Robotic Prostate Cancer Surgery

Why Remove the Prostate?

Radical prostatectomy removes the entire prostate gland and typically the seminal vesicles, with nearby lymph nodes evaluated or removed when clinically appropriate. Surgery may be considered for patients with localized or locally advanced prostate cancer when removing the prostate offers an appropriate approach to cancer control.

The tissue removed during surgery is examined by a pathologist, providing detailed information about the extent and characteristics of the cancer. These findings, together with postoperative PSA testing, help guide follow-up care and determine whether additional treatment should ever be considered.

Who May Be a Candidate for Robotic Prostatectomy?

Whether surgery is appropriate depends on factors including the stage and risk characteristics of the prostate cancer, imaging and biopsy findings, age, overall health, life expectancy and personal treatment priorities. Surgery is one of several potential approaches to prostate cancer and should be considered alongside other appropriate options, which may include active surveillance, radiation therapy or focal treatment for selected patients.

Learn more about Prostate Cancer and how treatment decisions are individualized.

The Surgeon Controls the Robotic System

During robotic-assisted surgery, the surgeon operates from a console near the patient and controls the movement of the surgical instruments in real time. The system translates the surgeon’s hand movements into precise movements inside the body while providing a magnified, three-dimensional view of the surgical area.

Robotic technology extends the surgeon’s ability to work through small incisions, but surgical judgment and experience remain central to the procedure. Decisions involving cancer removal, preservation of nearby structures and nerve-sparing are made by the surgeon according to each patient’s anatomy and cancer.

Nerve-Sparing Prostate Surgery

The nerves involved in erectile function travel very close to the prostate. When the location and extent of the cancer allow, the surgeon may use a nerve-sparing approach to preserve one or both neurovascular bundles during prostate removal.

Nerve-sparing is not appropriate in every case. If cancer extends close to or involves these structures, removing additional tissue may be necessary to achieve the primary goal of cancer control. The surgical approach is therefore individualized rather than determined by robotic technology alone.

Urinary Continence After Prostatectomy

Temporary urinary leakage is common after the urinary catheter is removed because the urinary system must adjust after prostate removal. Bladder control generally improves during recovery, although the timing and degree of recovery vary from patient to patient.

Pelvic floor exercises may be recommended to help strengthen the muscles involved in urinary control. If urinary leakage persists, additional evaluation and treatment options are available and can be discussed with the urology team.

Erectile Function After Prostatectomy

Erectile function may take longer to recover than general physical activity or urinary control. Recovery depends heavily on erectile function before surgery, age, overall health, cancer characteristics and whether nerve-sparing surgery can be performed safely. Nerves that are preserved during surgery may still require time to recover from the effects of the operation.

Medications for erectile dysfunction, vacuum erection devices, injection therapy and other treatments may be considered during recovery depending on the individual patient. Your urologist can discuss an appropriate approach to sexual rehabilitation based on your function before surgery and your recovery afterward.

Sexual Function, Orgasm and Fertility

Radical prostatectomy changes some aspects of sexual function permanently because the prostate and seminal vesicles are removed. Erections and orgasm are separate functions, and many men remain able to experience orgasm after surgery even if erectile function changes. Orgasm after prostatectomy is dry because semen is no longer produced and ejaculated, and the sensation of orgasm may feel different.

Because natural ejaculation no longer occurs after radical prostatectomy, natural fertility is lost. Patients who may want biological children in the future should discuss fertility preservation, including sperm banking, before treatment.

Returning to Normal Activities

Walking and gradually increasing activity are important parts of recovery after prostatectomy. Patients should follow their surgical team’s guidance about lifting, exercise, driving, sexual activity and returning to work, since the appropriate timing depends on healing, overall health and the course of recovery.

Physical recovery from minimally invasive surgery often progresses over several weeks, but feeling better does not necessarily mean that internal healing is complete. Your care team will help determine when different activities can safely be resumed.

Understanding Your Surgical Pathology

After surgery, a pathologist carefully examines the prostate and other tissue that was removed. The pathology report provides important information about the cancer, including its Grade Group, extent within or beyond the prostate, surgical margins and, when lymph nodes were removed, whether cancer was found within them.

Your surgeon will review these findings with you and explain what they mean for your prognosis and follow-up care. Most patients require surveillance rather than immediate additional treatment after prostatectomy, while certain pathology findings or subsequent PSA results may lead to discussion of additional therapy.

PSA Monitoring After Prostatectomy

Because the prostate gland has been removed, PSA is expected to fall to an undetectable or very low level after surgery. PSA blood testing is therefore an important part of long-term follow-up and can help identify persistent or recurrent prostate cancer before it causes symptoms.

Your care team will determine how frequently PSA should be measured based on your pathology, PSA results and individual risk. If PSA remains detectable or begins to rise after surgery, additional evaluation can help determine whether further treatment should be considered.

If Additional Treatment Is Needed

A detectable or rising PSA after prostatectomy does not automatically mean that cancer has spread or that every patient requires the same next treatment. PSA pattern, surgical pathology, imaging when appropriate and other clinical factors help determine the next step.

For some patients, radiation therapy to the prostate bed or nearby areas may be recommended after surgery, sometimes together with hormone therapy depending on the clinical situation. Learn more about Radiation Therapy for Urologic Cancers.

Saint John’s patient Dan Garr shares his experience with prostate cancer, robotic surgery and recovery.

Long-Term Prostate Cancer Follow-Up

PSA monitoring remains important even when recovery is going well and there are no symptoms of prostate cancer. Follow-up allows your care team to evaluate PSA results over time, address urinary or sexual concerns and determine whether additional evaluation is ever needed.

If PSA or other findings suggest persistent or recurrent cancer, treatment decisions are individualized. Depending on the clinical situation, options may include radiation therapy, hormone therapy or other treatments, with specialists working together to determine the appropriate next step.

Multidisciplinary Care When You Need It

Prostate cancer care does not necessarily end with surgery. At Providence Saint John’s Health Center, urologic oncologists can collaborate with radiation oncologists, medical oncologists and other specialists when additional expertise or treatment is appropriate.

This coordinated approach allows each stage of care to be considered in the context of the treatment you have already received, the characteristics of your cancer and your individual priorities for health and quality of life.