Recovery After Prostate Cancer Surgery

The first weeks after prostate cancer surgery (radical prostatectomy) are when patients have the most questions: When will the catheter come out? When will bladder control return? When can I go back to work, drive or resume my sex life? On this page we walk you through recovery after surgery, day by day and month by month.

The information here is based on the discharge advice Prof. Dr. Murat Binbay gives to his robotic radical prostatectomy patients. For the operation itself, who it is suitable for and how the techniques compare, see our prostate cancer surgery page.

Recovery Timeline After Prostate Cancer Surgery

Recovery after robotic surgery is considerably faster than after open surgery. A typical course looks like this:

The First Days in Hospital

After surgery, the patient is first monitored closely for a few hours and then moved to their room. Because the incisions in robotic surgery are small, pain is generally mild and most patients do not need strong painkillers.

• Early mobilisation: You will be asked to sit up in bed and take a short walk on the same evening. Walking early helps the bowels start working and reduces the risk of blood clots.
• Diet: Water and clear fluids are given first; a normal diet is resumed once the bowels are working.
• Drain: The thin drain placed in the abdomen is usually removed on day 2.
• Discharge: If there are no problems, patients go home about 48 hours after surgery.

Going Home with a Catheter: Catheter Care

During the operation the bladder is reconnected to the urethra. To let this connection heal, the patient goes home with a urinary catheter. The catheter is usually removed about 1 week after surgery, in the clinic, in a few minutes and without pain.

• Always keep the urine bag below the level of your bladder so that urine does not flow back.
• Gently clean the area where the catheter enters the penis with soap and water once or twice a day.
• You can use a large bag at night and a small leg bag during the day.
• A small amount of urine or blood-stained leakage around the catheter, especially when straining, is common and usually normal.
• If no urine drains into the bag for 3 hours and you feel fullness or pain in the lower abdomen, the catheter may be blocked; contact your team immediately.

What to Pay Attention to at Home

Diet and fluids: Drink at least 3 litres of water a day. For the first 10 days, avoid foods that cause gas (fizzy drinks, pulses, cabbage, dairy products). Constipation and straining put pressure on the healing area; eat a high-fibre diet and, if needed, use a mild laxative recommended by your doctor.

What is considered normal:

• Light pink urine or a small amount of blood when straining may appear on and off for the first 6 weeks.
• Bruising and swelling in the groin, scrotum and around the incisions resolve within 1–2 weeks.
• Shoulder pain is caused by the gas used to inflate the abdomen during surgery and disappears within a few days.

When Should You Contact Your Doctor Immediately?

• A fever above 38.5°C (101.3°F)
• Increasing redness, swelling or discharge at the incision sites
• No urine draining into the bag for 3 hours, with lower abdominal pain
• Dark red urine or bleeding with clots
• Swelling and pain in one leg, or sudden shortness of breath
• Persistent nausea, vomiting or increasing abdominal swelling

Urinary Incontinence After Prostate Cancer Surgery

The prostate surrounds the urethra and helps with urinary control. Because it is removed during surgery, most patients experience some leakage for a while after the catheter comes out. This is usually temporary: the external urinary muscle (sphincter) gradually takes over the job on its own.

• Bladder control usually improves gradually over weeks and months. Night-time control returns first; leakage when coughing, sneezing or lifting improves last.
• Using incontinence pads during this period is normal; a falling number of pads is the best sign of recovery.
• In robotic surgery performed by experienced hands, where nerves and muscle tissue are preserved, bladder control returns earlier.
• Permanent incontinence occurs in a small number of patients and can be treated: options include medication, sling surgery and an artificial urinary sphincter.

Kegel (Pelvic Floor) Exercises

The most effective way to speed up the return of bladder control is to train the pelvic floor muscles. Start the exercises after the catheter has been removed.

1. Find the right muscle: Try to stop the flow of urine midstream. The muscle you use is the pelvic floor muscle. Do this only once or twice to identify the muscle; do not repeat it as an exercise while urinating.
2. Squeeze and relax: Squeeze the muscle for 5 seconds, then relax for 5 seconds. Avoid tightening your abdomen, buttocks or thighs, and do not hold your breath.
3. Repeat: Do a set of 10 repetitions 3 times a day. Over time, increase the squeeze to 10 seconds.
4. Use it in daily life: Briefly squeeze the muscle just before you cough, sneeze or stand up.

Sex Life and Erections After Surgery

The nerves responsible for erections run along both sides of the prostate. If the extent of the cancer allows, these nerves are preserved during surgery (nerve-sparing surgery). Even when the nerves are preserved, they are affected during the operation, so it takes time for erections to return.

• Timing: Erectile function usually improves gradually over months; full recovery can take 1–2 years.
• Key factors: Erectile function before surgery, age, other conditions (diabetes, vascular disease) and the extent to which the nerves could be preserved have the greatest impact on the outcome.
• Penile rehabilitation: Medication and regular stimulation started early after surgery help maintain the health of penile tissue and support recovery. Your doctor will decide which medication to use and when to start.
• Further treatments: For patients who do not respond adequately to tablets, there are options such as penile injections, vacuum devices and permanent solutions such as a penile implant.

When can you resume sexual activity? After the catheter has been removed and the first check-up has been done, sexual activity can usually be resumed within a few weeks, on your doctor's advice. Even if erections have not fully returned, sensation and orgasm are generally preserved.

Having Children After Surgery

Because the prostate and seminal vesicles are removed during surgery, no semen is released at orgasm (dry orgasm). Natural conception is therefore not possible after surgery. Patients who wish to have children in the future are advised to discuss sperm banking with their doctor before surgery.

PSA Follow-up After Surgery

Because the prostate is removed completely, PSA is expected to fall to an undetectable level after surgery. PSA monitoring is the most important way to find out whether the cancer has come back.

• First test: About 6–8 weeks after surgery.
• Frequency: Determined by the pathology result; generally more often in the first years, then once a year.
• Rising PSA: After an undetectable level, values of 0.2 ng/mL or higher on two consecutive tests are considered biochemical recurrence, and further treatment options are discussed.

For more details, see our articles why does PSA rise after prostate cancer treatment and PSA persistence after radical prostatectomy.

Pathology Results: Is Further Treatment Needed?

The pathology report, available 2–3 weeks after surgery, shows the grade of the cancer (Gleason/ISUP), whether it has spread beyond the prostate, the status of the lymph nodes and whether the surgical margins are clear. Most patients do not need further treatment after surgery and are followed with PSA tests only. If there is tumour at the surgical margin, lymph node involvement or PSA remains detectable, radiotherapy or hormone therapy is evaluated together with the oncology team.

Life Expectancy After Prostate Cancer Surgery

Prostate cancer is one of the cancers with the best outcomes when detected at an early stage. For disease confined to the prostate, 5-year survival is almost the same as in the general population of the same age. The main factors that determine long-term survival after surgery are the stage and grade of the cancer, the pathology result, regular PSA follow-up and the patient's general health. A rise in PSA detected early during follow-up can also usually be treated successfully.

After surgery, protecting your cardiovascular health, stopping smoking, weight control and regular exercise support both your general health and your recovery.

Frequently Asked Questions About Recovery After Prostate Cancer Surgery

How long does recovery take after prostate cancer surgery?

After robotic surgery, patients are discharged in about 48 hours, the catheter is removed after around 1 week and most return to desk work within 2–3 weeks. Sport and heavy lifting should wait about 2 months. Full recovery of bladder control and erections can take several months.

Is urinary incontinence permanent?

In most patients it is temporary and improves over weeks and months. Kegel exercises speed up this process. Permanent incontinence occurs in a small number of patients and can be treated with medication or surgery.

Is my sex life over after surgery?

No. In patients who can have nerve-sparing surgery, erections can return over time; sensation and orgasm are usually preserved. If erections are not sufficient, effective treatments are available, from medication to implant surgery.

What should my PSA be after surgery?

Because the prostate is removed completely, PSA is expected to be undetectable (usually below 0.1 ng/mL). Values of 0.2 ng/mL or higher on two consecutive tests are evaluated separately by your doctor.

When can I drive?

Driving is not recommended for the first 10 days or while the catheter is in place. After that, you can drive once you can move comfortably enough to brake suddenly.

Will I need chemotherapy or radiotherapy after surgery?

Most patients do not. If the pathology result shows risk factors or PSA rises, radiotherapy or hormone therapy may be considered.

Can I have children after surgery?

Because no semen is released after surgery, natural conception is not possible. If you would like to have children in the future, talk to your doctor about sperm banking before surgery.

Can the cancer come back?

For early-stage tumours removed with clear margins, the risk of recurrence is low but not zero. That is why regular PSA follow-up is carried out; a rise detected early can usually be treated successfully.

You can read about our patients' experiences on the prostate cancer patient reviews page.