A prostate cancer diagnosis can leave you with many questions about your treatment options. For some men, prostate cancer surgery offers an effective way to treat cancer that has not spread beyond the prostate.

Prostate cancer surgery is an operation to remove all or part of the prostate in order to treat prostate cancer. The most common procedure is a radical prostatectomy, which removes the entire prostate gland and seminal vesicles. In some cases, nearby lymph nodes are also removed to determine whether the cancer has spread.

The goals of prostate cancer surgery are to remove the cancer, provide accurate staging information, and reduce the risk of recurrence. Surgery is one of several effective treatment options. It is not the right choice for everyone. Your healthcare team will recommend treatment based on your diagnosis, overall health, and personal priorities.

Is Prostate Surgery Right for You?

Prostate cancer surgery is most often recommended for men with localized prostate cancer. Some men with locally advanced or higher-risk disease may also benefit from surgery as part of a broader prostate cancer treatment plan.

Before recommending a radical prostatectomy, your doctor will consider several factors, including:

• PSA level
• Gleason score and grade Group
• Cancer stage
• Age and overall health
• Life expectancy
• Personal treatment goals

In general, candidates for a radical prostatectomy are healthy enough to undergo major surgery and have a life expectancy of at least 10 years.

Surgery is not always the best option. Men with low-risk prostate cancer may be candidates for active surveillance, which closely monitors the cancer before treatment is needed. Men with metastatic prostate cancer or serious medical conditions may benefit more from other therapies.

Choosing surgery for prostate cancer is a personal decision. Understanding the benefits and risks of each option can help you make the choice that is right for you.

Types of Prostate Cancer Surgery 

There are several kinds of prostate cancer surgery.  

radical prostatectomy  

A radical prostatectomy is the most common type of prostate cancer surgery. During a radical prostatectomy, the surgeon removes the entire prostate gland and the seminal vesicles. Nearby lymph nodes may also be removed if there is concern that the cancer has spread. 

• Open radical prostatectomy: Uses a single incision in the lower abdomen.
• Laparoscopic radical prostatectomy: Uses several small incisions and specialized instruments. This is sometimes called keyhole surgery.
• Robotic-Assisted radical prostatectomy: This is the most common approach in the United States. The surgeon controls robotic instruments to perform the operation through several small incisions. 

Salvage prostatectomy

This may be considered if prostate cancer returns after radiation therapy.  

transurethral resection of the prostate (TURP)

This may be used to relieve urinary obstruction caused by advanced disease, but it does not cure cancer.  

orchiectomy

This lowers testosterone levels by removing the testicles and is occasionally used to treat advanced prostate cancer. Although orchiectomy is a surgical procedure, it functions as a form of hormone therapy.

lymph Node Removal During Prostate Cancer Surgery 

Some men undergo a pelvic lymph node dissection during a radical prostatectomy. This procedure removes nearby lymph nodes so they can be examined for cancer cells. 

lymph node removal provides important staging information. It helps your healthcare team understand whether the cancer has spread beyond the prostate and whether additional prostate cancer treatment may be recommended after surgery. 

Doctors decide whether to remove lymph nodes based on factors such as your PSA level, grade Group, Gleason score, imaging results, and predictive tools called nomograms. For some men with higher-risk prostate cancer, PSMA PET imaging may also help guide treatment planning.

Pelvic lymph node dissection is generally safe, but it does carry some additional risks.

These include swelling and a lymphocele, which is a collection of lymphatic fluid that sometimes develops after surgery. Your surgeon will discuss whether the benefits of lymph node removal outweigh the risks in your individual case.

Risks and Side Effects of Prostate Cancer Surgery 

Like any major operation, prostate cancer surgery carries risks. These include bleeding, infection, blood clots, pain, and complications related to anesthesia. Your surgical team takes many steps to reduce these risks before, during, and after surgery.

The most common long-term side effects of a radical prostatectomy are urinary incontinence and erectile dysfunction.

Both incontinence and erectile dysfunction can affect a man, not only physically, but emotionally and socially. Erectile dysfunction may occur because the nerves responsible for erections run alongside the prostate. Nerve-sparing surgery can reduce this risk when appropriate, but recovery still takes time. Some men recover sexual function within months, while others continue improving for up to two years.

As for bladder control, following recovery, some urine leakage is expected after the catheter is removed. For most men, bladder control improves over the following months. More than 90% regain normal urinary function, but about 5% to 10% experience permanent stress incontinence.

Other temporary side effects from surgery may include:

• Fatigue
• Pain or soreness
• Temporary urinary symptoms
• Constipation during recovery

Less common complications include wound infection, lymphocele, bladder injury, and rectal injury. Men who have previously undergone radiation therapy or prostate surgery may have a higher risk of complications because of scar tissue.

Your age, overall health, and cancer stage all influence your recovery and long-term outcomes. 

Recovery After Prostate Cancer Surgery

Recovery after prostate cancer surgery is different for every patient. Most men stay in the hospital for one or two days. A urinary catheter is usually needed for one to two weeks while the area heals.

Before leaving the hospital, your care team will explain how to care for your catheter and incision. They will also review symptoms that require medical attention, such as fever, worsening pain, heavy bleeding, or problems with catheter drainage.

Recovery Time

Most men recover from surgery within six to 10 weeks, although urinary and sexual function may continue improving for several months. 

Many men with desk jobs return to work within a few weeks. Physically demanding jobs often require a longer recovery period.

Speeding Up Recovery

Walking soon after surgery helps improve circulation and reduce the risk of blood clots. Heavy lifting, strenuous exercise, and other demanding activities should be avoided until your surgeon says it is safe. 

Following your surgeon’s recovery instructions, staying hydrated, and gradually increasing activity can help support healing. 

Urinary Control, Erectile Function, and Nerve-Sparing Surgery

Concerns about bladder control and sexual function are common before a radical prostatectomy. These side effects are an important part of treatment planning.

Whenever possible, surgeons use nerve-sparing techniques to preserve the nerves responsible for erections.

• A unilateral nerve-sparing procedure preserves nerves on one side of the prostate.
• A bilateral nerve-sparing procedure preserves nerves on both sides.

Whether these techniques can be used depends on the location and extent of the cancer.

Many men regain bladder control within several months. Pelvic floor exercises are often recommended to strengthen the muscles that support continence. 

Recovery of erectile function usually takes longer. Age, overall health, baseline sexual function, and cancer stage all influence recovery. Your doctor may recommend medications or other forms of penile rehabilitation to support healing.

While preserving urinary and sexual function is important, removing the cancer remains the primary goal of prostate cancer surgery. Your healthcare team can help you understand what outcomes are most likely based on your diagnosis.

Will I Need Additional Treatment After Surgery? 

For many men, prostate cancer surgery is the only treatment they need. Others may benefit from additional therapy based on the results of surgery and their pathology report.

After a radical prostatectomy, the removed prostate and any lymph nodes are examined for signs that cancer has spread beyond the prostate. Your doctor will also review your surgical margins. A positive surgical margin means cancer cells are found at the edge of the removed tissue, which may increase the risk of recurrence.

Radiation

Some men may benefit from radiation therapy after surgery. Most patients are monitored with regular PSA testing, and salvage radiation may be recommended if PSA becomes detectable or begins to rise. In select patients with particularly high-risk features, radiation may be recommended before a PSA recurrence develops.

Salvage radiation may be recommended if PSA remains detectable or begins to rise after surgery.

hormone Therapy

Men with higher-risk prostate cancer may also receive hormone therapy along with radiation. 

After a successful radical prostatectomy, PSA levels typically become undetectable. Regular PSA testing is an important part of follow-up care and helps your healthcare team monitor for recurrence. 

Questions to Ask Before Choosing Prostate Cancer Surgery 

Choosing surgery is a personal decision. Asking questions can help you better understand your options and feel more confident about your treatment plan.

Consider asking your surgeon:

• Am I a good candidate for prostate cancer surgery?
• Is nerve-sparing surgery an option?
• What side effects should I expect?
• How many radical prostatectomies do you perform each year?
• What alternatives should I consider?
• Will I need additional treatment after surgery?

If you have high-risk or locally advanced prostate cancer, consider seeking a second opinion. Meeting with both a urologist and a radiation oncologist can help you understand all of your treatment options. 

Support From the Prostate Cancer Foundation of Chicago

You do not have to face prostate cancer alone. 

The Prostate Cancer Foundation of Chicago provides free monthly support group meetings, educational presentations for the newly diagnosed and their families. Whether you are considering prostate cancer surgery or recovering after treatment, our team is here to answer questions and connect you with reliable information and local support.

Contact the Prostate Cancer Foundation of Chicago to learn more about our programs and find the guidance you need throughout your prostate cancer journey.