips of water.

Getting out of bed 

You will be encouraged to get out of bed and start moving around slowly as soon as you can- usually on the morning after your operation. This reduces your risk of having a blood clot. 

You may be prescribed daily injections for two to four weeks to reduce the risk of blood clots. If you need injections, your nurse will teach you how to inject yourself, or you will be referred to a district nurse who can give you the injections. 

You’ll be able to go home one to five days after the operation, depending on your recovery and your doctor’s advice.

Going home

You may worry about going home after having lots of support in the hospital – but you’ll have the name of someone to contact at the hospital if there’s a problem. A district nurse may visit you at home during the first few weeks. Talk to your doctor or nurse about this before your surgery.  

Looking after your catheter

Before you go home, your nurse will show you how to look after your catheter.

The catheter will be attached to a bag that can be worn inside your trousers, strapped to your leg. Make sure the tube isn’t bent or blocked, as this could stop urine draining into the bag.

The following tips can help prevent urine infections while you have a catheter.

• Always wash your hands with warm, soapy water before and after touching your catheter.
• Wash the catheter and the area near the tip of your penis at least twice a day with warm water and unscented soap. Use one wash cloth for this and a different one for the rest of your body. Wipe downwards along the catheter, away from your body, and dry it carefully afterwards.
• Drink plenty of water (about 1.5 to 2 litres, or 3 to 4 pints a day).
• Eat plenty of fibre to avoid constipation (difficulty emptying your bowels) as this can stop the catheter draining properly.

Your catheter will be removed at the hospital one to two weeks after your surgery. Your doctor or nurse will make sure you can urinate before you go home- you might need to wait for a couple of hours so they can check. 

You may notice some blood in your urine while the catheter is still in and just after it’s removed. This is quite common and usually stops on its own.

It’s common to leak urine when the catheter is removed. Take some absorbent (incontinence) pads and spare underwear and trousers to the hospital. Close-fitting underwear can help to keep the pads in place and men often find loose trousers most comfortable.

Some hospitals will provide a few absorbent pads and your local NHS service may provide some for free. You can buy more from pharmacies, chemists, large supermarkets or online. You may also be able to order them from a supplier without paying VAT.

Our surgery support pack might be helpful.

Your wound

After keyhole surgery, the cuts are usually closed with glue, clips or stitches. The cuts heal within a few days and the stitches slowly dissolve and fall out on their own, so they don't need to be removed.

If you have open surgery, the cut is usually closed with stitches or clips. Some types of stitches need to be removed in hospital or by your GP after one to two weeks.

You may feel some pain around your wound, but your hospital will give you painkillers before you go home. The pain should slowly improve as your wound heals and is usually gone in four to six weeks after surgery. 

The scars from your operation will fade over time. The muscles and tissues inside your body also need time to heal. This may take several months. 

You will need to take it easy for the first couple of weeks after surgery. Gentle exercise around the home and a healthy diet will help your recovery. Light exercise such as a short walk every day will help improve your fitness. Avoid lifting heavy objects or doing manual work for eight weeks after surgery. Talk to your doctor about when it’s safe to return to usual activities or work.  

It’s safe to masturbate when you feel ready, there’s no need to wait. After keyhole surgery, you can have sex or be sexually active once your catheter is removed, but most men wait several weeks. After open surgery, wait until the wound has healed and it feels comfortable before you try having gentle sex. If you receive anal sex, you may have to wait six weeks before having sex. This is because surgery may damage the back passage, which can make anal sex uncomfortable.

Constipation

Your bowel habits may take a few weeks to return to normal. You may have no bowel movements for several days after surgery. This is usually caused by the painkillers you’ll be taking.

If this carries on or becomes uncomfortable you may need medicine to help empty your bowels (called a laxative). Your doctor may give you laxatives to prevent constipation, but if not, ask your pharmacist for some as soon as you start having trouble. It’s important you don’t strain.

Eating high fibre foods (such as wholegrains and fruit), drinking plenty of fluids, and doing gentle physical activity will help.

Feeling tired

Some men get fatigue (extreme tiredness) for a few weeks or months after surgery. This should pass with time. Try to eat healthily and be physically active when you feel able to.

When to call your doctor or nurse

It’s important to tell your doctor or nurse if:

• your bladder feels full or your catheter isn’t draining urine
• your catheter leaks or falls out
• your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
• your wound area or the tip of your penis becomes red, swollen or painful
• you have a fever (high temperature of more than 38ºC or 101ºF)
• you feel sick (nauseous) or vomit
• you get cramps in your stomach area that will not go away
• you get pain or swelling in the muscles in your lower legs
• you haven’t been able to have a bowel movement, even after taking laxative, it might mean that you need a stronger laxative. 

Your doctor or nurse will let you know if you should go to the hospital.

What happens next?

You will have regular check-ups after your operation – this is called follow-up. Your check-ups will usually start between six and eight weeks after surgery, and they will usually be every three to six months. Around two years after your treatment, you may start to have appointments less often. For example, you might have your first few appointments at hospital and then be offered follow-up at your GP surgery or over the phone. 

PSA blood test

You will have a PSA test a week before your check-up, so the results are available at the appointment. The PSA test is a good way of checking if your treatment has worked.

Your PSA level should drop so low that it’s not possible to detect it (less than 0.1 ng/ml). A rise in your PSA level can suggest some prostate cancer cells were left behind. If this happens, your doctor will talk to you about further tests and treatment.

Looking at the prostate

After your prostate is removed, it will be sent to a laboratory to be looked at under a microscope. If you had lymph nodes removed these will be looked at too. This can give your doctor a clearer idea of how aggressive the cancer was and how far it had grown or spread. 

At your first check-up your doctor might talk about ‘negative or clear surgical margin’ or ‘positive surgical margin’. 

• Negative or clear surgical margin – this means that the tissue the surgeon removed was surrounded by a layer of normal tissue. It suggests all the cancer was removed.
• Positive surgical margin – this means there are cancer cells on the edge of the tissue the surgeon removed. It suggests that some cancer cells may have been left behind and you may need further treatment.

Further treatment

If your results suggest some cancer cells may have been left behind or the cancer has come back, you might be offered radiotherapy on its own or with hormone therapy. You may also be able to take part in a clinical trial.

Going back to work

The amount of time you take off work will depend on how quickly you recover, how much physical effort your work involves, and whether you feel ready to go back to work. If you have open surgery, you might need longer to get back to your usual activities than after keyhole surgery.

Driving

You will be able to sit in a car as a passenger while your catheter is still in. You may want to avoid long journeys for the first two weeks after the catheter is removed until you are more used to dealing with any problems, such as leaking urine.

There are no official guidelines for how long you should wait before driving. Speak to your doctor about when it’s safe for you to drive. You need to feel you can do an emergency stop and drive comfortably. Check with your insurance company how soon after surgery you are insured to drive. 

What are the side effects?

Like all treatments, surgery can cause side effects. These affect each man differently and you might not get all the possible side effects. Experiencing side effects can be hard to deal with and it can affect you physically, mentally and emotionally. We have created a wellbeing hub to help support you. 

The most common side effects of surgery are leaking urine (urinary incontinence) and problems with getting or keeping an erection (erectile dysfunction).

Your risk of getting these side effects depends on your overall health and age, how far the cancer has grown, how likely it is to grow and your surgeon’s skill and experience. 

Worrying about possible side effects can make you feel down. Before your surgery, talk to your doctor or nurse about the side effects. Knowing what to expect can help you deal with them.

Urinary problems after surgery

Leaking urine

Most men can’t control their bladder properly when their catheter is first removed. This is because surgery can weaken the muscles and nerves that normally stops urine from leaking.

You might just leak a few drops if you exercise, cough or sneeze (stress incontinence). Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery. You might also leak urine during sex.

Your risk of leaking urine depends partly on your age and whether you leaked urine before surgery. Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.

Difficulty urinating

A few men (less than 5 out of every 100 men) may find it difficult to urinate after surgery (urine retention). This can be caused by scarring around the opening of the bladder or the urethra (the tube you urinate through).

Some men find they suddenly and painfully can’t urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency (A&E) department.

Watch Paul's story for one man's experience of managing urinary problems after surgery:

Sexual problems after surgery

Erection problems

After surgery, including nerve-sparing surgery, most men find it difficult to get an erection strong enough for sex. It can take anything from a few months to few years for erections to return and they may not be as strong as before. Some men will always need medical help to get erections, and some men might not be able to get erections even with medical help.

There are treatments available, including tablets called PDE5 inhibitors, vacuum pumps, injections, cream and pellets. There are specialist services available to support men with erection problems.

Your doctor may suggest starting treatment for erection problems before surgery or in the first few weeks afterwards. This is known as penile rehabilitation.

If you have anal sex and prefer being the penetrative partner, you normally need a strong erection, so erection problems can be a particular issue. There are things that can help, such as using a constriction ring along with tablets. Read our information for gay and bisexual men.

Change in penis size and shape

Some men notice that their penis is a bit shorter or curved after surgery. Using a vacuum pump, possibly with PDE5 inhibitor tablets, could help maintain the size of your penis.  Read more about penis shortening.

Changes to orgasm

The seminal vesicles, which make most of the fluid in semen, are removed during surgery. This means you won’t ejaculate any more. You may have a ‘dry orgasm’ instead – where you feel the sensation of orgasm but don’t ejaculate. This may feel different to the orgasms you’re used to.

Some men may also have delayed orgasms (difficulty reaching orgasm), pain when they orgasm, less intense orgasms, or may not be able to orgasm at all.

Desire for sex (libido)

Being diagnosed with prostate cancer and the time leading up to surgery can make you feel down or anxious. Even after surgery, you might feel anxious about how successful the treatment has been, or upset about the changes to your body and sex life. Feeling down or stressed can mean you lose interest in sex.

Having children

After your operation, you won’t be able to father a child naturally. You may want to think about storing your sperm before having surgery so that you can use it later for fertility treatment. Ask your doctor or nurse about storing sperm.

Loss of sensitivity

If you receive anal sex, a lot of the pleasure comes from the penis rubbing against the prostate. Some men who receive anal sex find their experience of sex changes after surgery.

Read more about how prostate cancer treatment can affect your sex life and the treatments available. Plus find ways to manage changes to your sex life.

Dealing with prostate cancer

Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no ‘right’ way to feel and everyone reacts differently.

Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment.

• Do you think surgery is a good option for me and why?
• What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
• How many of these operations have you done and how many do you do each year?
• Can I see the results of radical prostatectomies you’ve carried out?
• How long should I expect to be in hospital?
• What pain relief will I get after the operation?
• How and when will we know whether the operation has removed all of the cancer?
• How often will my PSA level be checked?
• What is the chance of needing further treatment after surgery?
• What support can you offer me if I get long-term side effects?

References

Updated: July 2024 | Due for Review: July 2027