Radical Prostatectomy (RP)

What is a radical prostatectomy?


The prostate gland is found only in males. It sits below the bladder and wraps around the urethra (the tube that carries urine out of the body). The prostate helps make semen. The seminal vesicles are the 2 sacs that connect to the vas deferens (tubes that carry sperm from the testicles). The pelvic lymph nodes are small oval collections of immune system tissue that filter lymph fluid. When prostate cancer spreads, these lymph nodes are often one of the first places it goes.

A common way to remove the prostate is through an incision (cut) done in one of two ways:

  • A retropubic or suprapubic incision, which is made in the lower abdomen (belly)


  • A perineum incision, which is made in the skin between the scrotum and the rectum

Radical prostatectomy is used to treat prostate cancer that is confined to the prostate gland and the seminal vesicles. There are several ways to do a radical prostatectomy:

Radical prostatectomy with retropubic (or suprapubic) approach

This is the most common method. The incision is made in the lower abdomen. If there’s a chance the cancer has spread, the healthcare provider may remove lymph nodes around the prostate gland first so they can be checked in the lab before the prostate is removed. Cancer has spread beyond the prostate gland if it's found in the lymph nodes. If that's the case, then surgery may be stopped, since removing the prostate won't remove all of the cancer. In this situation, other treatments will be used.


Radical prostatectomy with perineal approach

With the retropubic approach, there is a smaller, hidden scar behind the scrotum for a better cosmetic effect. Also, major abdominal muscle groups are avoided. So, there's generally less pain and recovery time.

Laparoscopic radical prostatectomy



Why might I need a radical prostatectomy?


Other less common reasons for radical prostatectomy include:

  • Inability to fully empty the bladder
  • Recurrent bleeding from the prostate
  • Bladder stones with prostate enlargement
  • Very slow urination


What are the risks of a radical prostatectomy?

Some possible complications of retropubic and perineal methods may include:

  • Impotence (erectile dysfunction). Recovery of sexual function may take up to 2 years after surgery and may not be complete. Nerve-sparing prostatectomy lowers the chance of erectile dysfunction, but doesn't guarantee that it won't happen.
  • Lymphedema. Lymphedema is a condition in which fluid collects in the soft tissues, causing swelling. This may be caused by inflammation, blockages, or removal of the lymph nodes during surgery. Although rare, if lymph nodes are removed, fluid may collect in the legs or genital region over time. Pain and swelling result. Physical therapy is often helpful in treating the effects of lymphedema.

Some risks associated with surgery and anesthesia in general include:

  • Reactions to medications used during surgery
  • Bleeding
  • Blood clots
  • Infection

One risk of the retropubic approach is rectal injury. This can cause stool incontinence or urgency.


How do I get ready for a radical prostatectomy?

Some things you can expect before the surgery include:

  • Your doctor will review your medical history and do a physical exam to be sure you're in good health before you have the surgery. You may need tests to make sure the cancer is confined to the prostate and has not spread to other parts of your body.
  • Tell your doctor if you're sensitive to or are allergic to any medications, latex, iodine, tape, contrast dyes, and anesthesia.
  • Make sure your doctor has a list of all medicines (prescribed and over the counter) and all herbs, vitamins, and supplements that you're taking.
  • If you smoke, top as soon as possible to improve your recovery from surgery and to improve your overall health.
  • Follow all other instructions that your healthcare provider gives you.

What happens during a radical prostatectomy?


Generally, a radical prostatectomy (either retropubic or perineal approach) follows this process:

  1. You'll need to remove any jewelry or other objects that may get in the way during the procedure. A bracelet with your name and an ID number will be put on your wrist. You may get a second bracelet if you have allergies.
  2. You'll remove your clothing and put on a hospital gown.
  3. You'll be asked to empty your bladder.
  5. The doctor may choose regional anesthesia instead of general anesthesia. General anesthesia puts you into a deep sleep during the surgery. Regional anesthesia is medicine delivered through an epidural (in the back) to numb the area to be operated on. You'll also get medicine to help you relax and pain medications. The doctor will decide which type of anesthesia is best for you.
  6. Once you're sedated, a breathing tube may be put through your throat into your lungs and you'll be connected to a ventilator. This will breathe for you during the surgery.
  8. A soft, flexible tube called a Foley catheter will be put into your bladder to drain urine.

Radical prostatectomy, retropubic or suprapubic approach

  1. You'll lie on your back on the operating table.
  2. An incision will be made from below your  belly button to the pubic region.

Radical prostatectomy, perineal approach

  2. An upside-down, U-shaped incision (cut) will be made in the perineal area (between the scrotum and the anus).
  5. The seminal vesicles may be removed if there's concern there may be cancer in them.

Procedure completion, both methods

  1. The incision will be sutured or stapled closed.

What happens after a radical prostatectomy?

In the hospital


Once you're awake and stable, you may start to drink liquids and will be taken to your hospital room.

You may get pain medication as needed, either by a nurse, or by giving it yourself through a device connected to your IV line.

You will be able to eat solid foods as you're able to handle them.

Your healthcare team will show you how to do breathing exercises and movements while in bed to help your body recover. You may wear compression stockings on your legs. These reduce your risk for blood clots. Your activity will be gradually increased, and you will be urged to get out of bed and walk around for longer periods.

The drain will generally be taken out the day after surgery.

The Foley catheter that was put in to drain your urine will stay in place for about 1 to 3 weeks as you heal. You'll be given instructions on how to care for your catheter at home.


At home



You shouldn't drive until your doctor tells you it’s OK. Other activity restrictions may apply, such as no heavy lifting for 3 to 4 weeks.

Once the Foley catheter is removed, you'll probably have some leaking of urine. The length of time this occurs can vary. Your doctor will give you suggestions for improving your bladder control. Over the next few months, you and your doctor will be checking for any side effects and working to improve any problems with incontinence or erectile dysfunction.

Tell your doctor if you have any of the following:

  • Fever and/or chills (may be a sign of infection)
  • Increase in pain around the incision
  • Inability to have a bowel movement
  • Inability to urinate once catheter is removed
  • Changes in your urine output, color, or odor


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