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Surgery can play an important role in treating prostate cancer. If the cancer hasn’t metastasized (spread outside the prostate), surgery may eliminate the cancer and offer the possibility of a cure. When prostate cancer has spread beyond the prostate, surgery may sometimes be used as part of palliative care (treatment that focuses on relieving symptoms and improving quality of life). However, prostatectomy (surgery to remove the prostate) can also cause side effects.
There are several different types of surgery for prostate cancer. In this article, we’ll describe the six main surgical techniques, how they differ, and when each one may be recommended. We’ll also explain what to expect during recovery and discuss common side effects. Learning about these options can help you have more informed conversations with your doctor and feel confident when discussing your prostate cancer treatment options.
A radical prostatectomy is one of the most common surgeries used to treat prostate cancer. It involves removing the entire prostate gland to get rid of the cancer. The seminal vesicles, which help make semen, are also removed. In some cases, nearby lymph nodes — small organs that are part of the immune system — are removed at the same time to check whether cancer cells have spread. This is called a pelvic lymph node dissection.
Radical prostatectomy is most often recommended for people with localized prostate cancer (stages 1 and 2), meaning the cancer is still contained within the prostate. Many people have no evidence of cancer after this surgery and may remain cancer-free for many years.
In some higher-risk cases, doctors may suggest prostatectomy if they believe the cancer can still be controlled with surgery. Sometimes, radiation therapy is recommended after surgery to lower the chance of the recurrence (cancer returning).
A radical prostatectomy is performed by a urologist, a doctor who specializes in treating conditions that affect the urinary tract and the reproductive system.
You’ll be under general anesthesia during the procedure, which means you’ll be asleep and won’t feel anything. The surgery usually takes between two to four hours, depending on the specific surgical approach. The surgeon carefully separates the prostate from nearby structures, including the urethra (the tube that carries urine out of your body).
After removing the prostate, the surgeon reconnects the bladder to the urethra. A catheter (a thin, flexible tube) is placed to help drain urine while you heal. Most people are able to go home one to three days after surgery.
As with all major surgeries, a radical prostatectomy can cause side effects. Most people experience at least some short-term changes while their body heals. The most common side effects include:
These side effects may occur after open surgery, robot-assisted laparoscopic radical prostatectomy (RALP), or laparoscopic radical prostatectomy. However, recovery time and severity can vary from person to person. Your doctor will monitor you closely after your procedure to catch any problems early.
RALP is now the most common way to remove the prostate in the United States. During RALP, the surgeon performs the procedure using robotic arms, often through a system known as the da Vinci robot. The robot doesn’t make decisions on its own. Instead, it allows the surgeon to make very precise movements while controlling the instruments.
RALP is considered a minimally invasive surgery because it is performed through several small incisions (cuts) in the lower abdomen. A tiny camera provides the surgeon with a clear, magnified view of the prostate gland and nearby nerves.
Compared with open surgery, RALP is often associated with less blood loss, a shorter hospital stay, and a quicker recovery. Many surgeons also use nerve-sparing techniques to help protect urinary control and reduce the risk of erectile dysfunction.
A laparoscopic radical prostatectomy is similar to robot-assisted surgery but does not use a robotic system. Instead, the surgeon operates directly using surgical laparoscopic tools and a camera, while watching the procedure on a video screen. As with robotic surgery, the prostate is removed through several small incisions in the lower abdomen.
Laparoscopic prostatectomy was more common before robotic surgery became widely available, but it is still performed in some places. While outcomes can be very good with this approach, recent studies suggest that RALP may lead to faster recovery and improved overall results for many people.
Open radical prostatectomy is the traditional form of prostate cancer surgery. In this procedure, the surgeon makes one large incision in the lower abdomen. This approach allows the surgeon to see and reach the prostate gland directly using standard surgical instruments.
Open surgery is generally associated with a higher risk of blood loss, more discomfort after surgery, and a longer recovery period compared to minimally invasive techniques such as robotic or laparoscopic surgery. However, open prostatectomy can still be very effective, especially when performed by an experienced urologist.
There are two main approaches for open radical prostatectomy: retropubic and perineal.
A retropubic prostatectomy is the most common type of open surgery for prostate cancer. The surgeon makes an incision in the lower abdomen, just behind the pubic bone, to remove the entire prostate gland. This approach also allows the surgeon to more easily check and remove nearby lymph nodes if necessary.
A perineal prostatectomy is performed through an incision in the perineum, the area between the scrotum and the anus. This method often results in less pain after surgery and a quicker recovery compared to the retropubic approach. However, it makes lymph node removal more challenging, so it is used less often today.
A transurethral resection of the prostate (TURP) is not used to treat prostate cancer itself. Instead, it may be performed in people with prostate cancer to relieve urinary symptoms caused by a blockage in the prostate. During the procedure, a thin surgical instrument is inserted through the urethra, and small pieces of the prostate are removed to improve urine flow.
TURP is most often used to treat benign prostatic hyperplasia (BPH), which is a noncancerous enlargement of the prostate. For people with prostate cancer, TURP may be recommended if the enlarged prostate is blocking urine and causing discomfort, especially if major surgery is not an option.
Possible risks of TURP include bleeding, infection, temporary urinary control problems, and changes in ejaculation.
A cystoprostatectomy is a surgery to remove both the prostate gland and the bladder. This is a more extensive procedure that may be considered for people with locally advanced prostate cancer (stage 3). In this stage, the cancer has grown beyond the prostate and may affect nearby organs, but has not spread to distant parts of the body. Cystoprostatectomy is much less common than other prostate cancer surgeries and is only recommended in select cases.
Compared with other prostate cancer surgeries, cystoprostatectomy is more complex and involves a longer recovery. Today, it may be done using minimally invasive or robotic surgery as well. In some cases, nerve-sparing techniques are used to help preserve sensation and sexual function. It may be considered when other treatments are unlikely to be effective.
Recovery after any prostate cancer surgery will take some time, and it may look a little different for each person. Most people spend one to three days in the hospital and go home with a catheter for a few weeks.
Recovery is often faster after RALP or laparoscopic surgery because the smaller incisions don’t cause as much pain as the open approach. Meanwhile, open surgery may involve more pain and a longer healing period. For both types, urinary control and sexual function may improve slowly over several months.
Depending on details about your prostate cancer, surgery may be just one part of a treatment plan that includes:
Your treatment plan for prostate cancer should be a shared decision between you and your cancer care team. To get the best treatment for prostate cancer, be an active participant in your care and share your preferences, goals, questions, and concerns with your doctor. Their role is to provide information about the potential risks and benefits of each treatment option, take your input into account, and recommend the path they think is most likely to be effective for you. In the end, your care team can help guide you, but you have the final say in which treatments to pursue.
On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.
Have you had surgery for prostate cancer? What was your experience like? Let others know in the comments below.
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