Who Is a Candidate for Radical Prostatectomy?
Radical prostatectomy may be offered to men with localized prostate cancer when definitive treatment is appropriate, especially if life expectancy and overall health make long-term cancer control meaningful. Selection depends on Grade Group, PSA, stage, MRI findings, cancer extent, life expectancy, urinary and sexual function, and personal priorities. Low-risk disease may be better managed initially with active surveillance. High-risk or selected locally advanced cases may require additional therapy after surgery.
Age alone does not decide eligibility; the risks of anesthesia, other illnesses, expected recovery and possible treatment benefit must be assessed individually.
What Happens During the Operation?
The surgeon removes the entire prostate and seminal vesicles, then reconnects the bladder to the urethra. A urinary catheter remains temporarily while the connection heals. Surgery may be open, conventional laparoscopic or robot-assisted, depending on available expertise and patient circumstances.
Pelvic lymph nodes may be removed when the estimated risk of nodal spread supports it; this decision balances staging value and complications. Robot assistance does not guarantee better cancer control or preservation of erections.
Can Nerve-Sparing Surgery Preserve Erections?
When cancer location and staging suggest a low risk of disease outside the prostate on a particular side, surgeons may preserve nearby nerves involved in erections. Nerve sparing is not always oncologically safe or technically possible. Outcomes depend on age, preoperative erectile function, tumor extent and surgical factors; recovery may take many months and may be incomplete.
Recovery Timeline: Catheter, Activity and Work
| Period | What to expect |
|---|---|
| Immediately after surgery | Pain control, early assisted walking, catheter care and monitoring for bleeding or infection |
| Approximately 1–2 weeks | Catheter removal is often considered around this period if healing is satisfactory; timing varies |
| Several weeks | Gradual return to routine tasks; follow specific lifting, driving and exercise restrictions |
| Months afterward | Continence and erectile-function recovery can continue; PSA monitoring remains essential |
These are broad ranges, not instructions to remove a catheter or resume activity independently. Follow the treating surgeon’s discharge plan.
Side Effects and Complications
Important possible complications include urinary incontinence, erectile dysfunction, urinary-anastomosis problems, bleeding, infection, blood clots and anesthesia complications. Removing the prostate causes loss of ejaculation and infertility through natural ejaculation. Some men notice changes in orgasm or penile length.
Pelvic-floor training and sexual rehabilitation may help selected patients. For a detailed explanation, see Prostate removal side effects and sex after prostate surgery.
Radical Prostatectomy vs Radiation Therapy
Both surgery and appropriate radiation regimens can be used with curative intent for many localized prostate cancers. Surgery provides a full pathology specimen and is followed by PSA that should become undetectable. Radiation avoids an operation but may require repeated treatment visits, or shorter courses depending on technique; androgen deprivation therapy is added in some risk groups.
Urinary leakage may be more prominent after surgery, while bowel symptoms are more closely associated with radiation. Erectile problems can occur after either treatment, with different timing and recovery patterns. There is no universally superior option for every risk group or patient. See radiation therapy options and side-effect comparisons.
PSA and Pathology Follow-Up
After radical prostatectomy, PSA is normally expected to become undetectable within about two months. The final pathology report describes the Grade Group, surgical margins, extent of cancer and any sampled lymph nodes. These findings help determine whether observation or additional treatment is appropriate.
The 2026 EAU follow-up guidance generally discusses PSA assessment every six months for three years, then annually, with individual variation. A confirmed rising PSA needs clinical interpretation; it does not automatically establish visible metastatic cancer. See PSA recurrence and salvage treatment.
Frequently Asked Questions
Is robotic surgery always better?
No. Surgeon experience, cancer characteristics and the center’s outcomes matter more than the label of the approach alone.
Will everyone become incontinent?
No. Recovery varies, but temporary leakage is common and persistent leakage remains possible.
Will surgery eliminate the need for cancer follow-up?
No. PSA monitoring and review of the pathology report are essential, and some men later need salvage treatment.
Related Prostate Cancer Guides
Medical References
Medical information notice: This guide is for general education only and does not replace assessment by a urologist or multidisciplinary cancer team. Surgery, nerve sparing, lymph-node removal and postoperative care must be individualized.