Last updated: 12 March 2026
Sources and references 
For many people, surgery will be a suggested treatment option. It is worth discussing with your urologist or treating doctor whether there are other options, such as radiation therapy, available to you.
The main surgery for localised and locally advanced prostate cancer is a radical prostatectomy. It removes all the prostate, part of the urethra and the seminal vesicles. The urethra is rejoined to the bladder, and the vas deferens (that carry sperm from the testicles to the penis) will be sealed.
Some people have a nerve-sparing radical prostatectomy, to avoid damaging the nerves that control erections. This is only for lower-grade cancers where the cancer isn’t close to these nerves, and it works best for those who had strong erections before diagnosis. Problems with erections are common even with nerve-sparing surgery.
Cancer cells can spread from the prostate to nearby lymph nodes. For intermediate-risk or high-risk prostate cancer, nearby lymph nodes may also be removed (pelvic lymph node dissection).
How the surgery is done
There are different surgery methods to remove the prostate:
- open radical prostatectomy – usually done through one long cut in the lower abdomen (belly)
- laparoscopic radical prostatectomy (keyhole surgery) – small surgical instruments and a camera are inserted through several small cuts in the abdomen. The surgeon performs the procedure by moving the instruments using the image on the screen as a guide
- robotic-assisted radical prostatectomy – laparoscopic surgery performed with help from a robotic system. The surgeon uses a 3D picture and control panel to move robotic arms holding instruments.
Making decisions about surgery
Talk to your surgeon about whether surgery or another treatment such as radiation therapy is the best option for you. Also ask what surgical methods are available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery.
The surgeon’s experience and skill are more important than the type of surgery offered. Compared to open surgery, both standard laparoscopic and robotic-assisted surgery usually mean a shorter stay in hospital, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects. Take the time you need to make the right decision for you.
What to expect after surgery
Recovery time
No matter which surgical method is used, a radical prostatectomy is major surgery and you will need time to recover. You can expect to return to your usual activities within about 6 weeks of the surgery. Usually you can start driving again in a couple of weeks, but heavy lifting should be avoided for 6 weeks.
Managing pain and discomfort
It’s common to have pain after the surgery, so you may need pain relief for a few days.
Having a catheter
You will have a thin, flexible tube (catheter) in your bladder to drain your urine into a bag. The catheter will be removed after 1–2 weeks once the wound has healed.
Side effects of prostate cancer surgery
You may experience some or all of the following side effects:
Nerve damage
The nerves needed for erections and the muscle that controls the flow of urine (sphincter) are both close to the prostate. It may be very difficult to avoid these during surgery, and any damage can cause problems with erections and bladder control. Sometimes the nerves will need to be removed to try to ensure all cancer is removed.
Loss of bladder control
You can expect to have some light dribbling or trouble controlling your bladder for some weeks to months after a radical prostatectomy. This is known as urinary incontinence or urinary leakage. You can use continence pads to manage urinary leakage. Bladder control usually improves in a few weeks and will continue to get better for up to a year after the surgery. In the long term, you might continue to have some light dribbling. Some people may consider having an operation to fix urinary incontinence. In rare cases, people have no control over their bladder. Find out more about help for urinary problems.
Changes in erections
Problems getting and keeping erections after prostate surgery are common. This is often called erectile dysfunction (ED) or impotence. Erections may improve over months to a few years. It’s more likely you won’t get strong erections again if erections were already difficult before the operation. Find out more about ways to manage problems with erections.
Changes in ejaculation
During a radical prostatectomy, the tubes from the testicles (vas deferens) are sealed and the prostate and seminal vesicles are removed. This means semen is no longer ejaculated during orgasm (a dry orgasm). Your orgasm may feel different – in some cases it may be uncomfortable or, rarely, painful. A small amount of urine may leak during orgasm (which isn’t harmful to your partner).
Infertility
A radical prostatectomy will cause infertility and you will not be able to conceive a child without medical assistance. If you wish to have children, talk to your doctor before treatment about sperm banking or other options.
Change in penis size
You may notice that your penis gradually becomes a little shorter after surgery. Talk to your doctor about whether vacuum erection devices and prescription medicines may help. A change to the size of your penis can be difficult to deal with. Find out how to get help improving erections.
Sources and references
This content has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Subcommittee initiative. We thank the reviewers: Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Alan Barlee, Consumer; Dr Patrick Bowden, Radiation Oncologist, Epworth Hospital, Richmond, VIC; Bob Carnaby, Consumer; Dr Megan Crumbaker, Medical Oncologist, St Vincent’s Hospital Sydney, NSW; Henry McGregor, Health Physiotherapist, Adelaide Men’s Health Physio, SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW; Dr Gary Morrison, Shine a Light (LGBTQIA+ Cancer Support Group); Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Graham Rees, Consumer; Kerry Santoro, Prostate Cancer Specialist Nurse Consultant, Southern Adelaide Local Health Network, SA; Prof Phillip Stricker, Chairman, Department of Urology, St Vincent’s Private Hospital, NSW; Dr Sylvia van Dyk, Brachytherapy Lead, Peter MacCallum Cancer Centre, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title
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