Prostatectomy

Overview

What is a prostatectomy?

A prostatectomy is a type of surgery in which a surgeon removes all or part of your prostate.

Your prostate is a small gland that’s part of the male reproductive system. It surrounds the urethra, which is the tube through which semen (ejaculate) and urine (pee) flow out of your body. It contributes extra fluid to your ejaculate. Fluid (semen) from your prostate enters the urethra during ejaculation, and muscles surrounding the urethra squeeze (contract) to push semen out of the urethra when you orgasm.

How many types of prostatectomy are there?

There are two primary types of prostatectomy.

Simple prostatectomy

Your prostate gland has two parts: an inner portion that grows as you get older and an outer part that forms a capsule. The inner portion is like the fruit of an orange, and the outer part is like the peel of an orange.

During a simple prostatectomy, a surgeon makes a vertical cut (incision) in your lower abdomen and removes the inner portion of your prostate through the cut while leaving the outer portion intact. They remove the inner portion in a similar way to how you may eat an orange. They scoop out the inner portion while leaving the outer portion intact.

They may also perform the procedure laparoscopically. Laparoscopic surgery is less invasive than traditional open surgery. The surgeon will make two to four small incisions (half an inch or less) in your abdomen. They then insert a thin rod with a camera at the end (laparoscope) into one incision to see inside your body. They insert surgical tools into the other incisions, then remove the inner portion of your prostate.

Radical prostatectomy

During a radical prostatectomy, a surgeon removes your entire prostate gland. They usually remove fat and tissues around your prostate, too. These may include seminal vesicles (glands that help make ejaculate) and lymph nodes. The surgeon then reattaches your urethra to your bladder using stitches and cuts your vas deferens, which is the tube that transports semen from your testicles to your urethra.

A radical prostatectomy may be an open surgery, or your surgeon may perform it laparoscopically.

During an open radical prostatectomy, the surgeon makes a vertical incision between your belly button and pubic bone to remove your prostate.

During a laparoscopic radical prostatectomy, the surgeon makes several small incisions through which they insert a laparoscope to see inside your body. They insert surgical tools into the other incisions.

You may be a candidate for a robotic laparoscopic radical prostatectomy. This is a robotic-assisted surgery. Your surgeon “pilots” a robot’s arms, which allows them to move much more carefully in hard-to-reach areas inside your body.

A laparoscopic radical prostatectomy and a robotic laparoscopic radical prostatectomy are less invasive than an open prostatectomy.

Some people may be candidates for a single port radical prostatectomy. This is a type of robot-assisted radical prostatectomy in which the instruments enter through one small incision in the lower abdomen. It’s a newer technique than traditional laparoscopic prostatectomy and robotic radical prostatectomy, which have incisions. It’s also less invasive, allows for a faster recovery and creates less scarring. However, because this is a newer procedure, it might not be an option in as many hospitals.

Is a prostatectomy a major surgery?

Yes, healthcare providers generally consider a prostatectomy to be a major surgery. A surgeon will surgically remove part or all of your prostate. Some surgery techniques are less invasive than others. Your surgeon will explain which technique they recommend and why.

Although prostatectomy is a major surgery, providers also consider it safe in people who are healthy enough to undergo surgery without major heart or lung problems.

Who needs to have a prostatectomy?

Healthcare providers most often recommend a radical prostatectomy to treat prostate cancer confined to the prostate in men and people assigned male at birth (AMAB).

A healthcare provider may also recommend a simple prostatectomy if you have a condition that blocks your urethra and affects how you pee, such as benign prostatic hyperplasia (BPH).

How common are prostatectomies?

Prostatectomies are a very common surgery for prostate cancer that hasn’t spread outside your prostate. Healthcare providers perform about 90,000 prostatectomies each year in the United States.

Prostate cancer is the second most common cancer that affects men and people AMAB, behind skin cancer. It affects about 1 in 8 men, at an average age of 66.

Can you live without your prostate?

Yes, you can live without your prostate.

What does removing a prostate do to a man or person AMAB?

Removing your prostate treats prostate cancer. You can still have sex after you’ve healed. However, it may be harder to achieve an erection, and you may have little or no semen when you orgasm.

Procedure Details

What happens before a prostatectomy?

Before a prostatectomy, you’ll meet with a healthcare provider. The provider will discuss what type of prostatectomy procedure is best for you. You may have a simple or radical prostatectomy.

The provider will check your general health. They’ll also take your vital signs (temperature, pulse and blood pressure).

Tell your healthcare provider about any prescription or over-the-counter (OTC) medications you’re taking. These include herbal supplements. Aspirin, anti-inflammatory drugs, certain herbal supplements and blood thinners can increase your risk of bleeding. You may need to temporarily stop taking certain medications before surgery. Be sure to check with a healthcare provider for guidance before stopping any medications.

Tell the healthcare provider about any allergies you have, as well. Include all known allergies. These include medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.

The healthcare provider will also give you specific directions on eating and drinking before your prostatectomy. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medications, you should take them with a small sip of water.

What happens during a prostatectomy?

A special team of healthcare providers will perform a prostatectomy. The team typically includes:

The anesthesiologist will sedate you (put you under) with general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure. After you’re under, a provider will insert a urinary catheter. A urinary catheter is a small, flexible tube that drains pee from your bladder into a bag.

The procedure varies according to whether you have an open prostatectomy or a robotic prostatectomy.

Open prostatectomy

During an open prostatectomy, the urologist will use a sharp, sterile knife (scalpel) to carefully make a vertical incision between your belly button and pubic bone (suprapubic). In some cases, the urologist may choose to make the incision in the skin between your anus and scrotum (perineum). However, this approach isn’t as common.

The incision is usually between 6 and 12 inches. A large incision gives the urologist a clear look at your prostate and the surrounding tissues. They’ll close the incision with stitches (sutures) or small metal staples. They may also secure a small silicone tube (surgical drain) to remove blood or fluid from inside your body. They’re typically in place for a few days immediately after surgery before a provider removes them. Removing a surgical drain usually isn’t painful, and it doesn’t require any extra pain medications or anesthesia.

Robotic prostatectomy

During a robotic prostatectomy, the urologist will use a scalpel to make one small incision (single port prostatectomy) or several tiny incisions (multi-port prostatectomy). The incisions are no bigger than about 3/4 of an inch. They’ll insert a laparoscope and robotic surgical equipment into these small incisions.

The urologist then removes your prostate gland and seminal vesicles from the surrounding tissues. They’ll then reattach your urethra to your bladder using small sutures. The urologist may also remove your lymph nodes and check them for cancer.

Once the procedure is complete, a healthcare provider will use stitches and/or staples to close your incisions. They’ll use sutures for robotic surgery. They may also secure a surgical drain at one of your incision sites.

How long does a prostatectomy take?

A prostatectomy usually takes about two to four hours to complete.

What happens after a prostatectomy?

After a prostatectomy, a healthcare provider will cover your incision sites with bandages or skin glue.

The anesthesiologist will stop putting anesthesia into your body. You’ll be conscious (awake) within a few minutes, but you’ll likely still feel groggy.

You’ll then move to a recovery room, where your healthcare providers will wait for you to wake up more fully and track your overall health. Once you wake up, your providers will treat your pain. A robotic prostatectomy is usually less painful than an open prostatectomy. However, you’ll still need pain medication and management techniques while you recover.

Anesthesia commonly causes nausea in the short term after surgery. If you have nausea, a provider will give you medication to treat it.

You must maintain a liquid diet for one to two days after surgery. A liquid diet helps give your body time to recover. As you heal, providers will reintroduce you to solid foods.

The day after surgery, providers will encourage you to get out of bed and walk. Walking encourages healing, promotes blood flow and restores function to your affected areas. It also helps prevent blood clots in your legs, pneumonia and other complications.

Nearly all people have a urinary catheter after a prostatectomy. The amount of time the urinary catheter stays in place depends on what type of surgery you have and how long your surgeon thinks it’ll take your bladder to heal. For a simple prostatectomy, a urinary catheter may be in play for two to three days. For a radical prostatectomy, it may be in place for as long as 10 to 14 days.

Once your healthcare providers determine you’re healthy enough and no longer require monitoring, they’ll discharge you to go home. Some people may go home the same day of the procedure, while others may stay in the hospital for one to two days. A family member or friend must drive you home. It’s also a good idea to have a family member or friend help take care of you for at least a few days after the procedure. You’ll feel tired for several weeks after the procedure. You should avoid heavy lifting or strenuous exercise for several weeks to ensure your incision sites heal properly.

Your healthcare provider will usually prescribe medications before you return home. These may include pain medications, stool softeners, antibiotics and blood-thinning medications.

How long is a hospital stay for a prostatectomy?

The typical hospital stay for a robotic prostatectomy is one to two days. However, some people may be able to go home on the day of the procedure.

The typical stay for an open prostatectomy is three to four days.

Risks / Benefits

What are the advantages of a prostatectomy?

The main advantage of a prostatectomy is treating prostate cancer or BPH. Prostate cancer, particularly high-grade or aggressive prostate cancer, may be deadly without treatment. The risks of having prostate cancer without treatment outweigh any risks associated with a prostatectomy in most patients.

What are the risks or complications of a prostatectomy?

All surgical procedures have risks. Some risks of a prostatectomy include:

  • Anesthesia risks.
  • Healing problems.
  • Possible need for a blood transfusion.
  • Infection.
  • Mass of clotted blood (hematoma).
  • Blood clots.
  • Fluid buildup at the surgical site (seroma).

Other risks of a prostatectomy include:

How does life change after prostate removal?

Many people will have temporary urinary incontinence after a prostatectomy. Incontinence rates are higher after radical prostatectomy than for simple prostatectomy. Types of incontinence may include:

  • Urge incontinence. Urge incontinence is a sudden, uncontrollable need to pee.
  • Stress incontinence. Stress incontinence is involuntarily peeing during physical exertion, such as exercising, coughing or sneezing.
  • Orgasmic incontinence (climacturia). Orgasmic incontinence is leaking pee when you’re sexually excited. You may also ejaculate pee when you orgasm.

Many people have excellent control of their urine stream once a provider removes their catheter, but some may leak varying amounts for several weeks. Most have good urinary control around six to 12 weeks after the procedure.

Many can resume having sex once they’ve healed after a prostatectomy, which may take four to six weeks.

Can you have an erection after a prostatectomy?

Erection issues aren’t as common after a simple prostatectomy for BPH, but almost all people have erectile dysfunction after a radical prostatectomy for prostate cancer. Erectile dysfunction occurs because the procedure bruises or otherwise damages the nerves that allow for erections, which are very close to the prostate gland. Sometimes your healthcare provider removes part or all of a nerve to treat prostate cancer.

Most people won’t experience erections for several months after a prostatectomy, even if your provider can preserve all of your nerves. Erection function should gradually improve around six months after surgery. However, it may take two full years after surgery to recover the same erection hardness and sexual function.

Even if you can’t get an erection after surgery, you can still experience an orgasm and have normal sensation. However, little or no ejaculate may be present. It’s important to begin sexual activity after you regain control of your urine stream to maintain blood flow to your penis. Maintaining blood flow helps prevent fibrosis. Fibrosis is the development of thick scar tissue after an injury. It can make it more challenging to achieve harder erections.

Therapies that help restore erections include:

Recovery and Outlook

What is the recovery time?

Most people can resume normal activities about eight weeks after an open prostatectomy. Recovery is usually faster after a robotic prostatectomy. Most people can resume normal activities four to six weeks after a robotic prostatectomy.

However, your recovery depends on the type of prostatectomy, your health history and any other conditions you have. A healthcare provider is the best person to tell you your recovery timeline.

When can I go back to work?

This depends in part on the kind of work you do. You should be able to return to work about two to three weeks after a prostatectomy. However, if you have a more physical job, you may need to take up to four to six weeks off work.

When to Call the Doctor

When should I see a healthcare provider?

Schedule follow-up appointments with your healthcare provider. Your appointments may be with your surgeon or with a member of their clinical team, such as a nurse practitioner, physician’s assistant, nurse, resident or fellow. They’ll want to check your incisions and stitches. If you don’t have dissolvable stitches, they may remove your stitches after one to two weeks. If you still have any surgical drains, they’ll remove those as well.

If your provider removed prostate cancer, they’ll also conduct regular tests to ensure your cancer is gone. They’ll conduct blood tests to check for elevated PSA (prostate-specific antigen) levels several times during the first year after removing prostate cancer to make sure it hasn’t come back. If your PSA levels rise after surgery, they may order imaging tests or additional lab work.

Contact your healthcare provider immediately if you experience any abnormal symptoms. Symptoms may include:

  • Heavy bleeding at your incision sites.
  • Discolored drainage from your incisions.
  • A fever of 100 degrees F (38 degrees C) or higher.
  • Infection.
  • Bad odor around the surgical site.
  • Skin separation at your stitches.
  • Increased pain.

Frequently Asked Questions

Is it better to have my prostate removed or radiation if I have prostate cancer?

Radiation therapy is another form of cancer treatment. During this treatment, a healthcare provider uses radiation to kill cancer cells.

There are risks and complications to radiation therapy as a treatment for prostate cancer. Like a prostatectomy, erectile dysfunction is a common risk. Incontinence is less of a risk with radiation therapy. However, radiation therapy can cause rectal irritation and bladder irritation (radiation cystitis). Bladder irritation may vary in severity. You may only experience it while you receive radiation treatments, or you may have it for years after you’ve stopped treatment.

Radiation therapy is an outpatient procedure, meaning you can go home afterward. A prostatectomy may be an outpatient procedure or an inpatient procedure. An outpatient procedure means you may go home from the hospital on the same day of your procedure. An inpatient procedure means you must stay in the hospital for one to two days under observation before you can go home.

Many types of radiation therapy typically require treatment five days a week for seven or more weeks. A prostatectomy and its recovery period can be intense, but many people recover in as little as four weeks at home.

A prostatectomy and radiation therapy are both effective treatment options for prostate cancer. It’s important to talk to a urologist and an oncologist as you consider your treatment options. They can answer all of your questions so you can make the best decision for your treatment plan.

A note from Cleveland Clinic

A radical prostatectomy is a common and effective treatment for prostate cancer. A simple prostatectomy is an effective treatment for benign prostatic hyperplasia. There are two ways to perform these procedures: an open prostatectomy and a robotic prostatectomy. Robotic prostatectomies are more common.

It’s common to feel a wide range of emotions before any surgery, especially a prostatectomy. If you have any questions, reach out to a healthcare provider. They can help you understand the procedure, your recovery, your long-term health and your quality of life after a prostatectomy.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 10/09/2022.

Learn more about our editorial process.

References

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