Surgery for prostate cancer – What’s the best technique?

If you are considering surgery for prostate cancer, it’s a relief to know that the cancerous prostate gland will be completely removed.

The medical term for this is radical prostatectomy.  The surgeons will also remove some surrounding tissues and the seminal vesicles.  These vesicles produce fluid that is part of the makeup of semen.

Prostate removal through radical prostatectomy is an attempt to cure prostate cancer.  It is generally presented as an option when the cancer is believed to be confined to the prostate gland.

Four main types

There are four main types that are performed today.  Click on the links to read about each technique.  Then discuss which approach will be the best with your doctor.


  • Radical retropubic prostatectomy
  • Radical perineal prostatectomy
  • Laparoscopic radical prostatectomy
  • Robotic-assisted laparoscopic radical prostatectomy


Salvage radical prostatectomy is another type of surgery that is only considered after initial treatment (such as radiation) has failed and the cancer has recurred.

Are there risks?

Every approach has certain risks and potential side effects. The main risks after surgery are:

  • Complications from anesthesia
  • Heart attack
  • Stroke
  • Blood clots
  • Infection
  • Bleeding is another risk (some men may require a blood transfusion)

Are there side effects?

The two main side effects that can occur are:

  • Urinary incontinence, which is the inability for a man to control urination
  • Impotence or erectile dysfunction, which is the inability for a man to get or maintain a natural erection for intercourse

Other factors

Incontinence and impotence can also occur with other treatments for prostate cancer.  Other factors can affect side effects as well, including:

  • The age of a man
  • Whether he currently has any urinary or erectile problems
  • The skill (or lack of skill) of the surgeon

Impotence rates

Rates of impotency vary widely. With nerve-sparing surgery, impotence rates have been reported as low as:

  • 10% for men under the age of 50
  • 25% to 30% for men under the age of 60
  • Three in four men over age 70

But you should know that some doctors have reported higher rates of impotence.

It is also very important to understand how a doctor defines the word impotence.  Make sure you ask before surgery!

Incontinence rates

Expect that your man will probably experience some level of incontinence right after radical prostatectomy. But this is expected to lessen within a few months until it is hopefully no longer a problem.

According to a study of 901 men (aged 55 to 74) five years after radical prostatectomy:

  • 15% of men had no bladder control or frequent “leaks” or “dribbling”
  • 16% of men leaked at least twice a day
  • 29% of men wore pads to control wetness, but these men were in different groups in the study so these percentages may be inflated


Find a surgeon with “great hands”

We cannot stress enough that the skill and experience of the surgeon are paramount for success with any surgical approach for prostate cancer.

Please do your homework to make sure that you choose the best surgeon!

Your choice of surgeon will be the most important factor in preventing long-term (or even permanent) incontinence and impotence.

Getting ready

Read the articles in our helpful tips section to prepare for your loved one’s upcoming surgery, including key products to buy ahead of time.


Return to treatments


The American Cancer Society. Prostate Cancer. Accessed March 17, 2015.

Bostwick DG, Crawford DE, Higano CS, Roach M, eds. American Cancer Society’s Complete Guide to Prostate Cancer. Atlanta, GA: American Cancer Society Health Promotions; 2005.

Walsh PC. Guide to Surviving Prostate Cancer. New York, NY: Time Warner Book Group; 2001.

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