Prostate removal for cancer (Radical prostatectomy)

An operation to remove the whole prostate gland to treat prostate cancer that is contained within, or close to, the prostate.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It removes the whole prostate to treat prostate cancer thought to be contained within or near the gland.
It is not the only treatment: active surveillance and radiotherapy are real alternatives that a specialist (MDT) team should discuss with you.
Two common, lasting effects are some leaking of urine and difficulty with erections; you will also no longer father children naturally.
Surgery removes the prostate but does not guarantee a cure — your PSA blood test is checked regularly afterwards to watch for any cancer left behind or returning.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeMajor cancer operation

AnaestheticGeneral anaesthetic (sometimes with a spinal)

How long it takesAbout 2–3 hours

Hospital stayUsually 1–4 nights in hospital

Time off workOften 4–6 weeks, longer for heavy work

When you'll see resultsA catheter for 1–2 weeks; first PSA blood test at about 6–8 weeks

On the NHS?Widely available on the NHS as one of the main treatments for localised prostate cancer

A general guide. Your surgeon will give you advice for your situation.

Best fit

Removes the prostate and the cancer within it in one treatment

Pause if

The cancer has spread well beyond the prostate, where surgery alone is unlikely to control it and other treatments may be better.

Main recovery point

You will have a catheter and possibly a drain. You will be helped to move early to reduce clot risk, and given pain relief. Most people go home within one...

Good aftercare

A named contact (often a specialist nurse) for catheter and recovery problems.

First few days (in hospital)

You will have a catheter and possibly a drain. You will be helped to move early to reduce clot risk, and given...

Week 1–2 (catheter in)

You manage the catheter at home. Expect bruising and swelling, and to feel tired. Stitches or clips are usually...

After the catheter comes out

Most men leak some urine at first and need pads. Keep doing pelvic floor exercises. Leakage usually improves...

Weeks 4–6

Many people return to lighter work and gentle activity, avoiding heavy lifting. Your first PSA blood test is...

Medical line illustration of prostate biopsy needle pathway for Prostate removal for cancer. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is a radical prostatectomy?

A radical prostatectomy is an operation to remove the entire prostate gland, the seminal vesicles next to it, and sometimes nearby lymph nodes. The bladder is then re-joined to the urethra (the tube that carries urine out). It is one of the main treatments for prostate cancer that is thought to be contained within, or close to, the prostate.

The aim is to remove all of the cancer while trying to protect the muscles that control urine and, where possible, the delicate nerves that allow erections. These nerves sit like a cobweb over the surface of the prostate, so they cannot always be saved — it depends on where the cancer is.

Surgery is not the only option, and it is not automatically the best one. For many men with low-risk, slow-growing prostate cancer, careful monitoring (active surveillance) or radiotherapy may be just as sensible, with a different pattern of side effects. The right choice should come from a specialist team discussion, not from a single opinion.

It is important to be honest that surgery removes the prostate but cannot promise a cure. Whether the cancer is fully cleared depends on the type of cancer, how far it has grown, and the findings once the prostate is examined under the microscope.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Robotic-assisted (keyhole) prostatectomy

The surgeon controls fine instruments through small cuts using a robotic system. This is now the most common approach in the UK and usually means less bleeding and a shorter hospital stay than open surgery.

Laparoscopic (keyhole) prostatectomy

A keyhole operation done with long instruments through small cuts, without the robotic system. The recovery is broadly similar to robotic surgery.

Open radical prostatectomy

The prostate is removed through one larger cut in the lower tummy (retropubic) or between the scrotum and back passage (perineal). Now used less often, but still appropriate in some cases.

Nerve-sparing prostatectomy

Where the cancer allows, the surgeon tries to preserve the erection nerves that lie against the prostate. It is not always possible, and even when nerves are spared, erections can take many months to recover and may not fully return.

With lymph node removal (lymphadenectomy)

If there is a risk the cancer has spread, nearby pelvic lymph nodes may be removed and examined to help understand the stage of the cancer.

Main options for localised prostate cancer

Option	What it involves	Key trade-off
Active surveillance	Regular PSA tests, scans and biopsies; treat only if it progresses	Avoids/delays side effects, but means living with monitored cancer
Surgery (prostatectomy)	Operation to remove the prostate	Risk of urine leakage and erection problems; one-off recovery
Radiotherapy	External beam or implanted seeds over a course of treatment	Avoids an operation; bowel, urinary and erection effects can appear later

There is no single right answer. The best option depends on your cancer, age, health and what matters to you, and should be decided with a specialist team.

Preparing for your surgery

Make sure your treatment options (surgery, radiotherapy, active surveillance) have been discussed by a specialist team (MDT), so you are choosing, not just consenting.
Meet the operating surgeon and ask about their personal results and how often they do this operation.
Tell the team about all medicines, especially blood thinners (warfarin, aspirin, clopidogrel, rivaroxaban), and any pacemaker, joint replacement or heart valve.
Start pelvic floor exercises before surgery if advised, as this may help bladder control afterwards.
Stop smoking if you can — it makes complications and slow healing more likely.
Plan for a catheter at home for 1–2 weeks, and arrange help, time off work and a lift home.
Discuss erections and fertility before surgery, including sperm storage if you may want children in the future.

What happens

The operation is usually done under general anaesthetic and takes about two to three hours. You are given antibiotics and measures to prevent blood clots, such as stockings and a blood-thinning injection.

The surgeon frees the prostate from the bladder and urethra and removes it along with the seminal vesicles, trying to spare the muscles that control urine and, where possible, the erection nerves. The bladder is then stitched back onto the urethra, and a catheter is placed to drain urine while this join heals.

A small drain may be left near the area for a day or two. Most people stay in hospital for one to four nights. The removed prostate is examined under the microscope, and the findings are discussed at a team (MDT) meeting to plan any further care.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

The cancer has spread well beyond the prostate, where surgery alone is unlikely to control it and other treatments may be better.
You are not fit enough for a general anaesthetic and a major operation.
Your cancer is low-risk and slow-growing, where active surveillance may spare you side effects you do not need.
Severe existing erection or continence problems mean surgery is likely to make daily life harder without clear cancer benefit.

Delay surgery if…

Your treatment options have not yet been discussed by a specialist (MDT) team.
You have an active infection, including a urine infection, that needs treating first.
Blood-thinning medicines need to be safely managed or paused around surgery.
You want children and have not yet had the chance to store sperm.
You feel rushed and have not had time to weigh surgery against radiotherapy and surveillance.

Alternatives to discuss

Active surveillance — close monitoring with PSA, scans and biopsies, treating only if the cancer progresses.
External beam radiotherapy, often with hormone treatment for higher-risk cancer.
Permanent seed brachytherapy (radioactive implants) in selected cases.
Focal treatments such as HIFU or cryotherapy in specialist centres, usually within trials.
Watchful waiting for older men or those with other serious illness, focusing on symptom control.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

The usual choice; you are fully asleep for the operation.

Spinal anaesthetic (in addition)

Sometimes combined with a general anaesthetic to help with pain relief; your anaesthetist will advise.

Benefits

Removes the prostate and the cancer within it in one treatment
Lets the cancer be examined under the microscope, giving accurate staging and margin information
May avoid the need for further treatment if the cancer is fully contained and removed
Gives a clear PSA target afterwards (it should fall very low), making it easier to spot any cancer that returns
Radiotherapy usually remains available later if it is needed

Risks & complications

More common

No longer producing semen at orgasm, so you cannot father children naturally
Difficulty getting or keeping erections, which can be long-lasting or permanent
Some leaking of urine, especially in the first weeks to months after the catheter comes out
Some shortening of the penis
Tiredness, bruising and discomfort while you recover

Less common

Leaking of urine lasting beyond a year, sometimes needing further surgery such as a sling or artificial sphincter
Cancer found at the edge of the removed prostate (positive margin), which may need monitoring or further treatment
Bleeding needing a blood transfusion or another operation
Wound pain, infection or a hernia at the incision
A collection of lymph fluid (lymphocele) if lymph nodes were removed

Rare but serious

Injury to the back passage (rectum), occasionally needing a temporary colostomy
Blood clots in the legs or lungs, chest infection, heart or stroke problems
Nerve pressure injury from the position during surgery
Narrowing of the join between bladder and urethra, making passing urine difficult

The two effects to weigh most carefully are urine leakage and erection problems, because they can be lasting and have a big impact on daily life. How likely they are depends on your age, your erections and continence before surgery, the cancer, and your surgeon's experience. Ask your surgeon for their own incontinence and erection-recovery results, and how they will support you if these problems happen.

Published figures to discuss

Outcomes vary a lot between men and between surgeons, and depend on age, the cancer, and continence and erections beforehand. The figures below come from UK patient information and reviews and are best read as general guidance, not a personal prediction. Your surgeon's own results matter, so it is reasonable to ask for them.

Figure	Reported range	How to interpret it	Source / confidence
Lasting urinary incontinence needing further surgery	Around 3–5% (about 1 in 20 to 1 in 33)	BAUS figure for leakage that persists beyond a year and may need a sling or artificial sphincter; milder, improving leakage is much more common early on.	Incontinence and erectile dysfunction after radical prostatectomy — PMC reviewpmc.ncbi.nlm.nih.govPublished figure
Positive surgical margin (cancer at the cut edge)	Roughly 1 in 10 to 1 in 50 in BAUS patient information	May lead to closer monitoring or further treatment; more likely with more advanced cancer.	Incontinence and erectile dysfunction after radical prostatectomy — PMC reviewpmc.ncbi.nlm.nih.govPublished figure
Bleeding needing transfusion or further surgery	Roughly 1 in 10 to 1 in 50 (BAUS)	Generally less with keyhole/robotic surgery than open surgery.	Incontinence and erectile dysfunction after radical prostatectomy — PMC reviewpmc.ncbi.nlm.nih.govPublished figure
Rectal injury	Roughly 1 in 50 to 1 in 250 (BAUS)	Uncommon but serious; may need a temporary colostomy to allow healing.	Incontinence and erectile dysfunction after radical prostatectomy — PMC reviewpmc.ncbi.nlm.nih.govPublished figure
Erectile dysfunction	Common; 'almost all' if nerves cannot be spared (BAUS)	Even with nerve-sparing, recovery is slow and may be incomplete; depends heavily on age and erections beforehand.	Incontinence and erectile dysfunction after radical prostatectomy — PMC reviewpmc.ncbi.nlm.nih.govSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from prostate removal happens in stages. The catheter and early soreness come first, then bladder control gradually improves over weeks to months, while erection recovery (if nerves were spared) can take much longer.

First few days (in hospital)

You will have a catheter and possibly a drain. You will be helped to move early to reduce clot risk, and given pain relief. Most people go home within one to four days.

Week 1–2 (catheter in)

You manage the catheter at home. Expect bruising and swelling, and to feel tired. Stitches or clips are usually removed at about 7–10 days, and the catheter typically comes out at around 1–2 weeks.

After the catheter comes out

Most men leak some urine at first and need pads. Keep doing pelvic floor exercises. Leakage usually improves steadily over the following weeks and months.

Weeks 4–6

Many people return to lighter work and gentle activity, avoiding heavy lifting. Your first PSA blood test is usually at about 6–8 weeks.

3–12 months

Bladder control continues to improve for most men. Erection recovery, where nerves were spared, is slow and may continue improving over a year or more, often with help from medicines or other treatments.

What's normal — and not a worry

Leaking urine when you cough, stand or move in the first weeks after the catheter is removed
Tiredness and reduced energy for several weeks
Bruising and swelling around the cuts and the scrotum
Erections being absent or weaker at first, even when nerves were spared
A 'dry' orgasm with no semen, which is expected after this operation

Aftercare

Look after your catheter as shown, and know who to call if it blocks or falls out.
Do your pelvic floor exercises regularly to help bladder control return.
Use continence pads as needed and don't be discouraged by early leakage.
Avoid heavy lifting and strenuous activity in the first weeks, as advised.
Take any prescribed blood-thinning injections to prevent clots for as long as advised.
Drink enough fluid and look after your bowels to avoid straining.
Ask early about erection-recovery treatments if this matters to you.
Keep all follow-up and PSA appointments.

Before-surgery checklist

Catheter supplies and clear instructions for home
Continence pads ready
Pelvic floor exercise plan understood
Time off work and help at home arranged
Blood-thinning injections and how to use them, if prescribed
Clinic's contact number for problems saved
Date for catheter removal and first PSA test noted

Scars and how they heal

Keyhole (robotic or laparoscopic) surgery leaves several small scars on the lower tummy, which usually fade well. Open surgery leaves one longer scar in the lower tummy or, less commonly, between the scrotum and back passage. Scars can be pink and firm at first and settle over months.

⚠ Get urgent help if…

Calf pain, swelling, or sudden breathlessness or chest pain (possible blood clot) — seek urgent help
Fever, increasing wound redness, swelling or discharge (possible infection)
Heavy bleeding, or large amounts of blood or clots in the urine
Your catheter stops draining, falls out, or you cannot pass urine after it is removed
Severe or worsening tummy pain, or fluid or stool leaking from the wound
Being unable to keep down fluids, or feeling very unwell

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

After successful surgery, your PSA (a blood marker made by prostate tissue) should fall to a very low or undetectable level, usually within a couple of months. A low, stable PSA is reassuring, but it is not the same as a guaranteed cure.

The examination of the removed prostate gives important information: the grade of the cancer, whether it had spread beyond the prostate, and whether it reached the cut edge (the margin). These findings, discussed by the team, guide whether any further treatment or simply ongoing monitoring is recommended.

How long it lasts

For cancer that was truly contained and fully removed, surgery can control it for the long term. However, some cancers return months or years later, which is why lifelong PSA monitoring is important. A rising PSA after surgery does not always mean further treatment is needed straight away, but it should always be discussed with your specialist.

Combining with other procedures

Surgery is sometimes followed by radiotherapy and/or hormone treatment if the examined prostate shows higher-risk features, or if the PSA rises later. Your team should explain in advance the chance that more than one treatment might be needed.

Follow-up & long-term care

You will have your first PSA blood test about six to eight weeks after surgery, then regular checks over the following years. The pathology results are discussed at a multidisciplinary team (MDT) meeting, and you should be told the findings and what they mean for any further treatment.

Lifelong PSA blood tests at intervals set by your team
Continued pelvic floor exercises while bladder control settles
Ongoing access to erectile-function support if you want it
Review of any further treatment if the PSA rises

Revision and secondary surgery reality

Further treatment with radiotherapy and/or hormones is sometimes needed if the PSA rises or the pathology shows higher-risk features.
Lasting incontinence may need a second operation (sling or artificial urinary sphincter).
A narrowed bladder–urethra join may need a procedure to stretch or open it.
Erection recovery often needs ongoing treatment such as tablets, injections, vacuum devices or implants.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

A named contact (often a specialist nurse) for catheter and recovery problems.
A clear PSA follow-up schedule and explanation of what the results mean.
Structured continence support, including pelvic floor physiotherapy.
Proactive erectile-function support offered, not left for you to ask.
MDT review of the pathology with a plan for any further treatment.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The surgeon's fee and how experienced they are in this operation
Whether robotic, laparoscopic or open surgery is used (robotic systems add cost)
Anaesthetic fee and theatre/facility time
Length of hospital stay, including any high-dependency care
Whether lymph nodes are removed and examined
Pathology (examining the prostate) and follow-up PSA tests
Support for continence and erectile recovery afterwards

Make sure your written quote includes

The surgeon's fee and the type of surgery (robotic, laparoscopic or open)
Anaesthetist's fee and hospital/theatre charges
Expected length of stay and what happens if you need to stay longer
Pathology examination of the prostate and follow-up PSA tests
Catheter supplies and district nurse or clinic support at home
Continence and erectile-function support, and any extra cost
What happens — and who pays — if there is a complication or you need further treatment

On the NHS? Radical prostatectomy is a standard NHS treatment for localised prostate cancer; private care may be chosen for speed, choice of surgeon or a second opinion.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Is my cancer suitable for active surveillance or radiotherapy instead of surgery, and what would you advise and why?
Can the erection nerves be spared in my case, and what is your honest expectation for my erections afterwards?
What are your own results for urine leakage and erection recovery, and how many of these operations do you do each year?
What is the chance I will need further treatment such as radiotherapy after surgery?
How will you support me if I have lasting leakage or erection problems?
What happens to my PSA after surgery, and how will we know if the cancer comes back?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Does removing the prostate cure the cancer?

It can control or remove cancer that is fully contained in the prostate, but no operation can promise a cure. Whether it is cured depends on the cancer and the findings afterwards, which is why your PSA is monitored for years.

Will I be able to have erections afterwards?

Many men have erection problems after surgery, at least for a while. Nerve-sparing surgery improves the chances, but recovery can take a year or more and may not be complete. Medicines and other treatments can help, and your team should support you.

Will I leak urine?

Most men leak some urine when the catheter first comes out and need pads. This usually improves over weeks to months with pelvic floor exercises. A small number have longer-term leakage that may need further treatment.

Can I still father children?

No — after a radical prostatectomy you no longer produce semen, so you cannot father children naturally. If you may want children in future, ask about storing sperm before surgery.

Is surgery better than radiotherapy or active surveillance?

Not necessarily. For many men these options give similar cancer control with different side effects. The best choice depends on your cancer and what matters to you, and should be discussed by a specialist team.

Is this available on the NHS?

Yes. Radical prostatectomy is a standard NHS treatment for localised prostate cancer. Some men choose private care for speed, choice of surgeon or a second opinion.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG131 — Prostate cancer: diagnosis and management BAUS — Radical prostatectomy patient leaflet (PDF) Prostate Cancer UK — Surgery (radical prostatectomy) Cancer Research UK — Problems after prostate surgery NHS — Prostate cancer treatment Incontinence and erectile dysfunction after radical prostatectomy — PMC review

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.