Prostate Surgery Complications: What Patients Should Know

By Jim Stallard,

Wednesday, October 28, 2015

Smiling physician speaking with patient.

Surgery is an effective prostate cancer treatment, but patients are understandably concerned about complications. Most men eventually recover urinary and sexual function, although many factors affect this outcome. Surgery for patients who have undergone unsuccessful radiation therapy carries a higher risk of complications. Every patient should talk with his surgeon about his own individual risk.

  • Surgery for prostate cancer is an effective treatment.
  • The procedure can affect urinary and sexual function.
  • These complications usually go away over time.
  • Complication risk rises in patients whose radiation therapy failed.
  • Men should talk to their surgeons for clear expectations.

Surgery has proved to be a very effective treatment for prostate cancer. One of the standard therapies for men with this disease is radical prostatectomy, a procedure that removes the entire prostate gland along with some surrounding tissue.

This operation is very complex, however, and requires a high level of technical precision, as the prostate is surrounded by nerves and structures important to normal urinary and sexual function. Many prostate cancer patients are understandably concerned about the possibility of complications that may occur as a result of this surgery.

James Eastham, Chief of Memorial Sloan Kettering’s Urology Service, has performed approximately 3,000 radical prostatectomies in his surgical career. Here, he explains the side effects of prostate cancer surgery and clarifies how a number of factors specific to each patient affect his overall risk of complications.

When you meet with patients who have opted for prostate cancer surgery, what complications seem to cause the most anxiety?

Patients are usually concerned about longer-term quality-of-life issues, such as urinary control — also called urinary continence — and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.

The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period — perhaps several months or a year after surgery — in which they do not have complete control.

For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, it’s not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.

You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. That’s true only for a very select group of patients,  usually those who are younger and had full erections prior to surgery.

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What typically increases the risk of complications from prostate cancer surgery?

Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.

Complication rates go up dramatically when we do surgery on patients who have failed other prostate cancer treatments.

Radiation is a very effective treatment for prostate cancer, but it doesn’t work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment — a procedure called salvage prostatectomy — is potentially curative.

Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures — which is a narrowing of the urethra that blocks urine flow — or injury to adjacent structures like the rectum.

MSK is a referral center for many patients whose radiation therapy did not work. Patients know that we have a high level of expertise in salvage prostatectomy, so this procedure makes up a significant portion of prostate surgeries at MSK compared with some hospitals. I treat a large number of these difficult cases — as do my colleagues here — and this can result in complication rates that are higher than if we had a more typical patient population.

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What is a common misconception you find in patients regarding complications that might occur after prostate cancer surgery?

I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, “I have a 75 percent chance of returning to my baseline function.” It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because — as is usually the case — the devil’s in the details.

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What advice would you give to a patient who wants to keep the risk of surgical complications as low as possible?

There are some things that patients can’t control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance — a method we’ve pioneered very successfully here at MSK.

For patients opting to undergo radiation therapy or surgery, it’s critical to know the outcomes of the individual doctor.

For patients opting to undergo radiation therapy or surgery, it’s critical to know the outcomes of the individual doctor. It’s well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.

These therapies are very effective. It’s always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.

Ultimately it’s all about finding a surgeon or a radiation oncologist with whom you feel comfortable — someone who sets realistic expectations based on your situation as a patient.

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If a diagnosis of a cancerous lump on the prostrate has been made, and CAT scan and Bone scan appts have been scheduled, what is the wait time for an appt at MSK and scheduling surgery?

Unless you are requesting a specific doctor, you can usually get in to see one of our prostate doctors within a few days. Timing for scheduling surgery depends on many factors, including obtaining medical clearance and what types of pre-operative tests may be needed. If you'd like to make an appointment, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment.

How common is it after successful surgery and sexual recovery for a man married 27 years to have a major lifestyle change and decide to divorce and be another person totally. Realize there was issues but just interested to know how much could be related to this life scary event. Thanks

Dear Betsy, we cannot say whether an individual's decision to end a marriage is related to their cancer experience. For some people it may be a factor.

Everyone's experience with cancer, and how they move forward with their lives after treatment ends, is different for everyone. To many people’s surprise, some cancer survivors report feeling some sadness once active, intensive treatment ends. This can be confusing; the expectation is that they'd feel happy. Unexpected gloominess, anxiety, and even fear about the future are common — and perfectly normal. It takes time to readjust to life after cancer and some people have a harder time with it than others. Some cancer survivors even develop post traumatic stress disorder, which can interfere with their quality of life.

We offer a cancer survivorship program that includes resources to assist with these issues and help support our patients after treatment ends (

We also offer programs for caregivers and loved ones of people with cancer, as they also need support and encouragement (

Thank you for reaching out to us.

My husband had robotic prostate surgery he has connection problems after surgery he has stool&gas pass through his penis, doctor says there's connection problems but be about 4-6 weeks before they repair.Have you ever heard of this problem?

Thank you for reaching out. We consulted with Dr. Eastham, who responded "It is a fistula which is a rare but known complication after radical prostatectomy. The usual recommendation is to wait until the patient has healed from the prostate surgery before attempting any repair. We typically involve a colorectal surgeon with experience with these types of repairs and perhaps a plastic surgeon. The key is patience and not to rush to do the repair. The tissues have to be healthy for the repair to work."

59 had prostate removed . Recover after surgery. Haven't gotten worse pain in scare area.Having a mid life moment or removing prostate is messing with my man hood. Fill lost. Thanks for reading .

Gary, thank you for reaching out.

You may be interested in Memorial Sloan Kettering's Male Sexual & Reproductive Medicine Program. You can learn more at… or call them at 646-422-4359.

This article may also be of interest:…

We also offer a support group for prostate cancer patients you may want to look into:

Thank you for your comment.

I had a radical prostatectomy about 4 months ago, but continue to have an indwelling catheter with dribbling,abdominal pain, diarrhea, constipation, and low back pain. My doctor stated that my prostate was very large from BPH and cancer (gleason score 4+3).He states that there was urinary leakage from a failure to re-connect he ends of the urethra. What do you suggest? Is it possible that I might have a permanent catheter? Would another surgery be beneficial? Frankly, my doctor does not know what to do, but he is very hesitant about repair surgery.
Thank you
Bruce T.

Dear Bruce, we are sorry to hear about your health issues. We can't offer specific medical advice or recommendations on our blog. If you would like to make an appointment with one of our specialists for a second opinion, please call our Physician Referral Service at 800-225-2225. Thank you for reaching out to us.

Age 58 steady climb in PSA lead to first biopsy with ASAP diagnosis. Did a 3d MRI and went for a second fusion biopsy with another ASAP diagnosis, PSA went down . PSA now up again to 6.2 new doctor wants to do another random 12-15 sample biopsy. Do you continue to do biopsys every three months? I'm confused. What should I do?

James, thank you for reaching out. We recommend that you speak with your physician about your concerns as every person's risk for prostate cancer is affected by a large number of factors. If you would like to make an appointment with a Memorial Sloan Kettering physician for a consultation, you can call our Physician Referral Service at
800-525-2225 or go to

In addition, you may be interested in learning about Memorial Sloan Kettering's active surveillance program for prostate cancer:…

Had surgery prostate removal with da Vinci August 2013 still in a lot of pain especially after sex hurts to have a bowel movement problems urinating pain in my testicles down legs and lower back have had numerous injections And a lot of Vicodin need help please suggest where to go for help

Dear Anthony, we are sorry to hear about your health issues. We recommend that you follow up with your surgeon to address your concerns. If you were treated at MSK, your care team can refer you to our Male Sexual Health Program, which helps men with many of these issues after treatment. Here is a link with more information:…. Thank you for reaching out to us.

My 75 year old, otherwise healthy, husband has a rapidly doubling PSA approximately 2.5 years after EBRT and goserelin (18 months). He is contemplating salvage prostatectomy and has had CT, bone scan, MRI and is scheduled for a TRUS biopsy to see if he qualifies. The surgeon has done 40 salvage prostatectomies and 4,000 regular prostatectomies in his career. Is that enough to have a high level of expertise? We know the outcomes are very much operator-dependent. How many salvage prostatectomies have the most experienced urologists at MSK done? Thank you.

Dear Wendy, we are sorry to hear about your husband's rising PSA. It's true that a surgeon's experience is an important factor to consider because it impacts treatment outcomes. The surgeon you describe in your question seems to have a good amount of experience doing this type of operation. If your husband would like to make an appointment for a consultation with one of our specialists before making his decision, please ask him to call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

My friend -age 58 had prostrate surgery 11 days ago. Catheter still in due to hematoma that formed. Still bloated with gas, fluid around lungs and now had blood coming from penis. Back on hospital with low blood pressure and pulse. On antibiotics and awaiting cat scan results. Is any part of this normal so many days post surgery?

Donna, we're sorry to hear your friend is going through this. We recommend you discuss your concerns with his healthcare team. Thank you for your comment.

I am in day 4 of recovery from robotic surgery at the gifted hands and heart of Dr. Laudone. The experience couldn't have been better (given it's surgery). The Josie Robertson center is beautiful, the staff caring and beyond competent, and the follow up care has been world class.
Thank you to the good people at MSKCC for making me feel as if my procedure was the only thing on their agenda.
Best wishes and deepest thanks to all,

Dear Frank, we appreciate you sharing your experience on our blog, and could not be happier that you felt well-cared for by Dr. Laudone and the rest of your care team at MSK. We wish you well as you continue to recover from your surgery. Thank you for your kind words!

My brother had a total prostrate removal 3 weeks ago at Strong Memorial Hospital in Rochester, NY. He was on a catheter for 2 weeks with some blood in urine. When the catheter was removed he was having pain, trouble urinating, and leakage. A week later his penis and testicles swelled up. The doctor said this was all normal. He had a follow up with his Dr. and cat scans. They found he has a hydra-seal causing the fluid to go in his testicles. Is this a usual complication? And would they do surgery to correct the hydra-seal?

Lisa, we're sorry to hear that your brother is experiencing complications. We recommend that you discuss the best course of action with his healthcare team. Thank you for your comment.

My husband was diagnosed with prostate cancer which turned out to be very aggressive. The first doctor told him not to worry he would be fine and "would not lose his hair." After I did some research, I realized we needed a second opinion. I called Sloane and has an appointment within two weeks. We opted for a radical prostetecomy. Dr. East ham performed the surgery and unfortunately the cancer had spread. We were referred to Dr. Morris who is currently treating him. If one can characterize cancer treatment as wonderful, Sloane certainly fits the bill. The care, the honesty of the doctors, and the wrap around services have been excellent. Despite a future which is still uncertain and some minor set backs, Memorial Sloane has delivered outstanding care to my husband.

Dear Flo, we are sorry to hear about your husband's diagnosis but glad to know he has felt well-cared for by his care team here at MSK. We wish him all our best as he continues with treatment. Thank you for sharing your experience on our blog.

I have had lower back pain for a year. I mentioned this to my Veterans Administration Dr and he don't seemed concerned. He did order a lower body xray and sent me to urology clinic. I have recently starten having blood in semen. I am diabetic and dont ejaculate anymore but blood still comes out of penis. As a veteran with 100% disability can I be treated at other places for second opion? Pain is sometime unbearable...

Dear Paul, we are sorry to hear about your health issues. We recommend that you circle back with your current physician and ask for a referral to a specialist in this area. Thank you for reaching out to us.

Hello! I just stumbled across this page while doing some research and found it very helpful. My husband (age 39) recently underwent a routine panel of blood tests prior to starting some hormone therapy treatments and it included a PSA screening which came back slightly elevated. He had a DRE which was "normal" and was given a course of antibiotics for possible prostatitis then the blood testing was repeated. He just found out that it (the PSA) came back higher than before. Now they have scheduled a biopsy. We are a bit nervous about it...what to expect and what news it will bring. I guess I'm wondering how often biopsies tend to turn out to be positive versus just "something to keep an eye on" ??? Also, I have been reading about treatments of prostate cancer (if it should come to that) and how it results in "dry orgasm" for the patient. Does that mean that he would NEVER EVER AGAIN ejaculate semen when he had an orgasm? Or is that something that just might happen in some people some of the time post operatively? Thanks for any advice or help you can give. Like I said...we are just getting our feet wet and hopefully things will work out okay. But we want to be prepared and know everything we can on the front end if at all possible.

Frances, we're sorry to hear that your husband is going through this. We recommend you discuss your concerns with his healthcare team. If his biopsy shows an indication of cancer, and you'd like to arrange for a consultation at MSK, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment.

I just turned 40 in Aug..2 and had the DaVinci surgery on July 7, only had to have the catheter for a week. ..No blood in urine, and no pain after all antibiotics taken..The dribbling i don't like, but i know it takes time. .I just wanna know how long do i have before i can achieve an erection on my own?. I've never had a problem getting it up..Will i have to be on the pill for the remainder of my life?

Dear David, we are sorry to hear about the side effects you have experienced after surgery. Every man has a unique recovery experience, so it's difficult to accurately predict if and when your ability to have an erection without medication will improve. We recommend that you discuss your concerns with your physician. If you were treated at MSK, you may also be interested in reaching out to our Male Sexual and Reproductive Health Program, which offers resources for men who are experiencing sexual health side effects after cancer treatment. To learn more, visit… or contact them directly at 646-888-6024. Thank you for reaching out to us.

Does MSK favor the use of robotics in performing prostrate surgery? I've heard mixed reviews on its effectiveness.

Dear Jack, we sent your inquiry to urologic surgeon Dr. Vincent Laudone and he responded:

"Robot-assisted surgery is used for an increasing variety of cancer operations at Memorial Sloan Kettering. Many of our surgeons perform radical prostatectomies (removal of the prostate gland) using the robot and robotic assisted prostatectomies are the most common treatment for prostate cancer in the USA. However, while the robotic operation seems relatively easy and safe to patients, that doesn’t mean that surgery is appropriate for all men with prostate cancer. The adoption of this technology around the nation has led to overtreatment of prostate cancer for many patients with low-risk cancers that are not dangerous and that should not have been treated in the first place. Some patients may be better served by an active surveillance program. In this approach, treatments such as surgery and radiation therapy are deferred because tests indicate that the tumor is currently not life threatening and is at low risk of progressing. Patients are carefully monitored for any signs of progression or changes in a tumor’s characteristics and treatment can be rendered at any future time as necessary.

"The focus of prostate cancer surgery at MSK is on men with cancer that is truly life threatening. It is important to know that our approach to prostate cancer is to do surgery only when necessary. Studies conducted by doctors at MSK have shown comparable outcomes with robotic and open surgery for men whose prostate cancer needs surgery. Which method is used is largely surgeon dependent. Surgeons get the best results when using the technique that they have the most familiarity and comfort. The robot is only a tool to assist the surgeon and is not a substitute for practiced skill, good judgment, and experience."

We hope this information is helpful. Thank you for reaching out to us.

Is an MRI scan before a prostrate biopsy a recommended method at MSK

Dear Jack, we sent your inquiry to urologic surgeon Vincent Laudone, and he responded:

"Currently there is no test that can reliably replace a biopsy. Prostate MRIs have improved significantly in recent years and are now probably the best indicator of what a biopsy is likely to show in a man with an elevated PSA. If the MRI is completely normal the likelihood that a prostate biopsy will show a significant cancer is low. If the MRI does show a lesion this gives us more confidence in recommending a biopsy and, most importantly, gives us a target to biopsy. New technology allows us to use the MRI images simultaneously with the ultrasound to perform the biopsy. This is called MRI/ultrasound fusion guided biopsy. If cancer is found on biopsy, the MRI provides information regarding the local extent of the disease, identifying spread outside of the prostate, in lymph nodes or in the bones of the pelvis. For all of the above reasons, MRIs are now increasingly recommended prior to biopsy. However, this is an evolving and dynamic technology in which the data regarding accuracy and usefulness of the MRI is still being accumulated. As a result, many insurance carriers do not routinely cover MRIs done prior to biopsy - although this is slowly changing."

We hope this information is helpful. Thank you for reaching out to us.

My husband is two weeks out from a radical prostectomy. He has pain in his penis when he has a bowel movement. Is this typical? Thank you.

Dear Joyce, we are sorry to hear about your husband's health issues. We recommend that he circle back with his surgeon to discuss the pain he is experiencing. It may or may not be related to his surgery, but his surgeon should be able to investigate the cause and hopefully offer options as to what might be done to alleviate it. Thank you for reaching out to us.

Had robotic prostate cancer removal about two ago...the prostate was removed along with 44 lymph nodes and the seminal vesicle which also had cancer....i had a PSA test yesterday and received the results today....My PSA was 0.8...
I believe that indicates that i still have cancer in the area...and take it that i need some kind of further treatment....Just wanted to know how bad that score is and what kind of treatment should i be looking at...

Dear Michael, we are sorry to hear about your diagnosis, and hope you are recovering well from surgery. We recommend that you circle back with your surgeon to talk about what that PSA number means for you, given your particular medical history and the biological characteristics of your disease. If you would like to arrange for a consultation with one of our specialists to discuss possible next steps in your care, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

My boyfriend had a nerve sparing robotic prostatectomy 2 years ago. He's had the development of peyronies that started a year ago with progression in the past 6 months. He's been reluctant to seek treatment until this month. He's also been reluctant to take his prescribed Cialis & we've had intercourse with partial erections on numerous occasions. He now has severe pain following orgasm & intercourse that progress to a point of debilitation & doesn't subside until the following day. He's seeing his MD concerning the curvature at the end of the month & I will not be going with him. Do you have any suggestions on what information I can give him as far as guidance in addressing these issues properly? I'd like to make sure he receives proper assessments & diagnostic are.

Dear Amanda, we are sorry to hear about your boyfriend's health issues. We are glad to know that he is following up with his physician regarding the pain and erectile issues he has been experiencing. His doctor should be able to offer suggestions to help address these problems.

There is also helpful information and resources available regarding the management of sexual issues related to treatment:
Sexual Health for Men:…
FAQ for men:…
From the American Cancer Society:…

We hope this information is useful and wish him all the best as he seeks out the follow up care he needs.

76 yr old. Health overall good. Elevated PSA 12. Biopsy 11 of 12 cores positive for cancer. Gleason 6/7. Bone scan negative. Cancer has not escaped the capsule. Would watchful waiting be advisable?

Hi Gary, a decision about whether to pursue watchful waiting is something you should discuss with your doctor, who is familiar with you and your case. If you'd like to arrange for a consultation with someone at MSK to discuss this, you can call 800-525-2225 or go to for more information on making an appointment. Thank you for your comment, and best wishes to you.

Hello, you mentioned in one response that the hospital approach to surgery (radical prostatectomy) is to perform it primarily in life threatening situations only.
Question: What would life threatening mean in prostate terms?

I have recurrent pc after brachy and ebrt. (2003) Currently considering HIFU or a radical salvage job.

Question: Regarding salvage prostatectomy, would the life threatening come into the picture and follow the same rationale?

David Coppell

David, thank you for reaching out. Each individual case is affected by a large number of factors, so unfortunately our doctors would not be able to determine the threat of cancer in a specific person without a consultation. If you are interested in making an appointment with a Memorial Sloan Kettering physician please call our Physician Referral Service at
800-525-2225 or go to

To learn more about prostate cancer treatment, you also can call the National Cancer Institute’s Cancer Information Service at 800­4CANCER (800­422­6237). To learn more about the CIS, including Live Chat help and how to send them an email message, go to

It's been a week since my husband's robotic prostatectomy and his stomach is swollen like he's pregnant. Also the head of his penis and sack is swollen, but has come down some but not his stomach. He has called the VA to see if this is normal, but they haven't called back yet. Is this normal? We are going back on the 18th should we go back sooner?

Dear Becky, we are sorry to hear bout your husband's health issues. Everyone recovers differently from surgery. We recommend that he report all of his symptoms to his surgeon to rule out any infection or other complications. If you are concerned about waiting, call his doctor's office and see if there is a nurse who can help answer some of your questions over the phone and determine if it's necessary to get an appointment sooner. For anything urgent, please take him to your local emergency room for immediate care. Thank you for reaching out to us.

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