Radical prostatectomy is recommended for men with prostate cancer when the tumor is confined to the prostate and there are no metastases in the lymph nodes or other organs.
The goal of this surgery is to completely remove the prostate, including its capsule, the seminal vesicles, and the distal ends of the vas deferens, in order to eliminate all cancer cells and offer a chance for a complete cure.
As part of what is known as “active surveillance,” doctors initially monitor small, low-aggressive tumors before performing surgery.
However, as soon as the disease shows signs of progression or the tumor spreads beyond the prostate, surgical removal of the entire prostate becomes necessary.
This procedure is also known as a radical prostatectomy.
A radical prostatectomy is generally considered when:
- the patient has locally confined prostate cancer or localized prostate cancer,
- the patient’s life expectancy is at least ten years,
- the patient’s general health permits major surgery,
- and there is a realistic chance of a cure through complete removal of the tumor.
Unlike radiation therapy or hormone therapy, radical prostatectomy aims to completely remove the tumor.
This procedure offers the best chances of a cure, particularly for locally confined prostate cancer, whereas additional therapies are often required in advanced stages.
Thanks to modern nerve-sparing surgical techniques, erectile function can often be preserved today without compromising oncological safety.
The prostate is located below the bladder. A radical prostatectomy can lead to a cure, especially in the early stages of prostate cancer © Henrie | AdobeStock
A radical prostatectomy is performed by urologists who specialize in the treatment of prostate cancer.
These physicians have extensive experience in the surgical treatment of prostate cancer and perform the procedure at specialized prostate centers or clinics for urology and oncology.
The operating physician—often an experienced surgeon—works with the patient to determine the optimal procedure, depending on the tumor stage, the location of the prostate cancer, and the patient’s overall health.
Radical prostatectomy can offer a high chance of cure, particularly for locally confined prostate cancer, while in advanced stages, a combination with radiation therapy or hormone therapy is often advisable.
Today, the surgical removal of the prostate can be performed in various ways:
- Open surgery through the lower abdomen (retropubic radical prostatectomy)
- Access through the perineum (perineal radical prostatectomy)
- Laparoscopic or robot-assisted radical prostatectomy
Depending on the approach and tumor size, the surgeon decides which procedure offers the greatest chance of success while minimizing the risk of complications.
Modern hospitals frequently use robot-assisted systems such as the da Vinci surgical system, which enable a particularly precise and nerve-sparing prostatectomy.
Patients with localized prostate cancer benefit most from radical prostatectomy, as this procedure allows for the removal of the entire prostate, including its capsule and adjacent lymph nodes.
This increases the chance of a complete cure, while experienced urologists and surgeons take care to preserve nerves and blood vessels as much as possible to minimize the risk of erectile dysfunction and urinary incontinence.
Radical prostatectomy is a complex surgical procedure in which the entire prostate, including its capsule, the seminal vesicles, and part of the urethra are removed.
The goal is the complete surgical removal of the prostate, including all tumor cells, to minimize the risk of recurrence.
Before the surgery, imaging tests are used to determine whether the tumor is confined to the prostate or has already spread to lymph nodes or other organs.
Depending on the findings, a lymphadenectomy (removal of the lymph nodes near the prostate) may also be performed during the prostate surgery.
This allows the surgeon to determine whether metastases have formed and whether radical removal of the prostate is clinically appropriate.
There are three established surgical approaches available for removing the prostate:
| Procedure | Description | Advantages |
| Retropubic radical prostatectomy |
Open surgery through the lower abdomen. The surgeon gains direct access to the prostate and can remove lymph nodes if necessary. |
Good visibility, ideal for an enlarged prostate. |
| Perineal radical prostatectomy |
Access via a small incision in the perineum. |
Less blood loss; suitable for patients who have had previous lower abdominal surgery. |
| Laparoscopic radical prostatectomy |
Minimally invasive procedure performed through small incisions in the abdomen. |
Faster recovery, less pain. |
| Robot-assisted radical prostatectomy |
A precision procedure using a computer-assisted system (e.g., the Da Vinci robot). |
Particularly gentle on the nerves, with precise dissection of the nerves and blood vessels. |
During the procedure, the surgeons take care to remove the prostate without damaging important structures such as the seminal vesicles and the internal sphincter. Especially with a robot-assisted radical prostatectomy or a perineal prostatectomy, the sphincter between the bladder and the urethra can often be completely preserved, which improves urinary control later on. In some cases, portions of the surrounding tissue are also removed to ensure that no cancer cells remain.
During a radical prostatectomy, the surgeon carefully separates the bladder and urethra from one another to preserve the internal sphincter.
The urethra and internal sphincter are then reconnected to the bladder (anastomosis).
The reconstructive suture is crucial for regaining urinary continence after surgery.
Depending on the anatomical situation and the location of the tumor, the procedure is performed with nerve-sparing techniques.
The goal is to preserve erectile function—and thus sexual function—as much as possible without compromising the complete removal of the prostate cancer.
Especially in patients with localized prostate cancer, radical prostatectomy can significantly improve the chances of a cure.
During the procedure, lymph nodes are often removed as well to reliably assess the possible spread of prostate cancer. The goal is to remove all tumor tissue and the prostate without damaging important anatomical structures.
As with any major surgical procedure, complications and side effects can occur after a radical prostatectomy. The most common consequences involve urinary continence and erectile function, as nerves, blood vessels, and muscles in the area of the prostate, urethra, and bladder are involved during the operation.
After a radical prostatectomy, many men initially report temporary incontinence, especially after the catheter is removed.
In most cases, these symptoms improve significantly within a few weeks or months. Targeted pelvic floor exercises can further reduce urinary incontinence.
Permanent incontinence is rare and usually depends on the tumor stage, the surgical technique, and the surgeon’s experience.
Patients who undergo robot-assisted radical prostatectomy often benefit from a faster recovery and lower complication rates. Studies show that men with locally confined prostate cancer who undergo surgery at an early stage achieve better long-term outcomes. Radical prostatectomy also offers the opportunity to completely remove tumor tissue while preserving important nerve pathways.
Another possible symptom is erectile dysfunction.
During a nerve-sparing prostatectomy, doctors attempt to preserve the nerves and blood vessels responsible for erections.
Nevertheless, erectile dysfunction or impotence may occur in some cases, especially if the tumor is very close to the nerves.
In such cases, medication or assistive devices (e.g., vacuum pumps or injections) can help.
Other possible side effects include:
- Narrowing of the urethra (urethral stricture) due to scarring
- Pain in the lower abdomen or groin area
- Loss of ejaculate (the seminal vesicles are also removed)
- Slight shortening of the penis due to anatomical changes following prostate removal
Radical prostatectomy can also lead to general postoperative complications such as bruising, wound healing problems, or swelling.
However, such complications are rare, especially when the surgery is performed using minimally invasive or robot-assisted techniques.
The outcomes of radical prostatectomy depend heavily on the surgical technique and the surgeon’s experience. Many patients recover more quickly, particularly after a robot-assisted radical or nerve-sparing prostatectomy. If the radical prostatectomy is performed completely while taking care to preserve the nerves and blood vessels, men can often notice significant improvements in urinary continence and erectile function just a few weeks after the surgery.
Long-term data from international studies, including the N Engl J Med Controlled Phase 3 Trial, show that patients with locally confined prostate cancer who undergo radical prostatectomy achieve better long-term outcomes after surgery than patients under active surveillance alone.
These results underscore that, despite potential side effects, radical prostatectomy offers a high chance of cure for many men with localized prostate cancer.
What exactly happens during a radical prostatectomy?
During a radical prostatectomy, the surgeon removes the entire prostate, including its capsule, the seminal vesicles, and the portion of the urethra that passes through the gland. Depending on the extent of the tumor, nearby lymph nodes may also be removed to ensure that no cancer cells remain in the surrounding tissue.
This surgical removal of the prostate is considered the global standard of care for localized prostate cancer and offers the chance of a complete cure, especially in cases of locally confined prostate cancer.
What complications can occur after surgery?
As with any major surgery, complications can occur. Typical complications include temporary urinary incontinence, erectile dysfunction, or minor bleeding. In rare cases, narrowing of the urethra or injury to the internal sphincter may occur.
However, advances in anatomically nerve-sparing prostatectomy and robot-assisted surgery have significantly reduced these risks. After a few months, most patients report good urinary continence and a partial or complete restoration of erectile function.
How do open, laparoscopic, and robot-assisted surgeries differ?
In open radical prostatectomy, access is gained through the lower abdomen.
Laparoscopic prostatectomy, on the other hand, is performed through small incisions in the abdomen, through which a camera and instruments are inserted.
State-of-the-art centers use the Da Vinci system for robot-assisted radical prostatectomy. This allows the surgeon to spare nerves and blood vessels with the utmost precision, which significantly mitigates the consequences of radical prostatectomy.
When is a radical prostatectomy appropriate, and when is active surveillance sufficient?
For locally confined prostate cancer, radical prostatectomy offers the best chance of cure.
However, if the tumor is growing slowly or the patient has a life expectancy of less than ten years, active surveillance may also be appropriate.
In this approach, the disease is monitored regularly, and surgery is performed only if the tumor progresses.
Patients should always make this decision together with their doctor. Patients with locally confined prostate cancer, in particular, can benefit from radical prostatectomy, as it offers a curative option and, in many cases, enables long-term freedom from the tumor.
