If you’ve been diagnosed with prostate cancer, your doctor may have recommended a surgery called a radical prostatectomy. In this form of prostate cancer treatment, a surgeon will remove your entire prostate gland. Prostatectomy is often used as part of a treatment plan for people living with prostate cancer diagnosed at stage 1, 2, or 3 (often written with Roman numerals I, II, and III). For some people, prostatectomy may provide a cure for prostate cancer.

Prostatectomy often comes with possible risks and complications. However, the complications of a prostatectomy aren’t always permanent, and some people won’t experience all of them. Keep reading to find out more about common risks and complications of a prostatectomy.

Deciding if Prostatectomy Is Right for You

Your urologist (a surgeon specializing in the urinary tract) or oncologist (a cancer specialist) will help you weigh the potential benefits of the surgery versus the possible risks and complications so you can make an informed decision about your treatment plan.

Prostatectomy Techniques Have Improved

It’s important to know that modern techniques often result in complications that are less severe than they used to be. If you’ve heard stories from people who underwent a prostatectomy many years ago, their experiences may be different from people undergoing the surgery today.

It’s important to note that your chances of experiencing different complications can vary based on the type of surgery you have. Radical prostatectomy is the most commonly recommended surgery, and several different surgical procedures may be used. Different types of prostatectomy surgery include:

• An open prostatectomy, in which a surgeon cuts into the lower abdomen or perineum (area between the scrotum and anus) in the traditional way
• A laparoscopic prostatectomy, in which the surgeon uses a thin instrument with a tube to remove your prostate
• A robot-assisted prostatectomy, in which the surgeon uses a machine with robotic arms to remove your prostate

Other Treatments May Contribute to Side Effects

Note that treatment options for prostate cancer may include hormone therapy or other types of treatment alongside surgery. Each treatment can have its own side effects, and it may be difficult to figure out which treatment is causing which changes in your body. That’s why it’s important to be open and honest with your oncology team about any side effects you experience and to track when they started and how they affect you. This will give your healthcare team the best possible chance of helping you manage them so you can keep your quality of life high.

Possible Risks or Complications of Prostatectomy

Your healthcare provider can tell you how likely you are to experience a specific complication. Your risk may be high based on your overall health and any issues you’ve experienced before your surgery.

Here are some of the most common complications of prostatectomy.

1. Erectile Dysfunction

Erectile dysfunction, or ED, refers to the inability to get an erection or to keep one long enough to participate in fulfilling sexual activity. Most people who have a prostatectomy are likely to experience erectile dysfunction in the period immediately after their surgery. This may impact their sexual function and quality of life.

There are two small nerve bundles right next to your prostate that control your ability to have an erection. Your surgeon will do their very best not to harm these when they remove your prostate, which is called the nerve-sparing approach. Sometimes, though, you may have prostate cancer that has grown into these nerves or very close to them. In these cases, your doctor may need to remove the nerves along with the prostate.

Some research indicates that a robot-assisted prostatectomy is less likely to result in long-term ED compared with other types of surgery, but more studies are needed to prove this. No matter what kind of surgery you have, you may be able to regain erectile function over time. For some people, it can take a year or two to regain function. There are also many options to help with ED, including medications, penile implants, and vacuum devices.

2. Other Sexual Complications

In addition to erectile dysfunction, you may experience other sexual complications after surgery to remove your prostate. These may or may not change your sexual function and can include:

• Infertility, because the surgery involves cutting the vas deferens, which carries sperm to combine with your semen
• Less intense orgasms
• Pain with orgasm
• Changes in the length of your penis
• Little to no fluid when you ejaculate, known as a dry orgasm

These complications occur if tissue or nerves are damaged during the surgery. In general, the less invasive the surgery, the less likely you are to experience these complications and the less significant they’re likely to be. Depending on the complications you have, your healthcare provider can help you figure out how to manage them.

3. Urinary Dysfunction

You may also experience problems urinating after a prostatectomy. This can show up in different ways. You may have:

• Urine that leaks out after you think you’re done peeing
• Urgent need to urinate even when you don’t really need to
• Blockages in your bladder
• Urinary incontinence or loss of bladder control (urine that overflows and leaks out of your bladder)
• Urgent and frequent need to urinate at night
• Trouble emptying your bladder or taking a long time to get your urine out
• Urine that leaks out when you sneeze, cough, or lift something heavy (stress incontinence)

These issues may develop if surgery damages the muscles or nerves around your bladder. Most people find that they get control of their bladder back eventually, though it can take up to six months of recovery time for that to happen. Once again, you may be less likely to have these complications in a robot-assisted prostatectomy than with other types of prostate cancer surgery.

If urinary problems continue, you might need physical therapy for your bladder or pelvic floor, medications, or another surgery to help fix the issue. Your urologist can help you find the best treatment for your needs.

4. Inguinal Hernia

Some people experience a painful and uncomfortable condition called inguinal hernia after a prostatectomy. An inguinal hernia can develop when an area in your groin becomes weak and fatty tissue or part of your intestine pushes through it. This condition is more common in people who have had a prostatectomy because the surgery can damage the parts of the abdominal wall that normally hold fatty tissue and intestines inside.

Some studies show that the risk of this kind of hernia is the same regardless of the type of surgery you have, while others show that it’s more common with open prostatectomy versus laparoscopic or robotic surgery options. Your doctor can help you assess your level of risk. They can also help you decide if you need surgery to treat a hernia or if you can wear supportive garments to help avoid symptoms and prevent it from worsening.

5. Lymphedema

If your oncologist removes lymph nodes during your prostatectomy, you may experience a type of swelling in your abdomen or legs called lymphedema. If you no longer have enough lymph nodes to effectively remove lymph fluid, it can build up. Eventually, so much fluid can build up that it causes pain and makes your abdomen or groin area look swollen. The fluid may also drain down into one or both of your legs, making them swell, too. Your doctor may recommend medication, teach you how to manually help your body drain the fluid, or suggest another surgery to fix the situation.

6. Pain

Pain is another possible complication of a prostatectomy. While this doesn’t usually last longer than six months after the surgery, complications like inguinal hernia or lymphedema can make it last longer. Pain during orgasms or ejaculation may also occur, as well as pain during urination. Be open with your cancer care team about pain, and they can help you find ways to manage it.

If you have pain that lasts longer than six months or pain that continuously increases in severity, you should talk to your doctor about looking for unrelated causes. Robot-assisted surgeries are less likely to cause pain, though you will likely still need painkillers for a while after the procedure.

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On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.

Which complications of prostatectomy have affected you the most? Did you find effective ways to deal with them? Let others know in the comments below.