Radical Prostatectomy (Robotic): Surgery, Recovery and Side Effects

🔵What is a radical prostatectomy?

A radical prostatectomy is surgery to remove the whole prostate and the seminal vesicles, sometimes with nearby lymph nodes; the bladder is then re-joined to the urethra. According to the NHS, it also means you cannot father children through sex. See our prostate cancer guide.

2Who it may suit: surgery, active surveillance or radiotherapy

According to Prostate Cancer UK, surgery may be offered when the cancer has not spread outside the prostate and you are generally fit and healthy, and it may be an option for some men with locally advanced cancer. Heart, lung or bowel problems or previous major abdominal surgery may rule it out.

• Active surveillance: regular tests and scans instead of immediate treatment, suggested by the NHS for small cancers without symptoms. NICE says people with the lowest-risk localised cancer (Cambridge Prognostic Group 1) who could have radical treatment should be offered active surveillance first, to avoid overtreatment.
• Radical radiotherapy: NICE lists surgery and radiotherapy as the alternatives when surveillance is not suitable or acceptable. The NHS says radiotherapy treats cancer that has not spread very far.

The choice depends on the risk group, including the Gleason score, your health and priorities. Cancer that has spread further is covered in advanced prostate cancer.

🔬How the cancer is diagnosed and assessed before surgery

According to the NHS, men referred to a specialist usually have a prostate MRI scan first, which gives a clearer view of the prostate. If more information is needed, a biopsy takes small tissue samples with a needle to look for cancer cells. After a diagnosis, CT, MRI, PET or bone scans may be used to help the team decide on treatment. With the PSA level and tumour grade, these results show whether surgery is a reasonable option.

4Open, keyhole and robotic surgery compared

Prostate Cancer UK states that all three approaches give similar results and similar rates of side effects. A 2017 Cochrane review (two randomised trials, 446 men, short-term data) found little or no difference in urinary and sexual quality of life, a probably shorter hospital stay with robotic surgery and possibly fewer blood transfusions with keyhole or robotic surgery, but no high-quality evidence on long-term cancer outcomes.

5Preparation, the operation and the hospital stay

A pre-assessment visit checks your health and medicines; tell the team about blood thinners and follow their instructions. The Aneurin Bevan University Health Board leaflet advises starting pelvic floor exercises before surgery. The operation is done under general anaesthetic, and where the cancer allows, the surgeon tries to spare the nerves that help with erections (nerve-sparing surgery).

According to Prostate Cancer UK, the hospital stay is usually one to five days, and Cancer Research UK says most people go home one day after robotic surgery.

6Catheter and recovery at home

Most men go home with a urinary catheter, which according to Prostate Cancer UK is usually removed at the hospital after one to three weeks. Never remove the catheter yourself. Prostate Cancer UK advises avoiding heavy lifting or manual work for eight weeks. Your team will advise on driving, work and sex.

7Bladder control and erections after surgery

Urine leakage: according to Prostate Cancer UK, most men cannot fully control their bladder when the catheter first comes out, and leakage usually improves within one to six months, although some men leak for a year or more. The Aneurin Bevan leaflet states that about 1 in 20 to 1 in 33 men still leak after a year. Pelvic floor exercises are central; see urinary incontinence.

Erections: Prostate Cancer UK says most men find it hard to get an erection strong enough for sex at first, and recovery can take a few months to a few years; some men always need treatment. Orgasm is still possible, but without semen. Options are discussed in our guide to erectile dysfunction, and treatment is chosen by your doctor.

⏰Follow-up PSA and when to seek urgent care

After the prostate is removed, PSA should become almost undetectable: Prostate Cancer UK says it should fall below 0.1 ng/ml, with check-ups usually starting six to eight weeks after surgery. A later rise may need further tests or treatment.

Contact your team promptly, or seek emergency care, if you have:

• a catheter that stops draining, leaks heavily or falls out, or a painfully full bladder
• sudden, painful inability to pass urine, for example after the catheter is removed (Prostate Cancer UK advises going to A&E)
• a fever above 38°C (the threshold given by Prostate Cancer UK), chills, or a red, swollen or oozing wound
• blood clots in the urine
• pain or swelling in the lower leg, which Prostate Cancer UK notes can be a blood clot; call an ambulance for chest pain or sudden breathlessness, as a clot can travel to the lungs
• persistent vomiting or tummy pain, or no bowel movement despite a laxative

❓Frequently asked questions

10Sources

1. Treatment for prostate cancer – NHS
2. Tests and next steps for prostate cancer – NHS
3. Quality statement 2: Treatment options (Prostate cancer, QS91) – NICE
4. Surgery: radical prostatectomy – Prostate Cancer UK
5. Surgery to remove prostate cancer – Cancer Research UK
6. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer – Cochrane Database of Systematic Reviews (2017)
7. Robotic Assisted Radical Prostatectomy – patient information leaflet, Aneurin Bevan University Health Board (Royal Gwent Hospital urology)