- A radical prostatectomy removes the whole prostate to treat localized prostate cancer; a simple prostatectomy removes only part of the gland for severe benign enlargement.
- Whether surgery is the right choice — versus active surveillance or radiation — is a shared decision made with your urologist and oncologist based on your cancer, age, and health; there is no one-size-fits-all answer.
- Most radical prostatectomies in the US are now done robotically through small incisions, though open surgery remains a valid option; surgeon experience matters more than the platform.
- The two main functional side effects are urinary incontinence and erectile dysfunction; nerve-sparing technique, when oncologically appropriate, aims to preserve erectile function.
- Recovery generally spans weeks to months, with continence usually improving over 3 to 12 months and erectile recovery slower and more variable.
- Cost varies widely by approach, hospital, and insurance — treat any figure as an estimate and ask about bundled pricing; see a qualified clinician for decisions about your care.
Prostate cancer is the most commonly diagnosed cancer among men in the United States and the second leading cause of cancer death among men, according to the National Cancer Institute. Surgery remains one of the primary treatment options for localized disease. A prostatectomy is the surgical removal of all or part of the prostate gland, performed either for cancer (radical prostatectomy) or for benign enlargement causing severe urinary symptoms (simple prostatectomy). The procedure has changed substantially over the past two decades, with most centers now performing it robotically through small incisions rather than through a traditional open approach. Outcomes depend heavily on cancer stage, surgeon experience, and post-operative rehabilitation — and whether surgery is the right choice at all is a decision made with your care team, not a foregone conclusion.
What a Prostatectomy Is and Who Might Need One
The prostate is a walnut-sized gland that sits below the bladder and surrounds the urethra. According to the American Urological Association, two main forms of prostatectomy are performed:
A radical prostatectomy removes the entire prostate, the seminal vesicles, and surrounding tissue. It is most often used to treat localized prostate cancer. A simple prostatectomy removes only the inner portion of the prostate to relieve obstructive urinary symptoms from severe benign prostatic hyperplasia (BPH); it is generally reserved for very large glands when less invasive options are not feasible.
Candidates for radical prostatectomy generally have cancer believed to be confined to the prostate, a reasonable life expectancy (often described as at least 10 years), and acceptable surgical risk. But eligibility is only part of the picture — active surveillance, radiation, and focal therapies are alternatives (discussed below), and choosing among them is a shared decision that your urologist and, where relevant, a radiation oncologist and medical oncologist help you make based on your specific cancer and priorities.
How the Procedure Is Performed
Most radical prostatectomies in the US are now done with robot-assisted laparoscopy. The surgeon sits at a console controlling instruments inserted through small abdominal incisions while a 3D camera provides high-definition visualization. Mayo Clinic notes that robotic prostatectomy typically takes about 2 to 4 hours under general anesthesia.
The surgeon dissects around the prostate, attempting to spare the neurovascular bundles when it is oncologically appropriate, since those nerves affect erectile function. The bladder is then reconnected to the urethra over a catheter, which typically stays in for roughly 7 to 14 days. Lymph nodes may also be removed for staging.
Open retropubic prostatectomy uses a single incision from the navel to the pubic bone and remains a valid option at some centers, particularly in certain anatomic or clinical situations. Perineal prostatectomy, through an incision between the scrotum and anus, is rarely performed today. For benign disease, TURP (transurethral resection of the prostate) is far more common than simple prostatectomy. Which approach is used is determined by your surgeon based on your anatomy, cancer characteristics, and their experience — robotic and open surgery both have a place.
Nerve-Sparing and Shared Decision-Making
Nerve-sparing prostatectomy attempts to preserve the neurovascular bundles that run alongside the prostate and are important for erections. Whether one or both bundles can be spared depends on where the cancer sits and how far it extends — the surgeon will not compromise cancer removal to preserve nerves. This is one of several trade-offs to discuss beforehand. Ultimately, the decision about surgery versus other treatments, and about how aggressively to attempt nerve-sparing, is made together with your urologist and oncology team, weighing cancer control against quality-of-life goals. There is rarely a single “right” answer, which is why a candid conversation — and often a second opinion — is valuable.
Preparation and What to Expect on the Day
Pre-operative work-up usually includes recent prostate biopsy results, MRI imaging, lab work, and an electrocardiogram. Blood thinners and certain supplements are stopped on a schedule your team provides. Some surgeons recommend pelvic floor exercises (Kegels) starting weeks before surgery to help urinary continence recovery.
You will typically arrive several hours before the procedure, having fasted since midnight. After surgery, you wake up in recovery with a urinary catheter and small abdominal dressings. Most patients spend one night in the hospital after robotic surgery and about 2 to 3 nights after open prostatectomy, though this varies. Walking usually begins within hours to reduce the risk of blood clots.
Recovery Timeline
Most men return to desk work about 2 to 4 weeks after robotic prostatectomy, with open surgery often taking 6 to 8 weeks. According to Cleveland Clinic, the catheter is generally removed at a follow-up visit around 7 to 14 days, after which urinary control gradually returns over weeks to months.
Pelvic floor rehabilitation typically starts after catheter removal. Many men regain useful continence within about 3 to 6 months, with continued improvement up to roughly 12 months. Erectile function recovery is usually slower and depends on age, baseline function, and whether nerves were spared. Phosphodiesterase-5 inhibitors (such as sildenafil or tadalafil) are often prescribed early to support recovery, but any medication should be taken only as directed by your physician.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience heavy bleeding, a fever above about 101°F (38.3°C), severe abdominal pain, calf pain or swelling, sudden shortness of breath, inability to urinate after catheter removal, or signs of a serious urinary tract infection such as flank pain with fever. These can signal a blood clot, infection, or other complication that needs urgent evaluation.
Risks, Side Effects, and Outcomes
Beyond general surgical risks (bleeding, infection, blood clots, and injury to nearby structures), prostatectomy carries two functional side effects that deserve careful discussion:
Urinary incontinence is common immediately after catheter removal, and many men regain control within about 6 to 12 months. A minority — often cited around 5 to 15 percent — have persistent stress incontinence that may warrant additional treatment. Erectile dysfunction is also common; even with bilateral nerve-sparing, a substantial share of men do not fully return to their pre-surgery erection quality, with outcomes depending on age, baseline function, and surgeon experience. Other potential effects include changes in penis length, dry orgasm (no ejaculate), infertility, and pelvic pain. These figures are general ranges and vary by patient and center.
Cancer outcomes for localized disease are generally very good. NCI’s SEER data report 5-year relative survival greater than 99 percent for prostate cancer that has not spread beyond the prostate or nearby tissue — verify the current figure, and remember that individual prognosis depends on grade, stage, and other factors your oncology team will explain.
Alternatives and Active Surveillance
Surgery is not the only option for prostate cancer, and for many men it is not the best one. Active surveillance — close monitoring with periodic PSA tests, exams, imaging, and sometimes repeat biopsies, without immediate treatment — is appropriate for many low-risk cancers and avoids treatment side effects. Radiation therapy (external beam or brachytherapy) achieves comparable cancer control for many patients. Focal therapies such as cryotherapy or HIFU treat only part of the prostate in selected cases. Hormone therapy is used mainly for more advanced disease. Which path fits depends on your cancer’s risk category, your age and health, and your own priorities — again, a shared decision with your clinicians.
For BPH causing severe obstruction, less invasive procedures — including TURP, laser enucleation (HoLEP), prostatic urethral lift (UroLift), and water vapor therapy (Rezum) — are usually tried before simple prostatectomy. Discussing all of these with a urologist who treats a high volume of prostate disease helps clarify which option fits your particular situation.
Cost Considerations
Costs vary widely by approach, hospital, region, and insurance, so any figure should be treated as a rough estimate rather than a quote. Without insurance, robotic prostatectomy is often cited in the range of roughly $20,000 to $50,000 in the US, including surgeon, anesthesia, and facility fees; open prostatectomy may be somewhat less expensive on equipment but can involve a longer hospital stay. With commercial insurance, out-of-pocket costs commonly run a few thousand dollars after the deductible, depending on your plan. Medicare covers medically necessary prostatectomy for appropriate diagnoses. Our healthcare costs guide explains how to estimate professional and facility fees and ask about bundled pricing, and the broader medical conditions resource library includes prostate disease background and screening guidance. Confirm all figures with your providers and insurer.
Frequently Asked Questions
Will I be incontinent forever after a prostatectomy?
Most men regain useful urinary control within about 3 to 6 months, with continued improvement up to a year. A minority — often estimated around 5 to 15 percent — have persistent stress incontinence significant enough to consider further treatment. Pelvic floor physical therapy helps recovery for many patients.
Can I still have sex after a prostatectomy?
Often yes, but the experience usually changes. Erectile function recovery depends on age, pre-surgery function, and whether nerves were spared. Orgasm is usually preserved but is dry — no ejaculate is produced because the seminal vesicles are removed. Many men return to satisfying sex with or without medical aids, though timelines and outcomes vary.
How does robotic prostatectomy compare to open surgery?
Robotic surgery generally involves less blood loss, shorter hospital stays, and smaller scars. Cancer control and long-term continence and erectile outcomes appear broadly similar between robotic and open approaches in experienced hands. Surgeon experience tends to matter more than which platform is used.
Will my PSA be undetectable after surgery?
If all cancerous tissue is removed, PSA typically drops to undetectable levels (often defined as less than 0.1 ng/mL) within about 6 to 8 weeks. PSA monitoring continues for years afterward to detect any recurrence early. Your urologist will explain what your results mean.
Who decides whether I need surgery at all?
You do, together with your urologist and oncology team. Surgery, radiation, and active surveillance can all be reasonable depending on your cancer’s risk level, your age, and your health and preferences. A second opinion at a high-volume center is reasonable for any prostate cancer treatment decision.
The Bottom Line
A prostatectomy is a major decision that balances cancer control against meaningful side-effect trade-offs, and it is one option among several. Useful questions for your urologist include why surgery is being recommended over radiation or active surveillance for your cancer profile, the surgeon’s annual case volume, the planned nerve-sparing approach, the post-operative rehabilitation plan, and how outcomes are tracked at the institution. A second opinion at a high-volume cancer center is reasonable for any prostate cancer treatment decision. For related topics, see our medical conditions guide.
This article is general education and is not medical advice or a substitute for professional care. Decisions about prostate cancer treatment — including surgery versus radiation or active surveillance, and the surgical approach used — should be made with your urologist and oncology team based on your specific diagnosis. Cost figures are rough estimates that vary widely; confirm them with your providers and insurer. If you have concerning symptoms after surgery, such as heavy bleeding, fever, or inability to urinate, seek emergency care.
Sources
- American Urological Association / UrologyHealth.org — prostate cancer and prostatectomy patient information
- National Cancer Institute (NCI) — prostate cancer statistics, treatment options, and SEER survival data
- Mayo Clinic — robot-assisted (robotic) prostatectomy overview and procedure length
- Cleveland Clinic and MedlinePlus (U.S. National Library of Medicine) — recovery timelines and patient education