Radical prostatectomy for prostate cancer: surgery explained, with side effects and recovery

The NHS describes surgery for prostate cancer as removing the prostate gland. It is generally considered for men whose cancer is thought to be contained within the gland, who are fit enough for a general anaesthetic and who are expected to live long enough to benefit. Some cancers grow so slowly that treatment would cause side effects without adding life; for those, active surveillance with regular tests and scans is a standard approach.

Surgery is less suitable when cancer has clearly spread beyond the prostate, when other illness makes an anaesthetic risky, or when a man would rather avoid the likely effects on continence and erections. Your multidisciplinary team recommends options after MRI, biopsy and sometimes other scans, and you are entitled to ask for the pros and cons of each in writing.

Trust leaflets list the alternatives as active surveillance, open surgery, external beam radiotherapy, brachytherapy, standard keyhole surgery, high-intensity focused ultrasound and cryotherapy, though not every one is suitable or available for every man. The NHS highlights active surveillance and radiotherapy as the main alternatives.

Radiotherapy, sometimes with hormone treatment, is as established as surgery for localised disease and avoids an operation, but has its own bowel and bladder effects. A key point is that having one treatment can limit the options later, so many men see both a surgeon and an oncologist before deciding.

A pre-assessment visit usually includes blood tests, a heart tracing and questions about medicines and heart or lung disease. You will be told when to stop eating and drinking, and which tablets to pause. Most men are admitted on the morning of surgery.

Pelvic floor exercises are taught before surgery in some units, and one trust describes doing them three times each day. Stopping smoking, improving fitness and tackling constipation beforehand are sensible. Think about practical matters too: who will take you home, help with the catheter bag, and what you will tell your employer.

Most radical prostatectomies in UK hospitals are done by keyhole surgery with a robotic system. A trust leaflet describes six small cuts for the instruments. The surgeon sits at a console and controls the arms, removing the prostate and seminal vesicles and joining the bladder neck to the urethra. A catheter is placed, and a small drain may be used for a day.

Where possible, nerve bundles beside the prostate are saved on one or both sides to protect erections. This depends on how close the cancer is to the nerves and cannot always be done safely. Some hospitals still offer open or standard laparoscopic surgery. Lymph glands may be removed for testing if the risk of spread is higher.

You wake with a catheter and possibly a drain, and you are encouraged to walk the same day or next. A trust leaflet says most men are discharged the day after robotic surgery. You are taught how to manage the bag at home, and some hospitals give leg bags and overnight bags.

The catheter acts like a splint while the join heals. Leaflets give removal after about a week at one hospital and at least 7 days and usually 10 to 14 days at another. Once it is out, leakage is expected at first and eases with pelvic floor exercises. A trust leaflet describes nights dry within about two weeks for most, and full control over about three to six months, while another says a third are dry straight away, a third within three months, and almost all within a year. These are trust descriptions, so do not take them as a promise.

Leakage of urine and erection problems are the most common effects and are described in trust leaflets as affecting more than 1 in 10 men. Erections can take a long time to recover, up to 12 to 18 months for nerves to regrow and sometimes up to 24 months, and treatments such as tablets or injections can help. Semen is no longer produced, so orgasm is dry, and some men notice a change in how it feels.

Less often there is scarring at the bladder-urethra join, pain in the perineum, a leak from the join, infection, hernia, constipation or scrotal swelling. Rare risks include injury to the bowel or ureter, blood clots, and severe long-term incontinence. Cancer may also be found outside the gland on the final report, which can mean further treatment.

Ring your hospital nurse team if the catheter stops draining, you have lower tummy swelling or pain, cloudy or foul-smelling urine, a fever, or wound problems. Go to A&E or call 999 for chest pain, breathlessness, a swollen painful leg, or heavy bleeding.

Questions to ask: How many of these operations does my surgeon perform each year? Is nerve-sparing possible for me? What continence and erection results do they record? What follow-up PSA schedule will I have? Surgical technique is similar in both sectors. Private care may allow earlier surgery and a named surgeon, while NHS cancer pathways follow national timeframes, and you should compare outcomes and not just waiting time.