Prostatectomy: What to expect

Many prostate cancer patients don’t need surgery. But for young patients with prostate cancer that hasn’t spread, a surgery called a prostatectomy can help them become cancer-free and put prostate cancer treatment behind them. John Davis, M.D., a urologist who performs hundreds of prostatectomies each year, explains what patients undergoing this procedure can expect, including prostatectomy side effects and risks.

What is a prostatectomy?

A prostatectomy is the surgical removal of all or part of the prostate gland. Prostate cancer surgery types include:

• Robotic prostate cancer surgery: In this procedure, called robotic radical prostatectomy, a surgeon makes several small incisions in the lower abdomen and uses a robotic device to remove the prostate.
• Open radical prostatectomy: The surgeon makes one large incision in the lower abdomen to remove the prostate.

Robotic radical prostatectomies have become increasingly common over the years, and most surgeons prefer to conduct the procedure this way because it’s a little easier on them. But it’s important to know that both methods are safe.

At MD Anderson, we have nine urologists who are experts at performing robotic prostatectomies, and together, they conduct 800 to 900 prostatectomies a year. A few years ago, we were one of the first cancer centers to use a new tool called a single port robot to perform prostatectomies. This made the procedure a bit easier on patients because it only requires one small incision and allows them to recover a bit faster.

Who needs a prostatectomy?

Prostatectomies are common and safe, but like most cancer surgeries, they do have some risks and side effects, so we don’t recommended them for all patients. Prostatectomies are typically performed on otherwise healthy patients younger than 75 years old who have localized cancer, or cancer that hasn’t spread. Prostatectomies are most likely to be curative for these patients, meaning that the patient will be cancer-free after surgery.

For some patients, prostatectomies will be the only treatment they undergo. Others who may have a difficult time recovering from surgery or have more advanced cancer may also have chemotherapy or hormone therapy treatment as well. 

How long does it take to recover from a prostatectomy?

The procedure itself usually takes about two to five hours, and most patients go home the day after surgery. For patients who travel from out of town to MD Anderson for surgery, they can typically leave Houston after a week. Patients can go back to work at a desk job after about two weeks, and they’ll start to feel fully recovered anywhere from six to 12 weeks after surgery.

What side effects do patients experience following prostate removal?

Common prostatectomy side effects include:

• Urinary incontinence: Patients may experience trouble controlling their bladder. Bladder control typically returns slowly over time following surgery and fully returns within several weeks. Large cancer centers that perform high volumes of prostatectomies like MD Anderson report fewer problems with incontinence and can surgically correct it if it does continue.
• Erectile dysfunction: Surgeons can often rely on nerve-sparing techniques that lower the chances that a patient will experience erectile dysfunction. The chances of developing this side effect differ from patient to patient and increase with age, but many treatments and medication are available.
• Loss of fertility: A radical prostatectomy cuts the pathway between the testicle and the urethra so sperm can no longer leave the body. Patients concerned with this should ask their doctors about sperm banking.
• Lymphedema: Lymphedema occurs when lymph nodes are removed and fluid that once relied on them to move through the body start to build up, causing swelling. This is a rare complication, but when it does occur it can be treated with physical therapy.   

What complications are associated with a prostatectomy?

The risks associated with a prostatectomy are the same as many other major surgeries: reactions to anesthesia, blood clots or bleeding from surgery. These risks are unlikely and are far less likely to result with a more experienced surgeon.

What advice do you have for patients preparing for a prostatectomy?

Fortunately, prostate cancer patients who require surgery don’t need to have their prostatectomy right away. They can usually delay it a month or two. This gives them the advantage of having the surgery when it’s right for them and allows them to take the time to find the best care team.

I recommend finding a surgeon who you're comfortable discussing all the potential side effects with, who performs a high number of prostatectomies. High volumes means better results.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.