Prostatectomy Procedures (Prostate Removal Surgery)

Prostatectomy is the surgical procedure to remove all or part of the prostate gland. It is most commonly performed to treat localized prostate cancer or relieve urinary blockage caused by a significantly enlarged prostate. Although the term encompasses more than one type of operation, each prostatectomy is designed to address a specific urological condition while preserving quality of life whenever possible.

Understanding the different types of prostate surgery, what to expect during recovery, and how outcomes are assessed can help patients and their families make informed decisions about treatment. This guide explains the role of prostatectomy in the treatment of prostate cancer and benign prostate enlargement, the different surgical approaches available, potential benefits and risks, and what international patients should know about having prostatectomy in Turkey.

What Is a Prostatectomy?

The prostate is a small gland located below the bladder and in front of the rectum. It surrounds part of the urethra and produces fluid that forms part of semen. The prostate also produces prostate-specific antigen (PSA), a protein that can be measured with a blood test. PSA levels are commonly used to assess prostate health, help evaluate the risk of prostate cancer, and monitor men after prostate cancer treatment. As the prostate grows or develops cancer, treatment may involve removing some or all of the gland.

The type of prostate removal surgery depends mainly on why the operation is needed. Radical prostatectomy is a cancer operation in which the entire prostate and seminal vesicles are removed, sometimes together with nearby lymph nodes. Simple prostatectomy removes the inner portion of an enlarged prostate that is obstructing the urethra while leaving the outer portion of the gland in place.

For this reason, there is no single answer to questions such as what is a prostatectomy and how long recovery takes. These answers depend on which type of prostate surgery is performed.

Types of Prostatectomy

There are two main types of prostatectomy. The distinction is important because radical prostatectomy is intended to remove prostate cancer, while simple prostatectomy is performed to relieve severe urinary obstruction caused by benign prostate enlargement.

Radical Prostatectomy

A radical prostatectomy removes the entire prostate gland and seminal vesicles. Nearby lymph nodes may also be removed when indicated based on the cancer's risk and stage.

Radical prostatectomy is primarily used for men with localized prostate cancer who are considered appropriate candidates for surgery. The aim is to remove the cancer while preserving urinary and sexual function as much as possible.

During a nerve-sparing prostatectomy, the surgeon attempts to preserve the nerves responsible for erections when the location and extent of the cancer allow it. Nerve sparing is not appropriate in every patient because cancer control remains the primary objective.

Simple Prostatectomy

A simple prostatectomy is different. It does not remove the entire prostate. Instead, the surgeon removes the enlarged inner tissue that is obstructing the urethra, while the outer part of the prostate remains.

This operation may be considered for men with a very enlarged prostate and severe urinary obstruction when other treatments are unsuitable or unlikely to provide adequate relief.

Simple prostatectomy can be performed through an open operation or using minimally invasive techniques. Robotic simple prostatectomy (RASP) is one minimally invasive approach that may be considered for substantially enlarged glands.

Because prostate tissue remains after simple prostatectomy, PSA does not normally fall to an undetectable level as it does after radical prostatectomy.

Why Is a Prostatectomy Performed?

The reason for surgery determines which type of prostatectomy is appropriate. Radical prostatectomy is generally considered in selected men with prostate cancer, while simple prostatectomy is used to relieve severe obstruction from benign prostate enlargement.

Prostate Cancer and Surgery

Prostate cancer surgery may be recommended for men with cancer that is confined to the prostate or, in selected cases, disease for which surgery forms part of a broader treatment strategy. The decision depends on factors such as PSA level, biopsy results, imaging, cancer stage, age, general health, and life expectancy.

Factors considered when deciding whether surgery is appropriate may include:

• Cancer stage: Doctors determine whether the cancer is confined to the prostate or has extended beyond it.
• Gleason score and Grade Group: These describe how aggressive the cancer appears under microscopic examination.
• PSA level: PSA is considered alongside biopsy and imaging findings rather than used alone to determine treatment.
• Overall health: Other medical conditions and fitness for surgery are important when evaluating treatment options.
• Life expectancy: Expected longevity and the potential benefits of treatment are considered, particularly for older patients.

Surgery is only one form of prostate cancer treatment. Depending on the cancer's characteristics, doctors may also discuss active surveillance, chemotherapy, or other treatments. For some men with low-risk disease, active surveillance may be appropriate rather than immediate surgery. For others, surgery or radiation may offer a curative treatment approach.

Enlarged Prostate and Surgery

An enlarged prostate, medically known as benign prostatic hyperplasia, can press on the urethra and make it difficult for urine to leave the bladder. Many men with BPH can be treated with lifestyle measures or medication, and not everyone with an enlarged prostate needs surgery.

Surgery may be considered when:

• Medication is not effective: Persistent urinary symptoms may require a procedural treatment when medicines do not provide sufficient relief.
• Urinary retention occurs: Repeated or persistent inability to empty the bladder can be an indication for surgery.
• Bladder stones develop: Obstruction caused by BPH can contribute to bladder stone formation.
• Bleeding recurs: Repeated prostate-related bleeding may require surgical treatment.
• Bladder function deteriorates: Long-standing obstruction can affect the bladder and its ability to empty properly.

The appropriate BPH surgery depends on prostate size, anatomy, symptoms, previous treatment, general health, and the surgeon's experience. Simple prostatectomy is only one of several benign prostatic hyperplasia surgery options.

Surgical Approaches to Prostatectomy

The same basic operation can be performed through different surgical approaches. The choice depends on the type of prostatectomy, the patient's anatomy and cancer characteristics when applicable, available technology, and the surgeon's expertise.

Open Prostatectomy

An open prostatectomy uses a larger surgical incision to access the prostate. Open surgery remains an established approach but is used less frequently for radical prostatectomy and for benign enlargement because minimally invasive alternatives are available in many centers.

For BPH, open simple prostatectomy may still be considered when the prostate is substantially enlarged, particularly when endoscopic enucleation or other minimally invasive options are not available or appropriate.

Laparoscopic Prostatectomy

A laparoscopic prostatectomy is performed through several small incisions using a camera and specialized instruments. The surgeon views the operative field on a monitor while manipulating the instruments inside the abdomen.

Potential characteristics of a laparoscopic approach include:

• Smaller incisions: Several small incisions are used instead of one larger incision.
• Magnified visualization: A camera provides an enlarged view of the surgical field.
• Minimally invasive access: The approach can reduce the size of the abdominal wounds compared with open surgery.
• Use in radical prostatectomy: Laparoscopic radical prostatectomy can be performed in appropriately selected patients with prostate cancer.

Robot-Assisted Radical Prostatectomy

Robot-assisted radical prostatectomy uses a surgical robotic system controlled by the surgeon from a console. A high-definition, magnified three-dimensional view allows the surgeon to see the operative field closely, while specialized instruments can make precise movements within the pelvis.

A da Vinci prostatectomy is one example of robot-assisted surgery. The robotic system does not perform the operation independently; the surgeon controls the instruments throughout the procedure.

Potential advantages of robot-assisted surgery include:

• Magnified 3D visualization: The surgeon can view anatomical structures in detail during the procedure.
• Instrument mobility: Robotic instruments can make controlled movements within the confined pelvic space.
• Small incisions: The procedure is performed through several small access points.
• Potentially faster recovery: Minimally invasive surgery may allow some patients to resume normal activities sooner than after open surgery.

Robotic surgery is not automatically the right choice for every patient. Outcomes also depend on cancer characteristics, surgical technique, patient factors, and the experience of the surgical team.

Laser Prostate Surgery

Laser prostate surgery is primarily used to treat benign prostate enlargement. It is important not to confuse laser treatment of BPH with radical prostatectomy: HoLEP and other laser prostate surgery techniques do not replace radical prostatectomy as a treatment for prostate cancer.

Holmium Laser Enucleation of the Prostate (HoLEP)

HoLEP, or holmium laser enucleation of the prostate, uses a holmium laser to separate the enlarged obstructing prostate tissue from the prostate capsule. The tissue is then removed from the bladder and sent to pathology for examination.

HoLEP is a form of prostate enucleation rather than radical prostatectomy because the entire prostate is not removed.

Important characteristics of HoLEP include:

• Benign prostate treatment: HoLEP is used to relieve obstruction caused by BPH rather than to remove a known prostate cancer.
• Holmium laser: The laser helps separate the enlarged tissue from the surrounding prostate capsule.
• Size versatility: HoLEP can be used across a broad range of prostate sizes.
• Tissue examination: Removed tissue can be sent to pathology, where previously unsuspected cancer may occasionally be identified.

Other laser treatments include GreenLight laser prostate surgery, which uses laser energy to remove or vaporize obstructing prostate tissue. The most appropriate laser prostatectomy technique depends on individual anatomy and clinical circumstances.

Before Surgery: Evaluation and Preparation

Before prostate surgery, the urologist reviews the reason for treatment, the patient's general health, medications, and the results of diagnostic tests. The evaluation differs depending on whether the operation is being considered for cancer or benign enlargement.

Evaluation for Prostate Cancer

Men being evaluated for prostate cancer may undergo several tests to establish the diagnosis and determine whether surgery is appropriate.

These may include:

• PSA testing: Measures the level of prostate-specific antigen in the blood.
• Prostate MRI: Helps identify suspicious areas and assess the extent and location of disease.
• Prostate biopsy: Provides tissue samples that can confirm cancer and establish the Gleason score or Grade Group.
• Staging investigations: Additional imaging may be recommended when there is concern that cancer has extended beyond the prostate.
• General health assessment: Medical conditions, medications, and fitness for anesthesia are reviewed before surgery.

Evaluation for Enlarged Prostate

Men being evaluated for BPH may undergo a different set of investigations, depending on symptoms and previous treatment.

The assessment may include:

• Urine testing: Helps identify infection or other causes of urinary symptoms.
• PSA testing: May be used when clinically appropriate to assess prostate health.
• Ultrasound or other imaging: Can assess prostate size, bladder emptying, and urinary tract anatomy.
• Urinary flow testing: Measures how quickly urine passes through the urinary tract.
• Bladder assessment: May be recommended when there are concerns about incomplete emptying or impaired bladder function.

Preparing for Surgery

Before the operation, the surgical and anesthesia teams review medications and medical history. Blood-thinning medications may require special management, but patients should never stop prescribed medication without medical advice.

Patients are also given instructions about fasting, medications, hospital admission, postoperative activity, and catheter care.

Recovery After Prostatectomy

Prostatectomy recovery depends heavily on the type of operation. Recovery after radical prostatectomy is different from recovery after HoLEP or simple prostatectomy, and minimally invasive approaches may allow some patients to resume normal activities sooner than open surgery.

Hospital Stay and Catheter

A urinary catheter is commonly placed during prostate surgery because the urinary tract needs time to heal and function normally after the procedure.

Important aspects of catheter care include:

• Catheter duration: The catheter may remain in place for several days after radical prostatectomy, with timing determined by the surgical team.
• Home catheter care: Patients discharged with a catheter receive instructions on drainage, hygiene, and warning signs.
• Catheter removal: The catheter is removed when the medical team determines that healing is adequate.
• Hospital stay: Length of stay varies according to the procedure, surgical approach, and individual recovery.

Returning to Daily Activities and Work

Prostatectomy recovery time varies according to the procedure and the patient's health. Walking is generally encouraged early after surgery, while strenuous activity and heavy lifting are restricted during the initial healing period.

Recovery generally involves a gradual return to normal activities:

• Walking: Light walking is usually encouraged soon after surgery.
• Driving: Patients should wait until they are medically cleared and can comfortably control the vehicle without significant pain or limitation.
• Work: Return to work after prostatectomy depends on the type of work and the surgical approach.
• Exercise: Exercise should be increased gradually according to the surgeon's instructions.
• Heavy lifting: Strenuous lifting is generally restricted during the early healing period.

Robotic prostatectomy recovery may be shorter for some patients than recovery after open surgery, but individual recovery times vary.

Regaining Bladder Control and Sexual Function

Urinary leakage is common during the early period after radical prostatectomy because the urinary sphincter and surrounding tissues need time to recover. Bladder control often improves progressively over the following weeks and months.

Patients may benefit from:

• Pelvic floor exercises: These can strengthen the muscles involved in urinary control.
• Pelvic floor guidance: A physical therapist or healthcare professional can help patients learn the correct technique.
• Gradual activity: Normal activity should be resumed progressively rather than immediately.
• Sexual rehabilitation: Patients experiencing erectile difficulties may be offered medications, vacuum devices, injections, or other treatments.

Sexual recovery can take considerably longer than recovery from the surgical incisions. Erectile function depends on factors including age, erectile function before surgery, whether nerve-sparing was possible, the extent of cancer, and other health conditions.

Side Effects and Risks of Prostate Removal

The side effects of prostate removal depend on whether the entire prostate is removed and on the surgical technique used. Radical prostatectomy has particular effects on urinary and sexual function because the prostate, seminal vesicles, and nearby structures are involved.

Potential complications include:

• Urinary incontinence: Temporary urine leakage is common after radical prostatectomy, and a smaller proportion of patients may experience longer-lasting incontinence.
• Erectile dysfunction: Nerve injury or disruption can affect erections. Nerve-sparing surgery may help preserve erectile function when it is oncologically appropriate, but it cannot guarantee normal erections.
• Loss of ejaculation: After radical prostatectomy, semen is no longer produced in the usual way because the prostate and seminal vesicles have been removed. Patients can still experience orgasm, but the orgasm is typically dry.
• Infertility after prostate removal: Radical prostatectomy results in permanent infertility because sperm can no longer be delivered normally.
• Bleeding: As with other major operations, bleeding can occur during or after surgery.
• Infection: Surgical-site or urinary infections are possible complications.
• Blood clots: Major surgery can increase the risk of venous blood clots.
• Urethral stricture: Scar tissue can narrow the urethra and interfere with urine flow.
• Bladder neck contracture: Scar tissue at the bladder outlet can cause narrowing and may require additional treatment.
• Other prostatectomy complications: These may include injury to surrounding structures, lymphatic complications, or the need for further procedures.

Surgical technique and surgeon experience can influence outcomes, but no approach eliminates these risks. Before surgery, patients should discuss their individual risk profile rather than relying only on average outcomes.

Life Expectancy and Outcomes After Prostate Removal

For men treated for prostate cancer, long-term outcomes depend on cancer stage, Grade Group, PSA level, pathological findings, age, overall health, and whether cancer has spread outside the prostate.

Population-level data show that survival varies considerably according to disease stage. Current SEER statistics report very high five-year relative survival for localized and regional prostate cancer, while survival is substantially lower for distant-stage disease. These figures describe groups of patients and should not be interpreted as an individual's personal prognosis.

Several factors influence outcomes after radical prostatectomy:

• Cancer stage: Disease confined to the prostate generally has a different outlook from cancer that has spread.
• Tumor grade: Higher-grade cancers may behave more aggressively.
• Surgical margins: Pathology can show whether cancer cells extend to the edge of the removed tissue.
• PSA follow-up: Regular PSA monitoring helps identify biochemical recurrence.
• Overall health: Other medical conditions can affect long-term health independently of prostate cancer.

The survival rate after radical prostatectomy therefore cannot be reduced to one universal percentage. Although radical prostatectomy is intended to provide definitive local treatment, prostate cancer recurrence after surgery can occur.

Prostatectomy in Turkey

For international patients considering prostatectomy in Turkey, the treatment journey usually begins with a review of medical records and diagnostic results before travel. Depending on the condition, these may include PSA results, prostate MRI, biopsy pathology, imaging, medication lists, and previous treatment records.

Patients traveling for prostate surgery in Turkey should consider the complete treatment pathway rather than focusing only on the operation itself. This includes preoperative testing, anesthesia assessment, hospital care, catheter management, pathology, postoperative monitoring, and arrangements for follow-up after returning home.

Prostatectomy cost varies according to the type of operation, surgical approach, hospital stay, diagnostic testing, surgeon, and whether additional procedures are required. Robotic prostatectomy cost can differ from open or laparoscopic surgery because of the technology and resources involved.

Patients should request an individualized treatment plan and for international patients, it is also important to clarify what is included in the quoted treatment package and what may incur additional costs.

Why Choose Medical Park for Prostate Care?

Medical Park provides diagnostic and surgical urological care covering prostate disorders, prostate cancer, laparoscopic surgery, robotic surgery, and minimally invasive treatments. Its urology services include diagnostic assessment and surgical treatment planning based on each patient's condition.

For patients requiring prostate cancer surgery, the appropriate approach may include laparoscopic or robot-assisted radical prostatectomy depending on the patient's cancer characteristics and clinical assessment. For men with benign prostate enlargement, treatment may instead involve medication, HoLEP, laser prostate surgery, or simple prostatectomy depending on prostate size and the severity of obstruction.

For international patients, treatment planning can begin before arrival, followed by in-person evaluation, surgery when appropriate, postoperative care, and a follow-up plan designed around the patient's needs after returning home.