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Radical prostatectomy: what the operation involves | CION Cancer Clinics
A radical prostatectomy removes the whole prostate gland and the seminal vesicles, and sometimes the nearby lymph nodes, then joins the bladder back to the urethra. You are asleep throughout and wake with a catheter that stays for a week or two while the join heals. This page walks through what is removed, what happens on the day, and what the first weeks at home look like. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What does a radical prostatectomy actually involve?
- What is removed, what is kept, and what is rejoined
- What happens from admission to the ward
- What the first few weeks usually look like
- Words you will see on the operation note, in plain language
- Who this operation does not suit, and what this page cannot tell you
- Common questions about radical prostatectomy
The short answer
What does a radical prostatectomy actually involve?
A radical prostatectomy removes the whole prostate gland, the two small sacs behind it called the seminal vesicles, and sometimes the lymph nodes nearby. The surgeon then joins the bladder directly to the urethra, the tube you pass urine through, so that you can pass urine normally once the join has healed.
Why the whole gland comes out
Prostate cancer is often found in more than one part of the gland, and a biopsy only samples a few spots. Removing the gland whole lets the pathologist examine all of it, so the report you receive afterwards is more complete than any scan or biopsy taken before.
How long it takes and what you will feel
You are asleep under general anaesthetic for the whole operation, which usually takes a few hours. You wake up with a catheter, a soft tube draining urine from the bladder into a bag, and usually a small drain from the wound. Most men are walking the next day and go home within a few days, with the catheter still in place.
This page describes the operation in general. Your own surgeon will explain which approach and which steps apply to you.Inside the operation
What is removed, what is kept, and what is rejoined
Four decisions happen inside every prostatectomy. Knowing them makes the operation note easier to read.
The prostate and seminal vesicles
Both come out together in one piece. The seminal vesicles make part of the fluid in semen, and cancer can grow into them, so they are removed as standard.
The lymph nodes
Small glands beside the pelvic blood vessels are removed in men whose cancer has a higher chance of having reached them. In lower-risk cancer the surgeon may leave them alone.
Usually removed when
- The grade is high on biopsy
- The PSA was high before surgery
- The scan shows a bulky tumour
The nerve bundles
The nerves that control erections run down each side of the prostate. Where the cancer sits well away from them, the surgeon peels them off and keeps them. Where it sits close, they may be taken on that side to clear the cancer.
The join
With the prostate gone there is a gap between the bladder and the urethra. The surgeon stitches the two together. The catheter you wake with holds this join open while it heals.
Your report may call this join the anastomosis.Not sure whether this applies to you?
Ask an oncologistOn the day
What happens from admission to the ward
Admission and checks
You are usually admitted the day before or early on the morning of surgery. Blood tests, an ECG and the anaesthetist's review are completed. Bring every report and the list of medicines you take.
Going to sleep
In the theatre you are given a general anaesthetic through a drip. A breathing tube is placed once you are asleep and removed before you wake. You will not feel or remember the operation.
The operation
The surgeon reaches the prostate through one cut below the navel, or through several small cuts with a camera and instruments. The gland is freed, removed, and the bladder is joined to the urethra over a catheter.
Recovery room and the ward
You wake with the catheter, a drip and usually a wound drain. Pain is controlled with regular medicine. Nurses get you walking early, because moving lowers the chance of clots in the legs and chest infection.
Going home
Most men go home within a few days, catheter in place, with clear instructions on caring for it, what to eat, and which changes should make you phone the ward the same day.
After you go home
What the first few weeks usually look like
-
Living with the catheter
The catheter stays for roughly one to two weeks while the join heals. You empty the bag, keep the area clean and walk a little more each day. Some blood in the bag is expected early on.
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Catheter removal
A short clinic visit. Some centres check the join with an X-ray dye test first. Once the catheter is out, most men leak urine at first, especially on coughing or standing. Pads are normal at this stage.
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The pathology report
The removed gland is examined under the microscope. The report gives the final grade, how far the cancer reached, whether the edges were clear and whether any lymph nodes were involved.
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The first PSA blood test
Taken a few weeks after surgery, once any PSA from before the operation has cleared from the blood. With the prostate gone, the level is expected to fall to a very low or undetectable reading.
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Pelvic floor work and follow-up
Daily pelvic floor exercises help control return. Your team sets a schedule of PSA tests and reviews, and talks through erection recovery and any further treatment the report suggests.
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On your report
Words you will see on the operation note, in plain language
- Grade group or Gleason score
- How abnormal the cancer cells look under the microscope. A higher number means a faster-growing type.
- Margin
- The edge of what was removed. A clear or negative margin means no cancer cells were seen at the edge. A positive margin means some were.
- pT stage
- The stage worked out from the removed gland itself, rather than from a scan. It describes whether the cancer was inside the gland or had grown through its outer layer.
- Nerve-sparing
- The surgeon kept the nerve bundles on one side, both sides or neither. Your note will say which, and it matters for erection recovery.
- Anastomosis
- The stitched join between the bladder and the urethra. If it leaks a little, the catheter stays in longer.
!
One thing that cannot wait
If the catheter stops draining and your lower belly feels tight and painful, or if you develop a fever with shivering, do not wait until the morning. Phone the ward or go to the nearest emergency department the same day and say you have had a prostatectomy. A blocked catheter can strain the fresh join, and a fever can be an infection that needs treating quickly. Do not try to flush the catheter yourself.
Being straight with you
Who this operation does not suit, and what this page cannot tell you
A radical prostatectomy is offered when the cancer is believed to be still inside the prostate or only just beyond it, and when you are fit enough for a few hours of anaesthetic. It is not usually offered where the cancer has already spread to bone or distant organs.
Men for whom another path is often discussed
Some slow-growing, low-grade cancers are safely watched with regular PSA tests and scans instead of treated straight away. Some men with serious heart or lung conditions are steered towards radiotherapy, which needs no anaesthetic. Neither choice is a lesser one. Your team weighs your age, your general health, the grade and stage, and your own priorities.
What you will not find here
This page cannot tell you whether you should have the operation, how your urine control or erections will recover, or what your report will say. Those depend on your own cancer, your health before surgery and the findings in theatre. Bring your questions to the surgeon who has seen your scans and ask them to walk through these steps for your case.
If you would like a second opinion before deciding, that is a normal request. No surgeon will be offended by it.Questions we are asked
Common questions about radical prostatectomy
Will I be able to pass urine normally afterwards?
Yes, once the join has healed and the catheter is out. Most men leak at first, especially when coughing or standing up, and need pads for a while. Control improves over the following months with pelvic floor exercises. A small number of men leak for longer, and there are treatments for that too.
How many days will I be in hospital?
Usually a few days, and often less with keyhole approaches. You go home with the catheter still in and come back to have it removed. What decides the length of stay is how quickly you are eating, walking and managing pain, so ask your surgeon for their own centre's typical stay.
Is the cut large? Where is it?
In open surgery there is one cut running from below the navel down towards the pubic bone. In keyhole and robotic surgery there are several small cuts across the belly, one slightly larger so the gland can be lifted out. The scars fade over the following year.
Will I still produce semen?
No. The prostate and seminal vesicles make the fluid in semen, and the tubes carrying sperm are divided during the operation. Orgasm is still possible, but it is dry. If you may want children in future, ask about sperm banking before the operation, not after it.
Will my erections come back?
It depends on whether the nerve bundles could be kept, your age, and how erections were before surgery. Recovery is slow and can take many months. Your team will usually start tablets or other help early, because keeping blood flowing to the tissue helps recovery. Ask about this before the operation.
Can the lymph nodes be left alone?
Sometimes. In lower-risk cancer the chance of spread to the nodes is low enough that many surgeons leave them. In higher-risk cancer they are removed and tested, because knowing whether they contain cancer changes what comes next. Your surgeon decides this from your grade, PSA and scans.
What if the report shows cancer at the edge?
A positive margin means cancer cells were seen at the cut edge. It does not by itself mean the cancer is still there. Your team will watch the PSA closely and may suggest radiotherapy to the area, straight away or only if the PSA starts to rise. It is a planned discussion, not an emergency.
Is the operation covered by Aarogyasri or my insurance?
Often yes, when it is part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Cover for robotic surgery varies between schemes, so ask for a written estimate that names the approach. Call the helpline and we will check your cover.
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Sources
- Cancer Research UK — Surgery for prostate cancer
- NHS — Prostate cancer: treatment
- American Cancer Society — Surgery for prostate cancer
- National Cancer Institute — Prostate cancer treatment (PDQ), patient version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Open, Laparoscopic or Robotic ProstatectomyThe three ways the surgeon reaches the gland, comparedThe Catheter After ProstatectomyCaring for it at home and when it comes outRecovery Week by Week After ProstatectomyWhat to expect from the first day to the first monthsThe Day of the OperationAdmission, anaesthetic and the recovery room for any cancer surgeryProstatectomy Cost in HyderabadIndicative ranges and what the schemes cover
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