Prostate Cancer Surgery: What You Should Know

Prostate Cancer Surgery: What Patients Need to Know

Prostate Cancer Surgery: What Patients Need to Know. Prostate cancer surgery can be curative for appropriately selected men—but deciding whether to have surgery is just as important as deciding how the surgery should be performed.

For men diagnosed with prostate cancer, the word “surgery” can sound straightforward: remove the prostate and remove the cancer.

The reality is more complicated.

A prostatectomy can be an excellent treatment for some men with localized prostate cancer. But it can also cause important long-term side effects, particularly urinary incontinence and erectile dysfunction.

And not every man diagnosed with prostate cancer needs immediate treatment.

For some men with low-risk prostate cancer, active surveillance—regular PSA testing, imaging, examinations and sometimes repeat biopsies—can be an appropriate way to avoid or delay treatment-related side effects.

That means the first question should not necessarily be:

“Which prostatectomy should I have?”

It may be:

“Do I need a prostatectomy at all?”

This article explains what patients should know about prostate cancer surgery before making that decision.

I am a long-term survivor of an incurable blood cancer called multiple myeloma. My research and experience with evidence-based non-conventional therapies are the reason why I have lived in complete remission from my incurable blood cancer since achieving complete remission in early 1999. I have learned that the best way to manage aggressive cancers is to combine the best of conventional and evidence-based non-conventional therapies.

I have come to believe that therapy-induced side effects can be life-threatening while ruining quality of life. Consider therapies shown to reduce possible side effects.

If you’re considering having a prostatectomy, please read the personal prostatectomy experience of Bruce Nevin.

Scroll down the page and post a question or a comment if there’s anything you’d like to know about breast cancer.

Good luck,

David Emerson

Concepts Central to Managing Your Cancer-

Possible Conventional Prostate Cancer Therapies

Prostate Cancer Recovery from Prostatectomy

PeopleBeatingCancer Perspective

PeopleBeatingCancer supports an evidence-based integrative approach to cancer care.

For prostate cancer, FDA-approved and guideline-supported treatments—including surgery, radiation therapy, hormone therapy and active surveillance when appropriate—should form the foundation of treatment decisions.

Nutrition, exercise, sleep, stress management and other complementary strategies may support general health, treatment recovery and survivorship.

They should not be presented as substitutes for appropriate prostate cancer treatment.

My goal with this article is simple:

Understand the cancer. Understand your treatment choices. Understand the potential benefits and consequences before you choose.

What Is Prostate Cancer Surgery?

The most common cancer-directed operation is called a radical prostatectomy.

During a radical prostatectomy, the surgeon removes:

The entire prostate gland
The seminal vesicles
Sometimes nearby lymph nodes

The prostate surrounds part of the urethra, so removing the prostate requires the surgeon to reconnect the bladder to the urethra so that urine can continue to pass normally.

Radical prostatectomy is primarily used to cure localized prostate cancer, meaning cancer that has not spread to distant organs.

However, the decision to recommend surgery depends on much more than the fact that cancer has been found.

Your:

PSA level
Gleason score
Grade Group
MRI findings
Biopsy results
Clinical stage
Tumor location
Age
Overall health
Life expectancy
Personal priorities

all matter.

Related PeopleBeatingCancer resource: Prostate Cancer—Need to Know

Before Surgery: Do You Actually Need Treatment?

This may be the most important question in this entire article.

Some prostate cancers grow so slowly that they may never threaten a man’s health during his lifetime.

That is why active surveillance has become an important management strategy for appropriately selected men with low-risk prostate cancer.

Active surveillance does not mean ignoring prostate cancer.

Instead, it generally involves monitoring the cancer through some combination of:

PSA testing
Digital rectal examination when appropriate
Prostate MRI
Repeat biopsy
Clinical assessment

If evidence suggests that the cancer is becoming more aggressive, treatment can then be considered.

The advantage is that a man who never needs definitive treatment may avoid treatment-related complications.

This is particularly important because prostatectomy can affect urinary and sexual function.

When Is Surgery Considered?

Radical prostatectomy may be considered when prostate cancer is sufficiently aggressive that treatment is warranted and the cancer is believed to be amenable to surgical removal.

For localized prostate cancer, treatment decisions commonly involve a comparison among:

Active surveillance
Radical prostatectomy
Radiation therapy
In selected situations, other approaches or combinations of treatments such as HIFU therapy

Risk classification is critical.

A man with very-low-risk prostate cancer may have very different treatment options from a man with high-risk localized disease.

For higher-risk cancers, surgery may also be combined with additional treatment depending on the pathology and whether cancer is found outside the prostate.

This is why PSA alone should not determine your treatment decision.

The Main Types of Prostatectomy

There are several ways a radical prostatectomy can be performed.

1. Robotic-Assisted Radical Prostatectomy

Robotic-assisted laparoscopic prostatectomy is now the most common surgical approach in the United States.

The surgeon operates through several small abdominal incisions using instruments controlled from a console.

Potential advantages include:

Smaller incisions
Less blood loss
Less postoperative pain
Shorter hospital stay
Faster early recovery

However, patients should understand an important point:

Robotic surgery does not eliminate the major long-term risks of prostatectomy.

Evidence indicates that robotic and open surgery have broadly similar long-term outcomes for important issues such as urinary incontinence and erectile dysfunction.

In other words:

“Robotic” does not mean “risk-free.”

2. Open Radical Prostatectomy

With open surgery, the surgeon makes a larger incision, usually in the lower abdomen.

Open prostatectomy is performed less often than in the past but remains an appropriate option in selected circumstances.

The long-term cancer-control results appear broadly comparable with robotic approaches when surgery is performed appropriately.

Does the Surgeon Matter More Than the Robot?

Possibly one of the most important questions a patient can ask is:

How experienced is my surgeon with radical prostatectomy?

The American Cancer Society notes that the experience and skill of the surgeon are likely to be among the most important factors affecting surgical success.

Therefore, I would ask:

How many prostatectomies do you perform each year?
How many have you performed in total?
What are your rates of urinary incontinence?
What are your erectile-function outcomes?
How often do you obtain negative surgical margins?
What percentage of your patients require additional treatment?
What is your complication rate?

Don’t be afraid to seek a second opinion.

A second opinion from another high-volume urologic surgeon can be particularly valuable before an irreversible operation.

Seek a second opinion- over-treatment, over-diagnosis?

What Is Nerve-Sparing Prostatectomy?

One of the major goals of prostate cancer surgery is to remove the cancer while preserving nearby structures whenever it is oncologically safe to do so.

The nerves responsible for erections run close to the prostate.

If the cancer is not involving these structures, the surgeon may be able to perform nerve-sparing surgery.

But nerve sparing is not always possible.

If the tumor is large or located close to the erectile nerves, removing those nerves may be necessary to achieve adequate cancer control.

This creates an important trade-off:

Cancer control comes first.

Preserving erectile function is important, but it should not be accomplished by leaving cancer behind.

Ask your surgeon:

“Do you expect to spare one or both neurovascular bundles, and why?”

What Happens to the Lymph Nodes?

During prostatectomy, some men also undergo pelvic lymph node dissection (PLND).

The purpose is primarily to determine whether prostate cancer has spread to nearby lymph nodes.

The decision to remove lymph nodes depends on the estimated risk that cancer has spread beyond the prostate.

Doctors may use clinical prediction tools, including nomograms, to help make this decision. Imaging such as PSMA PET can also contribute to staging in appropriate situations.

Lymph-node removal can provide valuable staging information and may influence decisions about additional therapy.

However, lymph-node removal itself has potential complications, including lymphocele and other surgical risks.

Therefore, ask:

“What is my estimated probability of lymph-node involvement, and how would the result change my treatment?”

What Happens Immediately After Prostatectomy?

After surgery, a urinary catheter is generally placed to allow urine to drain while the bladder-to-urethra connection heals.

The catheter commonly remains for approximately one to two weeks, although the exact timing varies.

Early recovery may involve:

Fatigue
Abdominal or pelvic discomfort
Blood in the urine
Temporary urinary urgency
Catheter-related discomfort
Urinary leakage
Reduced physical activity

Many men gradually return to normal activities over several weeks.

Your surgeon should provide specific instructions regarding:

Driving
Exercise
Lifting
Sexual activity
Work
Wound care
Catheter care

The Two Major Long-Term Side Effects of Prostatectomy

This is the section every prospective prostatectomy patient should read carefully.

1. Urinary Incontinence

After prostate removal, some men experience urinary leakage.

This may be:

Occasional dribbling
Leakage when coughing
Leakage when exercising
Stress incontinence
More persistent urinary-control problems

For many men, urinary control improves substantially during the months following surgery.

However, recovery varies.

Age, baseline urinary function, surgical technique, anatomy and other factors can influence the outcome.

Pelvic-floor rehabilitation may be recommended as part of recovery.

2. Erectile Dysfunction

Erectile dysfunction is another major potential consequence of prostatectomy.

Even when nerve-sparing surgery is possible, erectile function may take months—or longer—to recover.

Recovery depends on factors including:

Age
Erectile function before surgery
Whether one or both nerve bundles can be spared
Surgical technique
Cardiovascular health
Other medical conditions
Postoperative rehabilitation

The important point is that nerve-sparing surgery does not guarantee normal erections after surgery.

The NCI identifies impotence/erectile dysfunction as one of the recognized complications of radical prostatectomy.

Men should discuss sexual function before surgery rather than waiting until afterward.

Ask:

“What percentage of men like me regain erections sufficient for intercourse after your surgery?”

And ask the surgeon to define exactly what “regain sexual function” means.

What Happens to Ejaculation?

Radical prostatectomy causes a permanent change in ejaculation.

Because the prostate and seminal vesicles are removed and the vas deferens are interrupted, men generally experience an orgasm without ejaculation of semen—a “dry orgasm.”

The ability to have an orgasm may remain, although orgasmic sensation can change.

This distinction is important:

Erection and ejaculation are not the same thing.

A man can potentially regain erectile function after prostatectomy while no longer producing an ejaculate.

Can Prostatectomy Affect Fertility?

Yes.

Radical prostatectomy results in infertility through the sexual route because sperm can no longer travel into the urethra and be ejaculated normally.

For men who may want biological children in the future, fertility preservation should be discussed before surgery.

Options such as sperm banking may be considered.

Other Possible Complications

Like any major operation, radical prostatectomy can cause complications.

Potential risks include:

Potential complication	What patients should know
Bleeding	Usually manageable but can occasionally require intervention
Infection	Can occur after surgery
Blood clots	Risk associated with major surgery
Urinary incontinence	Common early; some men experience persistent leakage
Erectile dysfunction	Common, particularly early after surgery
Urethral/bladder problems	Can occur during healing
Lymphocele	Possible after lymph-node removal
Injury to nearby organs	Uncommon but potentially serious
Inguinal hernia	Can occur after prostatectomy
Bowel/rectal injury	Rare but recognized complication

The NCI and American Cancer Society both identify urinary and sexual dysfunction among the major potential complications of prostatectomy.

Surgery vs. Radiation: Which Is Better?

This is one of the most difficult decisions for men with localized prostate cancer.

There is no universal answer.

Both surgery and radiation can be effective treatments for appropriately selected men.

But their side-effect profiles differ.

In general, prostatectomy tends to produce more immediate urinary leakage and early erectile dysfunction, while radiation can cause urinary and bowel irritation and may produce sexual dysfunction more gradually.

That makes this an individual decision.

A man who strongly prioritizes urinary continence may view the choice differently from a man who strongly prioritizes avoiding radiation exposure.

Your age, cancer risk, anatomy, baseline urinary and sexual function, other health conditions and personal preferences all matter.

What Happens If Cancer Is Found at the Surgical Margins?

After prostatectomy, a pathologist examines the prostate and surrounding tissue.

The final pathology report can provide important information about:

Tumor grade
Tumor stage
Surgical margins
Seminal-vesicle involvement
Lymph-node involvement
Other pathological features

A positive surgical margin means cancer cells are present at the edge of the tissue removed during surgery.

This can increase concern about residual cancer, although it does not automatically mean that cancer will recur.

Depending on the complete pathology and subsequent PSA results, your oncology team may discuss additional treatment.

What If PSA Rises After Surgery?

After the prostate has been removed, PSA should fall to a very low or undetectable level.

A subsequent detectable or rising PSA can be an important sign of persistent or recurrent prostate cancer.

This is one reason postoperative PSA monitoring is so important.

A rising PSA does not necessarily mean that you have run out of treatment options.

Depending on the situation, doctors may consider:

Repeat PSA testing
Advanced imaging
Radiation therapy
Hormone therapy
Other systemic treatment

The earlier a biochemical recurrence is recognized, the more treatment options may be available.

PSA After Prostatectomy: What Does a Rising PSA Mean?

Prostate Cancer Surgery and Quality of Life

One of the biggest mistakes a newly diagnosed patient can make is thinking only about survival.

Survival matters enormously.

But so does how you live after treatment.

Before prostatectomy, think about:

Urinary function

How important is maintaining urinary continence to you?

Sexual function

How important is preserving erectile function?

Bowel function

Would avoiding long-term bowel effects influence your treatment preference?

Recovery time

How much time can you realistically devote to recovery?

Additional treatment

What happens if pathology suggests that surgery alone wasn’t sufficient?

Age and life expectancy

The potential benefit of eliminating prostate cancer must be weighed against the potential long-term consequences of treatment.

This is why prostate cancer treatment is fundamentally a shared decision-making process.

Before Prostate Cancer Surgery: Questions to Ask Your Surgeon

I would take this list to the consultation.

What is my PSA?
What is my Gleason score?
What is my Grade Group?
What is my clinical stage?
Is my cancer considered low, intermediate or high risk?
Am I a candidate for active surveillance?
Why do you recommend surgery instead of radiation?
Why do you recommend surgery instead of active surveillance?
What type of prostatectomy do you recommend?
How many prostatectomies do you perform each year?
What are your urinary incontinence outcomes?
What are your erectile-function outcomes?
Will you be able to spare both nerve bundles?
Do I need pelvic lymph-node dissection?
What are the risks of lymph-node removal?
What is the expected hospital stay?
How long will I have a catheter?
When can I return to work?
When can I exercise?
When can I resume sexual activity?
What will my postoperative PSA schedule be?
What happens if my surgical margins are positive?
What happens if my PSA becomes detectable after surgery?
What percentage of your patients require radiation or other treatment after prostatectomy?
Should I get a second opinion before deciding?

Can Lifestyle and Integrative Therapies Help After Prostatectomy?

This is where it is important to separate recovery from cancer treatment.

Good nutrition, regular physical activity, adequate sleep, stress management and maintaining a healthy body weight may support general health and recovery.

These strategies may also be particularly relevant to men recovering from prostate cancer because cardiovascular, metabolic and sexual health are closely interconnected.

But there is an important distinction:

Supporting recovery is not the same as treating prostate cancer.

There is currently no nutritional supplement that has evidence comparable with prostatectomy, radiation or other established prostate cancer treatments for eliminating localized prostate cancer.

I would therefore be very cautious about anyone who tells a newly diagnosed prostate cancer patient to replace surgery with supplements.

Nutrition After Prostate Cancer Surgery

Once your surgical team allows you to resume normal eating, a plant-forward dietary pattern can be a reasonable foundation for long-term health.

Consider emphasizing:

Vegetables
Fruits
Legumes
Whole grains
Nuts and seeds
Fish
Olive oil
Adequate protein
Fiber-rich foods

Consider the diet plans discussed below

PeopleBeatingCancer Evidence Rating: Prostate Cancer Surgery

Intervention/strategy	Evidence rating	What the evidence supports
Radical prostatectomy for appropriately selected localized prostate cancer	🟢 Strong	Established treatment option with curative intent
Active surveillance for appropriately selected low-risk disease	🟢 Strong	Established management strategy that can avoid treatment-related side effects
Experienced/high-volume surgeon	🟢 Strong / important	Surgical expertise is an important factor in outcomes
Nerve-sparing surgery when oncologically appropriate	🟢 Strong	Established surgical approach to preserve erectile-function potential
Pelvic-floor rehabilitation	🟡 Moderate	May support urinary recovery
Regular physical activity after recovery	🟡 Moderate	Strong general health and survivorship rationale; prostate-cancer-specific effects vary
Mediterranean/plant-forward diet	🟡 Moderate / evolving	Strong general-health rationale; prostate-cancer outcome evidence remains less definitive
Curcumin or other supplements as prostate cancer treatment	🟠 Preliminary	Laboratory/early human evidence does not establish cancer-control benefit
Supplements as a replacement for prostatectomy or radiation	🔴 Not supported	No comparable evidence for curing localized prostate cancer

How PeopleBeatingCancer Interprets These Ratings

🟢 Strong evidence — supported by clinical evidence and/or established guideline-based practice.

🟡 Moderate evidence — meaningful human evidence exists, but important uncertainties remain.

🟠 Preliminary evidence — promising biological, observational or early clinical evidence, but insufficient to establish clinical benefit.

🔴 Insufficient/not supported — evidence is inadequate to recommend the intervention for prostate cancer control.

When Should You Call Your Doctor After Prostatectomy?

Follow your surgical team’s specific instructions, but contact your medical team promptly if you experience concerning symptoms such as:

Fever
Increasing pain
Heavy bleeding
Worsening swelling
Redness or drainage from an incision
Difficulty with the catheter
Inability to urinate after catheter removal
Shortness of breath
Chest pain
Significant swelling or pain in a leg

Emergency symptoms should be treated as emergencies rather than waiting for a routine appointment.

The Bottom Line

Prostate cancer surgery can be an excellent treatment—but it isn’t automatically the best treatment for every man diagnosed with prostate cancer.

Before agreeing to a radical prostatectomy, understand:

How aggressive is my prostate cancer?
Do I actually need treatment now?
Am I a candidate for active surveillance?
Why surgery instead of radiation?
What are my surgeon’s urinary and sexual-function outcomes?
Can my nerves be spared safely?
Do I need lymph-node removal?
What happens if the pathology shows more aggressive disease than expected?
What will happen to my PSA after surgery?
What happens if my PSA rises?

The decision should not be based simply on the fear created by the word “cancer.”

It should be based on the biology of your cancer, your life expectancy, the likelihood that treatment will benefit you, the experience of your treatment team and—critically—the quality of life you want to preserve.

For some men, radical prostatectomy will be the right choice.
For others, radiation will be preferable.
For some, HIFU therapy will be preferable.
For still others, active surveillance may be the most appropriate initial strategy.

The best prostate cancer treatment is not necessarily the most aggressive treatment.

It is the treatment that provides the best balance of cancer control, longevity and quality of life for the individual patient.

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