Your radical prostatectomy is a technically demanding operation because your prostate lies deep within your pelvis and close to structures involved in your urinary control, erections and bowel function. Your surgeon must remove your prostate and any other tissue required for cancer control while protecting nearby structures whenever this is oncologically safe.
Your robotic system can improve your surgeon’s view and range of instrument movement, but it does not make your operation simple or automatic. Your surgeon controls every movement and clinical decision, while your wider theatre team supports your safety throughout the procedure.
What Is a Radical Prostatectomy?
During your radical prostatectomy, your surgeon removes your entire prostate and usually your seminal vesicles. Your surgeon then reconnects your bladder to your urethra so that your urine can pass through the reconstructed urinary pathway after the surgical join has healed.
Your operation is offered with curative intent when surgery is considered suitable for your cancer and general health. It may be an option if your cancer is localised or, in selected circumstances, locally advanced and your multidisciplinary team believes that long-term cancer control may be achievable.
Why Is the Prostate Difficult to Reach?
Your prostate lies deep within your pelvis, immediately below your bladder and in front of your rectum. The surrounding bones and limited working space can make access and instrument movement technically demanding.
Your surgeon therefore needs clear visibility, controlled instrument movement and detailed knowledge of your pelvic anatomy. These requirements apply whether your operation is performed through an open, laparoscopic or robot-assisted approach.
Which Structures Surround the Prostate?
Your prostate lies close to your bladder neck, urethra, urinary sphincter, rectum, pelvic blood vessels and the nerve bundles involved in erections. Your seminal vesicles are positioned behind your prostate and are normally removed during radical prostatectomy.
Your surgeon must identify and protect nearby structures while removing enough tissue to treat your cancer appropriately. Your individual risk of injury depends on your anatomy, cancer extent, previous treatment and the complexity of your operation.
What Does the Surgeon Need to Do?
Your surgeon must separate your prostate from your bladder, urethra, rectum and surrounding tissues before removing it with your seminal vesicles. Your surgeon may also remove pelvic lymph nodes when this is appropriate for your cancer risk.
After removing your prostate, your surgeon reconnects your bladder to your urethra and places a catheter so that urine can drain while the join heals.
Key Steps During Prostate Removal Surgery
| Step in Your Surgery | What Happens to You | Why It Matters to You |
| Accessing your prostate | Your surgeon reaches your prostate through an open or keyhole approach | Your anatomy and previous treatment can affect the difficulty of access |
| Separating your prostate | Your prostate is carefully separated from your bladder, urethra, rectum and surrounding tissues | Your surgeon aims to remove your cancer while protecting nearby structures |
| Considering nerve preservation | One or both nerve bundles may be preserved when this is safe for your cancer | Your nerve-sparing plan may influence your chance of erectile recovery |
| Removing your prostate | Your prostate and seminal vesicles are removed | This is the main cancer-treatment stage of your operation |
| Reconnecting your urinary tract | Your bladder is joined to your urethra | This restores your pathway for urination after healing |
| Supporting your healing | Your catheter drains urine while the join heals | Your catheter reduces pressure on your surgical repair |
| Assessing your recovery | Your team monitors your wounds, catheter, urine output and general health | This helps your team identify and manage complications promptly |
Why Is Cancer Control Challenging?
Your surgeon must remove your prostate and any additional tissue needed to obtain appropriate cancer clearance while protecting nearby structures when this is safe. Your operation may be more challenging when your tumour lies close to your prostate capsule, bladder neck, urinary sphincter, rectum or erection-related nerve bundles.
After your operation, your pathologist examines the removed tissue and reports whether cancer reaches an inked surgical edge. A positive surgical margin may increase your risk of recurrence, but it does not prove that cancer remains or mean that you automatically need immediate radiotherapy or another treatment.
Why Is Nerve-Sparing Difficult?
Your erection-related nerve bundles run close to the outer surface of your prostate. Preserving one or both bundles requires careful dissection and may not be appropriate when your cancer lies close to them.
Your cancer control must take priority over nerve preservation. Even when your nerves are preserved successfully, your erections may take many months to improve and may not return to their previous quality.
Why Is Continence Protection Important?
Your operation takes place close to your urinary sphincter and the supporting tissues involved in urinary control. Your surgeon aims to preserve suitable urethral length and supporting structures without compromising the removal of your cancer.
You are likely to experience some leakage after your catheter is removed. Your control often improves during the following weeks and months, although your recovery depends on your baseline function, age, anatomy and surgical factors.
Does Robotic Surgery Make the Operation Easy?
No. Your robotic system provides your surgeon with a magnified three-dimensional view and articulated instruments that can move within your confined pelvis. Your surgeon remains responsible for every instrument movement and clinical decision.
The technology can support controlled dissection and suturing, but it cannot determine your surgical boundaries, protect your nerves automatically or guarantee your cancer, continence or erectile outcomes.
How Does Open Surgery Compare?
Open and robot-assisted prostatectomy use different methods to access and remove your prostate. Both approaches require specialist expertise and aim to control your cancer while managing the possible effects on your urinary and sexual function.
Robot-assisted prostatectomy is generally associated with less blood loss and a shorter hospital stay than open surgery. However, comparative evidence has not consistently shown one approach to be superior across long-term cancer control, urinary continence and erectile function. Your surgeon’s experience and the performance of the wider team remain important whichever approach is used.
Why Does Surgeon Experience Matter?
Radical prostatectomy has a substantial learning curve, and your surgeon’s experience may influence your risk of complications, surgical-margin results and recovery of urinary and sexual function. You should consider experience alongside recent, clearly defined results and expertise with cancers similar to yours.
A high number of procedures does not guarantee your result, and a lower number does not prove poor care. Your outcome also depends on your cancer, health, anatomy and the performance of your wider hospital team.
Does the Hospital Team Matter?
Yes. Your operation relies on a coordinated team that includes the lead surgeon, anaesthetist, bedside assistants, theatre nurses and trained postoperative staff. Each member plays a role in ensuring your procedure is carried out safely and efficiently.
Your care also depends on specialists beyond the operating theatre, including pathologists, radiologists, specialist nurses and rehabilitation professionals. Their input influences your diagnosis, recovery and long-term follow-up.
What Can Make Your Operation More Complex?
Your operation may be more technically challenging if you have a very large prostate, obesity, previous abdominal or pelvic surgery, unusual anatomy or cancer extending beyond your prostate.
Previous infection, inflammation or treatment may also produce scarring that makes tissue planes harder to identify. Your surgeon should explain which factors apply to you and whether they change your risks or proposed surgical plan.
Is Salvage Prostatectomy More Difficult?
Salvage prostatectomy is performed after previous treatments such as radiotherapy or focal therapy have not controlled the cancer. These earlier treatments can cause scarring and tissue changes, making structures more difficult to identify and separate during surgery.
- Previous treatment effects: Earlier treatments can create scar tissue and changes that make surgery more technically challenging
- Surgical complexity: Altered anatomy can make it harder for the surgeon to safely remove the prostate
- Higher risks: You may face a greater risk of urinary incontinence, erectile dysfunction and other surgical complications than you would after primary prostatectomy.
- Specialist expertise: Salvage prostatectomy requires surgeons with specific experience in managing complex cases
- Careful selection: Your overall health, previous treatment and cancer situation are considered before surgery is recommended
Because of the increased complexity, salvage prostatectomy is usually performed by experienced specialists in selected patients. Discussing the potential benefits and risks with your treatment team can help you understand whether this approach is suitable for you.
Does Lymph-Node Removal Add Complexity?
You may undergo pelvic lymph-node dissection if your estimated risk of nodal involvement makes it appropriate. Your surgeon must carefully dissect around your pelvic blood vessels, nerves and lymphatic channels, adding time and technical steps to your operation.
Your lymph-node results can improve the accuracy of your cancer staging, but the direct treatment benefit of removing clinically undetected nodal disease remains uncertain. Your surgeon should explain your individual reasons for the procedure and your risks of lymphocele, swelling, infection, bleeding and blood clots.
What Are the Main Immediate Risks?
Your immediate risks may include bleeding, infection, blood clots, anaesthetic complications, urine leakage from the bladder-to-urethra join and injury to your bladder, rectum, ureteric openings or other nearby structures.
The probability and seriousness of each complication vary. Your surgeon may occasionally need to convert your keyhole operation to an open approach because of bleeding, dense scarring, equipment problems or the need to repair an injury safely.
What Are the Main Long-Term Challenges?
Your most important possible long-term effects include urinary leakage and difficulty achieving or maintaining erections. You may also experience changes to your orgasm, permanent loss of ejaculation, infertility, penile shortening or urine leakage during sexual activity.
Your risk depends on your age, function before surgery, general health, cancer characteristics and nerve-sparing suitability. You should receive individualised information and access to continence and erectile-function support when you need it.
How Difficult Is Recovery for You?
Your robot-assisted prostatectomy uses small abdominal incisions, but it remains major pelvic surgery. You will usually leave hospital with a urinary catheter and may experience tiredness, abdominal discomfort, temporary leakage and restrictions on lifting, driving, work and strenuous activity.
Your recovery varies according to your health, operation and any complications. You should follow your surgical team’s catheter, wound-care, activity and rehabilitation instructions rather than relying on one fixed recovery timetable.
How Are Surgical Outcomes Assessed?
Your cancer outcomes are assessed using your pathology report, surgical-margin status, lymph-node findings when applicable and postoperative PSA. Your functional outcomes may include urinary continence, erectile function, complications and quality of life.
When reviewing your surgeon’s results, you should ask how each outcome is defined, when it is measured and how complete the follow-up data are. You should not directly compare percentages based on different patient groups or definitions.
Myth vs Fact
| Myth | What You Should Know |
| Your robot performs the difficult parts automatically. | Your surgeon controls every movement and makes every clinical decision. |
| Your prostate is difficult to remove only because of its size. | Your operation is challenging mainly because of its deep position and nearby functional structures. |
| Your nerve-sparing plan can be guaranteed before surgery. | Your imaging informs your plan, but your surgeon may need to adapt it to protect your cancer control. |
| Your positive margin proves that cancer remains. | Your margin affects your recurrence risk but must be interpreted with your pathology and PSA. |
| Your robotic operation removes the risks of leakage and erectile dysfunction. | You may experience either effect regardless of the surgical approach. |
| Your open operation cannot control cancer as effectively. | Open, laparoscopic and robotic approaches can all provide effective cancer treatment. |
| Your lymph-node removal is always needed to treat your cancer. | Your procedure is selected according to your nodal risk and mainly improves staging information. |
| Your salvage prostatectomy has the same risks as your first operation. | Your previous treatment may cause scarring and increase your technical and functional risks. |
Key Takeaways
- Your radical prostatectomy is major pelvic cancer surgery.
- Your prostate lies close to your bladder, urethra, urinary sphincter, rectum and erection-related nerves.
- Your surgeon must balance cancer removal with preservation of urinary and sexual function.
- Your robotic system supports your surgeon but does not make decisions or operate independently.
- Your nerve-sparing plan depends on your cancer’s position and extent.
- Your urinary leakage commonly improves after your catheter is removed, but your recovery cannot be guaranteed.
- Your surgical complexity may increase because of your anatomy, cancer or previous treatment.
- Your salvage prostatectomy requires particularly careful selection and specialist experience.
- Your lymph-node surgery adds operative steps and possible complications.
- You should assess your surgeon’s results using clear definitions, suitable follow-up periods and information about the types of cancer they treat.
Frequently Asked Questions
1. Is your prostate surgery a difficult operation?
Yes. Your radical prostatectomy is technically demanding because your prostate lies deep within your pelvis near structures involved in urinary control, erections and bowel function.
2. Why is your prostate difficult to operate on?
Your prostate lies in a confined space below your bladder and in front of your rectum. Your surgeon must carefully separate it from nearby tissues before reconnecting your bladder to your urethra.
3. Which structures may be affected during your prostate surgery?
Your operation takes place near your bladder neck, urethra, urinary sphincter, rectum, pelvic blood vessels and erection-related nerves. Your individual risk depends on your anatomy, cancer extent and previous treatment.
4. Does robotic surgery make your operation easier?
Your robotic system can improve your surgeon’s view and instrument movement, but it does not make your operation simple or automatic. Your surgeon’s judgement, anatomy knowledge and technical experience remain essential.
5. Why does your surgeon’s experience matter?
Your surgeon’s experience may influence your complication, surgical-margin and functional outcomes. You should consider their recent workload and results alongside their experience with cancers similar to yours.
6. Can you always have nerve-sparing surgery?
No. Your nerve-sparing suitability depends on where your cancer lies and whether preserving one or both nerve bundles could compromise cancer removal. Your cancer control must remain the priority.
7. How may your surgery affect urinary control?
You are likely to experience leakage after your catheter is removed because your urinary sphincter and supporting tissues need time to recover. Your control often improves gradually, but your recovery cannot be guaranteed.
8. What can make your operation more complex?
Your surgery may be more difficult because of your prostate size, body shape, previous pelvic surgery, unusual anatomy, cancer extent or earlier radiotherapy or focal treatment.
9. Is your salvage prostatectomy more difficult?
Yes. Your previous treatment may cause fibrosis and make normal tissue planes harder to identify. You may also face higher risks of urinary, sexual and other complications than with primary prostatectomy.
10. What are your main risks after prostate surgery?
Your risks may include bleeding, infection, blood clots, leakage from the surgical join, urinary incontinence, erectile dysfunction and injury to nearby structures. Your surgeon should explain how these risks apply to you personally.
Final Thoughts: Understanding the Complexity of Your Prostate Surgery
Your radical prostatectomy is technically demanding because your prostate lies deep within your pelvis and close to structures involved in your urinary control, erections and bowel function. Your surgeon must balance appropriate cancer removal with the protection of these structures whenever this is safe for your cancer.
Your robotic system may support visualisation, instrument movement and minimally invasive access, but it cannot determine your result by itself. Your outcome also depends on your cancer characteristics, anatomy, baseline health, surgical plan, surgeon and wider clinical team. To discuss your diagnosis and whether prostate surgery is suitable for you, contact Prostate Clinic London to arrange a specialist consultation.
References
- Arroyo, C., Martini, A., Wang, J. and Tewari, A.K. (2019) ‘Anatomical, surgical and technical factors influencing continence after radical prostatectomy’, Therapeutic Advances in Urology, 11, article 1756287218813787. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6329031/
- Blank, F. et al. (2023) ‘Salvage radical prostatectomy after primary focal ablative therapy: a systematic review and meta-analysis’, Cancers, 15(10), article 2727. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10216462/
- British Association of Urological Surgeons (no date) Robotic-assisted radical prostatectomy (RARP). Available at: https://www.baus.org.uk/patients/information_leaflets/180/roboticassisted_laparoscopic_removal_of_prostate_for_cancer_rarp
- Cacciamani, G.E. et al. (2021) ‘Impact of pelvic lymph node dissection and its extent on perioperative morbidity in patients undergoing radical prostatectomy for prostate cancer: a comprehensive systematic review and meta-analysis’, European Urology Oncology, 4(2), pp. 134–149. Available at: https://pubmed.ncbi.nlm.nih.gov/33745687/
- Coughlin, G.D. et al. (2018) ‘Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study’, The Lancet Oncology, 19(8), pp. 1051–1060. Available at: https://pubmed.ncbi.nlm.nih.gov/30017351/
- Hoeh, B. et al. (2022) ‘Anatomical fundamentals and current surgical knowledge of prostate anatomy related to functional and oncological outcomes for robotic-assisted radical prostatectomy’, Frontiers in Surgery, 8, article 825183. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8901727/
- Marra, G., Marquis, A., Yanagisawa, T., Shariat, S.F., Touijer, K. and Gontero, P. (2023) ‘Salvage radical prostatectomy for recurrent prostate cancer after primary nonsurgical treatment: an updated systematic review’, European Urology Focus, 9(2), pp. 251–257. Available at: https://pubmed.ncbi.nlm.nih.gov/36822924/
- National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management. NICE guideline NG131. Last updated 15 December 2021 and last reviewed 13 August 2025. Available at: https://www.nice.org.uk/guidance/ng131
- Prostate Cancer UK (2024) Surgery: radical prostatectomy. Updated July 2024. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/surgery
- Royal College of Surgeons of England (2025) Robotic-assisted surgery: a pathway to the future. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/robotic-assisted-surgery/
- Van den Broeck, T. et al. (2021) ‘A systematic review of the impact of surgeon and hospital caseload volume on oncological and non-oncological outcomes after radical prostatectomy for non-metastatic prostate cancer’, European Urology, 80(5), pp. 531–545. Available at: https://pubmed.ncbi.nlm.nih.gov/33962808/
- Yossepowitch, O., Briganti, A., Eastham, J.A., Epstein, J., Graefen, M., Montironi, R. and Touijer, K. (2014) ‘Positive surgical margins after radical prostatectomy: a systematic review and contemporary update’, European Urology, 65(2), pp. 303–313. Available at: https://pubmed.ncbi.nlm.nih.gov/23932439/