What Happens When They Remove Your Prostate? A Closer Look

Prostate removal, called radical prostatectomy, is surgery to take out the entire prostate gland. It is most often done to treat prostate cancer that is believed to be confined to the gland. The surgery removes the cancer, but it also changes how your body works in ways that are usually permanent. The two most common lasting effects are urinary leakage and erectile dysfunction, and both are tied to the nerves and muscles that sit right next to the prostate.

What Is the Prostate and Why Does It Get Removed?

The prostate is a small gland that sits below the bladder and in front of the rectum. It surrounds the tube that carries urine out of the body, called the urethra. Its main job is to make fluid that becomes part of semen.

When cancer is found inside the prostate and appears not to have spread, removing the whole gland is one way to treat it. This is called radical prostatectomy. Surgeons can do it through a single cut in the lower belly (open surgery) or with tools and a camera through several small cuts (laparoscopic or robotic surgery).

All of these approaches remove the same structures. The prostate is gone, and so is the cancer inside it. The seminal vesicles, small glands that also add fluid to semen, are usually removed too.

Not everyone with prostate cancer needs this surgery. Many prostate cancers grow slowly and may never cause harm. For some men, especially older men or those with other serious health problems, monitoring the cancer with regular testing rather than treating it right away is a reasonable option. That decision depends on the cancer’s grade, the man’s age, his overall health, and his own priorities.

What Happens During Prostate Removal Surgery?

The surgeon removes the prostate and the seminal vesicles, then reconnects the bladder directly to the urethra. That reconnection is why urination changes after surgery. There is no longer a prostate surrounding the urethra, and the bladder sits lower in the pelvis.

Running along the prostate are bundles of nerves and blood vessels that control erections. Surgeons try to spare these nerve bundles when the cancer’s location allows it. Whether they can be saved depends on where the cancer is and how aggressive it looks. If cancer appears to touch or involve the nerves, the surgeon may remove them to get clear margins, meaning no cancer cells are left at the edge of the removed tissue.

Most men stay in the hospital for a short time, often one to two days, though this varies. A catheter, a thin tube that drains urine from the bladder, stays in place for a period after surgery while the reconnection heals. Your surgical team will tell you exactly how long yours will stay in.

What Happens When They Remove Your Prostate: The Immediate Recovery

The first days and weeks after surgery are mostly about healing and managing the catheter. You may feel tired, and there will be some soreness or discomfort around the incision sites. Most men are advised to avoid heavy lifting and strenuous activity for several weeks while the internal reconnection heals.

When the catheter comes out, the first thing many men notice is that urine leaks. This is expected, not a sign that something went wrong. The muscles that normally hold urine are temporarily weakened, and the bladder has to adjust to its new position and to no longer having a prostate beneath it.

Some men also have blood in the urine for a short time. This usually clears on its own. Your care team will give you specific instructions about what to watch for and when to call.

Will I Have Urinary Problems After Prostate Removal?

Urinary leakage is common right after surgery and improves for most men over the following months. The pelvic floor muscles, which help control urination, can be strengthened with exercises. Many surgeons and physical therapists teach these exercises, often called Kegels, before and after surgery.

How much leakage a man has long term varies widely. Younger men and men whose nerves were spared tend to have less leakage. Some men regain full control within weeks or months. Others continue to leak small amounts, especially with coughing, laughing, or lifting. A smaller number have ongoing leakage that affects daily life.

There is a less common problem called bladder neck contracture, where scar tissue narrows the reconnection between the bladder and urethra. This can make urination slow or difficult and may need a procedure to open it back up.

It is honest to say that no surgery can promise perfect urinary control. The range of outcomes is wide, and your surgeon’s own results and your specific situation matter more than any general statistic.

Will I Still Be Able to Get an Erection?

Erections depend on nerves that run very close to the prostate. Even when a surgeon spares these nerves, they can be bruised or stretched during surgery. This is why erectile function often changes after prostate removal.

Some men recover erections over time, sometimes over a year or more. Others do not recover without help. Whether the nerves could be spared, your age, your erectile function before surgery, and your overall health all play a role.

Because recovery can take a long time, many doctors recommend treatments to encourage blood flow to the penis soon after surgery. These may include medications, vacuum devices, or other approaches. The goal is to keep the tissue healthy while the nerves heal. Your doctor can explain what fits your situation.

It is important to be clear: nerve-sparing surgery improves the odds of recovering erections, but it does not guarantee them. Some men who have both nerves spared still have lasting erectile dysfunction.

How Does Prostate Removal Affect Sex and Fertility?

After the prostate and seminal vesicles are removed, the body no longer produces semen, and ejaculation no longer happens. This is a permanent change. Orgasms can still occur, and many men describe them as feeling different but still pleasurable.

Because there is no semen, a man cannot father a child naturally after this surgery. If having biological children is important, sperm banking before surgery is an option to discuss with your doctor.

These changes affect more than the body. Many men and their partners find it helpful to talk openly about expectations and to ask their care team questions. Sexual function is a medical topic, and doctors are used to discussing it.

What About Cancer Control and Follow-Up?

The main reason for the surgery is to remove the cancer. Afterward, your doctor will check a blood test called PSA, which stands for prostate-specific antigen. PSA is made by prostate cells, so after the prostate is removed, PSA should drop to very low or undetectable levels.

If PSA starts to rise later, it can mean some cancer cells remain or have come back. This is called a recurrence. Your doctor will monitor your PSA over time and decide whether any further treatment is needed. Not every rise in PSA means the cancer is spreading, and not everyone needs more treatment right away.

Follow-up visits and PSA tests are a normal part of life after this surgery. They are how your care team keeps track of whether the cancer stays gone.

Are There Alternatives to Removing the Prostate?

Radical prostatectomy is not the only option for prostate cancer that has not spread. Other choices include radiation therapy, which uses high-energy rays to kill cancer cells, and active surveillance, which means monitoring the cancer closely and treating it only if it shows signs of growing.

Each option has different trade-offs. Surgery removes the gland and gives a clear picture of the cancer under a microscope, but it carries the urinary and sexual side effects described here. Radiation avoids surgery but has its own set of possible side effects, which can appear later. Active surveillance avoids treatment side effects for a time but means living with a known cancer that is being watched.

Which path is best depends on the cancer, your health, and what matters most to you. This is a decision worth discussing carefully with your doctors, and it is reasonable to get more than one opinion.

What Should You Expect in the Long Term?

Most men recover from the surgery itself within a few weeks, but the urinary and sexual changes can take much longer to settle, and some may be permanent. The honest picture is that outcomes vary a great deal from one man to the next.

Good follow-up care makes a difference. Pelvic floor therapy can help with leakage. Treatments for erectile dysfunction can help many men. Regular PSA testing keeps track of the cancer. Talking with your doctor about what you are experiencing, rather than waiting, is the practical approach.

Prostate removal is a major surgery with real, lasting effects on daily life. Knowing what to expect ahead of time helps you prepare and helps you ask the right questions.