Preparing For Prostate Cancer Surgery: Before, During & After

“My average time is about 80 minutes across the board, so that’s an hour and 20 minutes max,” Dr. Razdan says of the assisted surgery he performs. “We are done with the surgery, they go back to the recovery area, then to their room.

“Four hours later, they’re walking around in the hospital. Overnight stay, next morning, they have breakfast and they’re out of the hospital,” he adds.

Many patients worry about surgery side effects such as incontinence (trouble controlling urine) and erectile dysfunction, but rest assured, most patients regain a high quality of life with time and support.

It’s important to maintain open communication with your care team, follow all postoperative instructions, and attend scheduled follow-ups to ensure the best possible recovery and long-term results.

Preparing For Surgery

A radical prostatectomy is a surgical procedure involving the complete removal of the prostate gland, the seminal vesicles, and, in some cases, the nearby pelvic lymph nodes.

This operation is a cornerstone treatment for patients with localized prostate cancer—typically for those who are younger, in good overall health, and diagnosed at an early stage. The goal is to remove all cancerous tissue and, when possible, achieve a cure. This procedure can be done using various surgical techniques, including traditional open surgery, laparoscopic surgery, or robot-assisted laparoscopic surgery (commonly performed with the da Vinci robotic system).

Preparation for a radical prostatectomy starts weeks before the actual surgery. Your healthcare team will provide detailed instructions, but the general steps typically include:

1. Medical Evaluation and Preoperative Testing: Before surgery, you will undergo a series of evaluations to ensure you are fit for the procedure. This may include blood work, an electrocardiogram (EKG) or chest X-ray if you’re over a certain age or have pre-existing medical conditions, a physical examination and consultation with an anesthesiologist, urine tests to rule out infections, and imaging (such as MRI or CT scans) to assess the extent of the cancer.
2. Medication Review: You’ll need to inform your doctor about all medications and supplements you’re currently taking. Some medications, particularly blood thinners (e.g., aspirin, warfarin, or clopidogrel), may need to be paused to reduce the risk of bleeding during surgery.
3. Bowel Preparation and Fasting: The night before surgery, you may be instructed to undergo bowel preparation — typically a laxative or enema — to clear the bowels and reduce the risk of infection. You’ll also need to avoid eating or drinking for a specific period (usually after midnight) before the surgery.
4. Lifestyle Preparation: If you smoke, you will be advised to stop several weeks before surgery, as smoking can impair healing and increase the risk of complications. You may also be encouraged to maintain a healthy diet and engage in regular physical activity to optimize your surgical outcome and recovery.

How Is The Procedure Performed?

Radical prostatectomy can be performed through several surgical approaches.

The most common methods include:

1. Open Radical Prostatectomy: This traditional approach involves making an incision in the lower abdomen to access and remove the prostate gland. It is effective but associated with a longer recovery time and more blood loss compared to minimally invasive techniques.
2. Laparoscopic Prostatectomy: A laparoscopic approach involves several small incisions in the abdomen through which long instruments and a camera are inserted. The surgeon performs the procedure while viewing the internal structures on a monitor.
3. Robot-Assisted Laparoscopic Prostatectomy (RALP): This is the most commonly used method in the United States and other developed countries. The robotic system provides enhanced precision, 3D visualization, and improved ergonomics for the surgeon. Small incisions are made in the abdomen, and robotic instruments are controlled remotely.

During the surgery the prostate gland and seminal vesicles are carefully dissected away from surrounding tissues, including the bladder and rectum. The urethra is reconnected to the bladder, usually over a Foley catheter to allow healing. Pelvic lymph nodes may be removed if there is a higher risk of cancer spread.

How long the surgery takes varies depending on the technique, but Dr. Razdan explains that many patients undergoing robot-assisted surgery are done in less than two hours.

The entire procedure is performed under general anesthesia.

Coping With Side Effects

As with any major surgery, a radical prostatectomy carries both general and procedure-specific risks and side effects. Here’s what you can expect immediately after surgery:

1. Hospital Recovery: Most patients stay in the hospital for one to two days following surgery. During this time, your care team will monitor your vital signs, manage your pain, and ensure that you are recovering appropriately. You’ll receive instructions on how to care for your surgical site, manage your catheter, and gradually increase your activity level.
2. Foley Catheter: A Foley catheter (a thin tube inserted into the bladder) will be left in place for 7 to 14 days after surgery to allow the urethra to heal. It drains urine from the bladder and is usually removed in a follow-up clinic visit once healing is confirmed.
3. Pain and Discomfort: Pain is typically mild to moderate and well-controlled with oral pain medications. You may also experience abdominal bloating or shoulder discomfort from the gas used during laparoscopic surgery.
4. Fatigue: It’s normal to feel tired for a few weeks post-surgery. Healing takes energy, and it may take time before you regain your full strength.
5. Urinary IncontinenceL A common early side effect is urinary incontinence, or the involuntary leakage of urine. This occurs because the surgery disrupts the muscles and nerves that control urination. In most cases, this improves significantly over time, especially with pelvic floor physical therapy (e.g., Kegel exercises). However, a small percentage of men may have long-term issues requiring further treatment.
6. Erectile Dysfunction: Another common concern after prostatectomy is erectile dysfunction. The nerves responsible for erections run very close to the prostate and may be temporarily or permanently affected during surgery. Nerve-sparing techniques aim to preserve erectile function, particularly in men who were potent prior to surgery. Medications such as sildenafil (Viagra) or tadalafil (Cialis), vacuum devices, or even penile injections may be used in recovery.

“If they have a prior good erectile function and they’re young and you’ve done a good nerve preservation, then they’ve got over a 95% chance that they will be able to resume sexual activity at some point in time, sooner rather than later,” Dr. Razdan explains.

Other possible complications include constipation brought on by medications and a lack of activity and increased risk of blood clots and infection. These risks can often by managed by working closely with your care team.

Post-Surgery: Long-Term Follow-Up Care

After catheter removal, you will have follow-up visits to monitor your recovery. Prostate-specific antigen (PSA) levels are checked periodically; ideally, your PSA should become undetectable after the surgery. Rising PSA levels may indicate residual or recurrent disease and may prompt further evaluation.

Many patients continue improving their urinary and sexual function over the course of several months. If issues persist, additional interventions — such as incontinence surgery or advanced erectile dysfunction therapies — may be discussed.

Questions To Ask Your Doctor

• How should I prepare in the week leading up to surgery?
• What type of surgery will I be getting?
• Will I be able to leave the hospital that day?
• How will I be monitored in the week and month after surgery?

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