Prostate cancer is the second most common cancer among American men, and 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 for either cancer (radical prostatectomy) or benign enlargement causing severe urinary symptoms (simple prostatectomy). The procedure has changed substantially in 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.
What a Prostatectomy Is and Who Needs 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 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 life expectancy of at least 10 years, and acceptable surgical risk. Active surveillance, radiation, and focal therapies are alternatives discussed below.
How the Procedure Is Performed
Most radical prostatectomies in the US are now done with robotic-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 2 to 4 hours under general anesthesia.
The surgeon dissects around the prostate, attempting to spare the neurovascular bundles when oncologically appropriate (this affects erectile function). The bladder is reconnected to the urethra over a catheter, which stays in for 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 an option at some centers. 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.
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 schedule. Some surgeons recommend pelvic floor exercises (Kegels) starting weeks before surgery to speed urinary continence recovery.
You will arrive several hours before the procedure, fasting 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 2 to 3 nights after open prostatectomy. Walking begins within hours to reduce blood clot risk.
Recovery Timeline
Most men return to desk work 2 to 4 weeks after robotic prostatectomy, with open surgery taking 6 to 8 weeks. According to Cleveland Clinic, the catheter is removed at a follow-up visit at 7 to 14 days, after which urinary control gradually returns over weeks to months.
Pelvic floor rehabilitation starts after catheter removal. Most men regain useful continence within 3 to 6 months, with continued improvement up to 12 months. Erectile function recovery is slower and depends on age, baseline function, and whether nerves were spared. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil) are often prescribed early to support nerve recovery.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience heavy bleeding, fever above 101 degrees Fahrenheit, severe abdominal pain, calf pain or swelling, sudden shortness of breath, inability to urinate after catheter removal, or signs of severe urinary tract infection such as flank pain with fever.
Risks, Side Effects, and Outcomes
Beyond surgical risks (bleeding, infection, blood clots, injury to nearby structures), prostatectomy carries two functional side effects that warrant discussion:
Urinary incontinence is common immediately after catheter removal, and most men regain control within 6 to 12 months. Roughly 5 to 15 percent have persistent stress incontinence requiring additional intervention. Erectile dysfunction is also common; even with bilateral nerve sparing, fewer than half of men return to pre-surgery erection quality, with rates depending on age, baseline function, and surgeon experience. Other potential effects include shortened penis length, dry orgasm (no ejaculate), infertility, and pelvic floor pain.
Cancer outcomes for localized disease are generally good. The National Cancer Institute reports 5-year relative survival above 99 percent for localized prostate cancer treated with surgery or radiation.
Alternatives and Active Surveillance
Surgery is not the only option for prostate cancer. Active surveillance — close monitoring without immediate treatment — is appropriate for many low-risk cancers and avoids treatment side effects. Radiation therapy (external beam or brachytherapy) achieves similar cancer control for many patients. Focal therapies such as cryotherapy or HIFU treat only part of the prostate. Hormone therapy is used for advanced disease.
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 these with a urologist who treats high volumes of prostate disease helps clarify which path fits a particular cancer profile and life situation.
Cost Considerations
Without insurance, robotic prostatectomy typically costs $20,000 to $50,000 in the US, including surgeon, anesthesia, and facility fees. Open prostatectomy is often slightly less expensive due to lower equipment costs but requires longer hospital stay. With commercial insurance, out-of-pocket costs typically run $2,000 to $7,000 after deductible. Medicare covers prostatectomy for appropriate diagnoses. Our healthcare costs guide covers how to estimate professional and facility fees and ask about bundled payment options. The broader medical conditions resource library includes prostate disease background and screening guidance.
Frequently Asked Questions
Will I be incontinent forever after a prostatectomy?
Most men regain useful urinary control within 3 to 6 months, with continued improvement up to a year. Roughly 5 to 15 percent have persistent stress incontinence severe enough to consider further treatment. Pelvic floor physical therapy speeds recovery for most patients.
Can I still have sex after a prostatectomy?
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 eventually return to satisfying sex with or without medical aids.
How does robotic prostatectomy compare to open surgery?
Robotic surgery generally has less blood loss, shorter hospital stays, and smaller scars. Cancer control and long-term continence and erectile function outcomes appear similar between robotic and open approaches in experienced hands. Surgeon experience matters more than which platform is used.
Will my PSA be undetectable after surgery?
If all cancerous tissue is removed, PSA should drop to undetectable levels (typically less than 0.1 ng/mL) within 6 to 8 weeks. PSA monitoring continues for years to detect any recurrence early.
The Bottom Line
A prostatectomy is a major decision with both cancer-control benefits and meaningful side-effect tradeoffs. Useful conversations with your urologist include why surgery is being recommended over radiation or active surveillance for your cancer profile, your surgeon’s annual case volume, expected nerve-sparing approach, 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.