About Your Prostate Surgery

This guide will help you prepare for your prostate surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

About Your Prostate

Your prostate is a walnut-shaped gland that is located below your bladder and lies above your rectum (see Figure 1). It surrounds your urethra, which is the tube that carries urine out of your body). Your prostate works with other glands in your body to make semen.

Seminal vesicles are the small glands near your prostate that make the fluid in semen (see Figure 1).

Lymph nodes are small bean-shaped structures found throughout the body. They make and store cells that fight infection.

Figure 1.
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About Your Prostate Surgery

A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.

A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision (surgical cut), which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.

Open prostatectomy

In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button (see Figure 2). They will remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.

Figure 2. Open prostatectomy incisions

Laparoscopic or robotic-assisted prostatectomy

During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen (belly) (see Figure 3). They will insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to assist with this procedure.

Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
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Before Your Surgery

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

The information in this section will help you prepare for your surgery. Read through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

Preparing for Your Surgery

You and your healthcare team will work together to prepare for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your doctor knows all the medications you’re taking.
  • I take medications I buy over-the-counter (without a prescription), including patches and creams.
  • I take supplements, such as herbs, vitamins, minerals, and natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I have had a problem with anesthesia (medication to make you sleep) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

About Drinking Alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important that you talk with your healthcare providers about your alcohol intake so that we can plan your care.

  • Stopping alcohol suddenly can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medication to help prevent them.
  • If you use alcohol regularly, you may be at risk for other complications during and after surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do to prevent problems before your surgery:

  • Be honest with your healthcare provider about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea, increased anxiety, or can’t sleep after you stop drinking, tell your doctor right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask us any questions you have about drinking and surgery. As always, all of your medical information will be kept confidential.

About Smoking

People who smoke can have breathing problems when they have surgery. Stopping even for a few days before surgery can help. If you smoke, your nurse will refer you to our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

About Sleep Apnea

Sleep apnea is a common breathing disorder that causes a person to stop breathing for short periods while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, the airway becomes completely blocked during sleep. It can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing machine (CPAP) for sleep apnea, bring it with you the day of your surgery.

Ask About Medications

We recommend taking medication to help you achieve an erection. This is to promote blood flow to your penis in order to keep these tissues healthy. Most insurance companies, including Medicare, do not cover sildenafil citrate (Viagra®) or tadalafil (Cialis®) prescriptions. Check with your insurance provider before surgery to see what your policy covers. If these medications are not covered, affordable options may be available. Work with your doctor and nurse to get this process started before your surgery.

Within 30 Days of Your Surgery

Presurgical Testing (PST)

Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your PST appointment.

During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will be giving you medication to put you to sleep during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests necessary to plan your care. Your NP may also recommend you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

It’s very helpful if you bring the following with you to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your doctor(s).

Complete a Health Care Proxy Form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. A health care proxy is a legal document that identifies the person who will speak for you if you’re unable to communicate for yourself. The person you identify is called your health care agent.

If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advanced directive, bring it with you to your next appointment.

Sperm Banking

This surgery will make you infertile. While you will still be able to have an orgasm, you will not be able to produce the sperm needed to have biological children. You should consider sperm banking before your surgery. Ask your nurse to tell you more about this process. For more information, ask your nurse for the resources Building Your Family After Cancer Treatment: Information for Men and Sperm Banking, or search for them on www.mskcc.org/pe

Male Sexual and Reproductive Medicine Program

Most men will have difficulty achieving an erection immediately after surgery. Consider making an appointment with an expert to discuss the effects of this surgery on your sexual health by calling the Male Sexual and Reproductive Medicine Program at 646-888-6024.

Do Breathing and Coughing Exercises

Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.

Exercise

Try to do aerobic exercise every day, such as walking at least 1 mile (1.6 kilometers), swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping market. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Eat a Healthy Diet

You should eat a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your doctor or nurse about meeting with a dietitian.

Identify Your Caregiver

Your caregiver plays an important role in your care. You and your caregiver will learn about your surgery from your healthcare provider. Your caregiver will need to be present after your surgery for the discharge instructions so that they are able to help you care for yourself at home. Your caregiver will also need to take you home after your surgery.

10 Days Before Your Surgery

Stop Taking Vitamin E

If you take vitamin E, stop taking it 10 days before your surgery because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Do Pelvic Floor Muscle (Kegel) Exercises

These exercises will strengthen the muscles that will be weakened from the surgery. Practice Kegel exercises before your surgery, so that you’ll know how it should feel. For more information, read Pelvic Floor Muscle (Kegel) Exercises for Men.

Figure 4. Hibiclens skin cleanser

Purchase Supplies

Hibiclens® is a skin cleanser that kills germs for 24 hours after using it (see Figure 4). Showering with Hibiclens before your surgery will help lower your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.

You also need to purchase a saline enema (such as Fleet®)for your bowel preparation. You can buy this at your local pharmacy without a prescription.

7 Days Before Your Surgery

Stop Taking Certain Medications

If you take aspirin, ask your surgeon if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

Stop Taking Herbal Remedies and Other Supplements

Stop taking herbal remedies or other supplements 7 days before your surgery. If you take a multivitamin, talk with your doctor or nurse about if you should continue. For more information, read Herbal Remedies and Cancer Treatment.

2 Days Before Your Surgery

Stop Taking Certain Medications

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®, Motrin®), or naproxen (Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

1 Day Before Your Surgery

Note the Time of Your Surgery

A clerk from the Admitting Office will call you after 2:00 pm the day before your surgery. The clerk will tell you what time you should arrive at the hospital for your surgery. If you’re scheduled for surgery on a Monday, you will be called on the Friday before. If you don’t receive a call by 7:00 pm the evening before your surgery, please call 212-639-5014.

Eat a Light Diet

Eat a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.

Do Your Bowel Preparation

The night before your surgery use a saline enema as instructed on the box.

Shower with Hibiclens

The night before your surgery, shower using Hibiclens.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well.
  3. Open the Hibiclens bottle. Pour some solution into your hand or a washcloth.
  4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
  5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
  6. Move back into the shower stream to rinse off the Hibiclens.
  7. Dry yourself off with a clean towel after your shower.
  8. Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume after your shower.

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating and drinking before your surgery

12 ounces of water

  • Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
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The Morning of Your Surgery

Shower with Hibiclens

Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens the same way you did the night before.

Don’t put on any lotion, cream, powder, deodorant, makeup, or perfume after your shower.

Take Your Medications

If your doctor or NP instructed you to take certain medications the morning of your surgery, take only those medications with a small sip of water. Depending on what medications you take and the surgery you’re having, this may be all, some, or none of your usual morning medications.

Things to Remember

  • Don’t put on any lotion, cream, deodorant, makeup, powder, or perfume.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Leave valuables, such as credit cards, jewelry, or your checkbook at home.
  • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.

What to Bring

  • A pair of loose-fitting pants. Sweat pants are a good choice.
  • Brief-style underwear that is 1 to 2 sizes larger than you normally wear.
  • Sneakers that lace up. You may have some swelling in your feet, lace up sneakers can accommodate this swelling.
  • Your breathing machine for sleep apnea (such as your CPAP), if you have one.
  • Your portable music player, if you choose. However, someone will need to hold this item for you when you go into surgery.
  • Your incentive spirometer, if you have one.
  • Your Health Care Proxy Form, if you have completed one.
  • Your cell phone and charger.
  • A case for your personal items, such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles, if you have it.
  • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.

Once You’re in the Hospital

You will be asked to state and spell your name and birth date many times. This is for your safety. People with the same or similar names may be having surgery on the same day.

Get Dressed for Surgery

When it’s time to change for surgery, you will get a hospital gown, robe, and nonskid socks to wear.

Meet With Your Nurse

You will meet with your nurse before surgery. Tell your nurse the dose of any medications (including patches and creams) you took after midnight and the time you took them.

Your nurse will place an intravenous (IV) line into a vein, usually in your arm or hand. The IV line will be used to give you fluids and anesthesia during your surgery.

Meet With Your Anesthesiologist

Your anesthesiologist will:

  • Review your medical history with you.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you will receive.
  • Answer any questions you may have about your anesthesia.

Prepare for Surgery

Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to begin. When it’s time for your surgery, your visitor(s) will be shown to the waiting area.

You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You will also have a urinary catheter (Foley®) placed to drain urine from your bladder.

Once your surgery is finished, your incision will be closed with sutures. Your breathing tube is usually taken out while you’re still in the operating room.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your stay and after you leave the hospital. You will learn how to safely recover from your surgery. Write down any questions you have and be sure to ask your doctor or nurse.

What to Expect

When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU) or recovery room.

You will receive oxygen through a thin tube that rests below your nose called a nasal cannula. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have a urinary catheter in your bladder to monitor the amount of urine you’re making. You may also have a Jackson-Pratt® drain (JP drain) to draw out fluid that collects under your incisions. You will also have compression boots to help blood flow in your legs.

You may have a pain pump called a patient-controlled analgesia (PCA) device. For more information, read Patient-Controlled Analgesia (PCA). Your pain medication will be given through an IV line.

Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

  • You will be encouraged to walk with the help of your nurse or physical therapist. We will give you medication to relieve pain. Walking helps reduce the risk for blood clots and pneumonia. It also helps to stimulate your bowels so they begin working again.
  • Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. For more information, read How to Use Your Incentive Spirometer.

Commonly Asked Questions

Will I have pain after my surgery?

Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse.

Typical pain after prostate surgery includes:

  • Pain in your abdomen in the area of your incisions
  • Gas pains
  • Pain in another part of your body, such as your back and shoulders
  • Pressure in your rectum, as if you need to have a bowel movement. The prostate gland lies just above the rectum, so this feeling is common. It will usually go away with time.

What other symptoms may I have after my surgery?

Gas pains after your laparoscopic or robotic-assisted prostatectomy

If you had a laparoscopic or robotic-assisted prostatectomy, the gas used during your surgery may apply pressure and cause pain in different areas of your body, especially your shoulders. This will go away after a few days. Walking around will help your body absorb the gas faster and reduce your pain.

Bladder spasms
You may have bladder spasms after surgery. These can feel like sudden and intense cramping pains in your lower abdomen and penis. You may also feel an urgent need to urinate. These spasms usually get better with time.

Bruising
You will have some bruising on your abdomen, penis, and scrotum. This will go away within 1 to 2 weeks after your surgery.

Bloating
You may have bloating in your abdomen for several days. Walking can help relieve gas and bloating.  Avoid carbonated (fizzy) drinks until you start to pass gas.

How can I manage my pain at home?

You may still have some pain when you go home and will probably be taking pain medication. Follow the guidelines below.

  • Take your medications as directed and as needed.
  • Call your doctor if the medication prescribed for you doesn’t relieve your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication.
  • As your incisions heal, you will have less pain and need less pain medication. A mild pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort. However, large quantities of acetaminophen may be harmful to your liver. Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse.
  • Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. Pain medication is most effective 30 to 45 minutes after taking it.
  • Keep track of when you take your pain medication. Taking it when your pain first begins is more effective than waiting for the pain to get worse.

Pain medication may cause constipation (having fewer bowel movements than what is normal for you).

How can I reduce the swelling in my penis and scrotum?

You will have swelling and bruising of your penis and scrotum. Your scrotum may get as big as a grapefruit. This is normal and will gradually go away once your catheter is removed.

You can help reduce the swelling by raising your scrotum on a rolled towel while you’re sitting or lying down. It also helps to wear brief style underwear instead of boxer shorts.

Do I need to change my diet?

The first few days after your surgery, you should have light foods (sandwich, yogurt, soup, and liquids) until you have your first bowel movement. Avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower. Once you have your first bowel movement, you can go back to your regular diet, as tolerated.

Drinking plenty of liquids is important while your catheter is in place after your surgery. Soups and broth are good choices until you regain your appetite.

How will my bowel function change after surgery?

  • You may not have a bowel movement for up to 5 days after your surgery. This is normal.
  • If you’re passing gas and haven’t had a bowel movement by the second evening you’re home from the hospital, take MiraLAX until your bowel movements are back to normal.
  • If you haven’t had a bowel movement in 4 days, call your doctor or nurse.
  • If you haven’t passed gas in 2 days, call your doctor.
  • Do not use an enema or a suppository for at least 6 weeks after your surgery.

How can I prevent constipation?

  • Take 1 capsule of docusate sodium (Colace®) 3 times a day. This is a stool softener with few side effects.
  • Walking can help stimulate your bowels so they begin working again.
  • Drink 8 (8-ounce) glasses (2 liters) of liquids daily. Drink water, juices, soups, ice cream shakes, and other drinks that don’t have caffeine. Drinks with caffeine, such as coffee and soda, pull fluid out of the body.
  • Slowly increase the fiber in your diet to 25 to 35 grams per day. Fruits, vegetables, whole grains, and cereals contain fiber. If you have an ostomy or have had recent bowel surgery, check with your doctor or nurse before making any changes in your diet.

Can I shower?

Yes. You can shower 24 hours after your surgery. Taking a warm shower is relaxing and can help decrease muscle aches. Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering, and leave your incision uncovered (unless there is drainage). Call your doctor if you see any redness or drainage from your incision.

Don’t take tub baths until you discuss it with your doctor at the first appointment after your surgery.

How do I care for my incisions?

The location of your incision will depend on the type of surgery you had. It’s normal for the skin below your incision to feel numb, because some of the nerves were cut. The numbness will go away over time.

  • By the time you’re ready to leave the hospital, your surgical incision will have begun to heal.
  • You and your caregiver should look at your incision with your nurse before you leave the hospital so you know what it looks like.
  • If any liquid is draining from your incision, you should write down the amount and color. Call your doctor’s office and speak with the nurse about any drainage from your incision.

Change your bandages at least once a day and more often if they become wet with drainage. When there is no longer any drainage coming from your incision, they can be left uncovered.

If you go home with Steri-Strips TM (thin pieces of tape) on your incision, they will loosen and fall off by themselves. If they haven’t fallen off within 10 days, you may remove them.

If you go home with glue over your sutures (stitches), it will also loosen and peel off on its own, similarly to the Steri-Strips. Do not pick at the glue or try to peel it off.

When is it safe for me to drive?

You may resume driving when your catheter is removed as long as you aren’t taking pain medication that may make you drowsy.

Don’t ride on a bicycle or motorcycle for 3 months after your surgery.

What exercises can I do?

Exercise will help you gain strength and feel better. Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed. Ask your doctor or nurse before starting more strenuous exercises.

When can I lift heavy objects?

Check with your doctor before you do any heavy lifting. Normally, you shouldn’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 6 weeks after your surgery. Ask your doctor how long you should avoid heavy lifting.

Will I have any tubes or drains when I go home?

Urinary catheter

When you go home, you will still have the urinary catheter (see Figure 5). Your nurse will teach you how to care for it and will give you supplies to take home. The catheter is usually removed 7 to 14 days after surgery. Taking care of your catheter is a big part of taking care of yourself after surgery. For more information, read Caring for Your Urinary (Foley) Catheter.

Figure 5. Urinary (Foley) catheter

You may have blood, stringy pieces of tissue, and blood clots in your urine while you have your catheter in. This is normal. It happens because the incisions (surgical cuts) inside your body are healing and the scabs are coming off. Drink 1 (8-ounce) glass of water every hour while you’re awake to help pass the blood.

You may also have blood or urine leaking from the tip of your penis around the catheter when you’re walking or having a bowel movement. As long as you’re seeing urine draining into your drainage bag, this is normal. If you don’t see urine in your drainage bag, call your doctor.

Keep the tip of your penis clean and dry. Apply the lubricating gel that your nurse gave you around the tip of your penis. This will prevent irritation.

Jackson-Pratt drain

You may also go home with your Jackson-Pratt drain (see Figure 6). Your doctor will decide when to remove the drain, depending on how much fluid is coming out. If you will need to go home with the drain still in, your nurse will teach you how to care for it. For more information, read Caring for Your Jackson-Pratt Drainage System.

Figure 6. Jackson-Pratt drain

What should I expect after my catheter is removed?

For 2 days after your catheter is removed, your bladder and urethra will be weak. Don’t push or put effort into urinating. Let your urine pass on its own. Don’t strain to have a bowel movement.

Are there special instructions to follow after my catheter is removed?

After your catheter is removed, you should decrease your daily liquid intake to what you normally drink. You should be drinking 4 to 6 (8-ounce) glasses of liquid every day.

  • Limit the amount of liquids you drink after 7:00 pm, and empty your bladder before you go to bed. This might prevent your having to get up at night.
  • Limit how much alcohol and caffeinated liquids you drink if you’re experiencing a lot of urine leakage.
  • Speak with your healthcare provider before you resume your Kegel exercises.

After your catheter is removed, call your doctor or nurse if you:

  • Aren’t able to urinate.
  • Have severe pain in your lower abdomen when you’re urinating.

Will I have trouble controlling my urine?

The muscles that hold urine in your bladder will be weak after your prostate is removed. This is why you may have trouble controlling your urine.

Other reasons you may have urinary leakage include:

  • Your bladder is full
  • You’re tired
  • You drink alcohol or drinks that contain caffeine

It may take several months to regain full control of your bladder.

Once your catheter is removed, you can do exercises to strengthen your muscles. These are the pelvic floor muscle (Kegel) exercises you practiced before your surgery.

You may also have urine leakage after your catheter is removed. It will slowly decrease over time. You may have some leakage when you strain, cough, or lift things. This is called stress incontinence.

At first, you may notice that your bladder control is better at night. This is because there is less pressure on your bladder when you’re lying down. For the first few months after your surgery, you may feel that you have to urinate often. Your bladder will take time to expand after it has been kept empty by the catheter.

For most people, urinary control will not be a problem. Your muscle strength will continue to improve for up to 12 months after surgery. If after 12 months you’re having problems with controlling your urine, talk with your surgeon. Surgical procedures such as a urethral sling or an artificial urinary sphincter may help. For additional information, visit the National Association for Continence website www.nafc.org

When can I go back to work?

Most people are able to return to work about 2 to 4 weeks after surgery. You may be comfortable with desk or office work once your catheter is taken out. If your work requires heavy physical activity, you may need a longer time to recover. Talk with your surgeon about when it will be safe to return to work.

When can I resume sexual activity?

You may resume sexual activity after your urinary catheter is removed.

Will I be able to get an erection?

Erectile dysfunction, usually called ED, means not being able to get an erection. After your prostate surgery, it will take time (weeks to months) for your erectile function to recover. In the initial weeks after having your catheter removed, you may not be able to achieve erections hard enough for sex, even with the use of medications like sildenafil citrate (Viagra). Your healthcare team will talk with you about your options to try to improve your ability to achieve an erection.

What are my options for treating erectile dysfunction?

We recommend taking medication for erectile dysfunction on a daily basis. This is to promote blood flow to your penis in order to keep these tissues healthy. Many insurance companies do not cover sildenafil citrate (Viagra) prescriptions. Check with your insurance provider before surgery to see what your policy covers.

Your doctor or nurse will give you information about your medication plan. Keep following this plan until your see your surgeon during your post-operative (post-op) visit.

Your plan may be one of the following:

Medication

Normal dose

Challenge dose

sildenafil citrate

(Viagra)

  • Take 25 mg 6 nights per week.
  • To make the 25 mg dose, split a 100 mg pill into 4 pieces. Use a pill cutter from your local drug store.
  • Take 100 mg 1 night per week.

sildenafil citrate

(generic)

  • Take 1 (20 mg) pill 6 nights per week.
  • Take 5 (20 mg) pills 1 night per week. This is a total of 100 mg.

tadalafil (Cialis)

20 mg pills

  • Take 1 (20 mg) pill every other day.
  • Do not take a challenge dose. A 20 mg dose of tadalafil (Cialis) is the highest dose you should take.

tadalafil (Cialis)

5 mg pills

  • Take 1 (5mg) pill 6 nights per week.
  • Take 4 (5 mg) pills 1 night per week. This is a total of 20 mg.

About the challenge dose

  • When you take the challenge dose, take the medication on an empty stomach. Take it about 2 hours before your evening meal.
  • The medication takes 30 to 60 minutes to start working. It will last in your system for up to 8 hours. At any time during these 8 hours, try to become sexually aroused through contact with a partner or yourself. Write down what happened and tell your doctor during your next visit.
  • If you haven’t had any response after trying the challenge dose for 4 weeks, call your doctor’s office. Your doctor may refer you to our Sexual Medicine team.

What if the pills aren’t working?

You may not be able to achieve erections hard enough for sex right away, even with pills like Viagra. This will take time. Taking the medication your doctor prescribed to you can help improve your ability to achieve an erection, but it may not work for everyone.  

If the medication isn’t working for you, there are other things you can do to achieve an erection. If you’re interested in learning about other treatment options for erectile dysfunction, make an appointment with our Male Sexual and Reproductive Medicine Program by calling 646-888-6024.

When will I get my pathology results?

Your surgeon will receive your results 10 to 14 days after your surgery. If you don’t receive a phone call after 14 days, call your surgeon’s office.

What should I talk to my doctor about?

  • Your final pathology report
  • Your PSA results
  • Any problems with your recovery
  • Any other treatment that you may need

What kind of follow-up care will I need?

You will need to have prostate-specific antigen (PSA) blood tests done after your surgery. PSA is a normal protein made by your prostate gland. PSA levels typically increase when cancer is present. If the cancer has been completely removed, the PSA level should not be detectable.

  • Have a PSA blood test done at the following times:
    • 6 to 8 weeks after surgery                  Date: ______________________________
    • 3 to 6 months after surgery                Date: ______________________________
    • 12 months after surgery                     Date: ______________________________
  • Starting 12 months after your surgery, have a PSA blood test done every 6 months. Do this until 5 years following your surgery.
  • Starting 5 years after your surgery, have a PSA blood test done every 12 months. Do this for life.
  • Your doctor may ask you to have PSA blood tests done more often. If they do, your nurse will give you more information.

If possible, have your PSA blood test done at a MSK location. If you can’t have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK doctor’s office.

MSK doctor: ___________________________

Fax number: ___________________________

Can I continue at MSK for my follow-up care?

Yes. We offer comprehensive follow-up care for men who were treated here for prostate cancer in our Survivorship Program. Your doctor will help you decide when you’re ready for this step. The program will help support you as you recover from the physical and emotional effects of prostate cancer, as well as watch for any signs of the cancer coming back.

An NP will work closely with your doctor and will be responsible for your care. The NP is a member of the prostate cancer treatment team at MSK and an expert in the care of cancer survivors. Your NP will:

  • Look for signs of the cancer returning.
  • Manage any effects of treatment, such as pain and fatigue.
  • Recommend screening tests for other cancers.
  • Provide counseling about living a healthy lifestyle, such as diet, exercise, and quitting smoking.

During visits with your NP, you will:

  • Talk with you about your medical history.
  • Perform a physical exam.
  • Order tests, such as x-rays, scans, and blood tests.
  • Make referrals to other healthcare providers, if needed.
  • Prescribe medication, if needed.

If you would like more information about our Survivorship program, talk with your doctor or nurse or visit our Survivorship Center online at www.mskcc.org/experience/living-beyond-cancer

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Many resources are available to patients and their families. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are here to help you and your family and friends handle the emotional aspects of your illness.

What if I have other questions?

If you have any questions or concerns, please talk with your doctor or nurse. You can reach them Monday through Friday from 9:00 am to 5:00 pm.

After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask for the doctor on call for your doctor.

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Resources

Educational Resources

MSK Support Services

This section contains a list of MSK support services, as well as the resources that were referred to throughout this guide. These resources will help you prepare for your surgery and recover safely. Write down any questions you have and be sure to ask your doctor or nurse.

Anesthesia
212-639-6840
Call with any questions about anesthesia.

Blood Donor Room
212-639-7643
Call for more information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Chaplaincy Service
212-639-5982
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital, and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.

Incontinence Specialist
646-497-9068
If you think you’d benefit from a consultation with a urologic surgeon specializing in incontinence, talk with your surgeon for a referral.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Male Sexual Reproductive Medicine Program
646-888-6024
Our Male Sexual and Reproductive Medicine Program helps male patients who are dealing with cancer-related sexual health challenges, including erectile dysfunction.

MSK Prostate Cancer Support Group
646-888-8106
This is a monthly meeting for men who have been treated for prostate cancer. Call for more information or to register.

Patient-to-Patient Support Program
212-639-5007
You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, we are able to offer you a chance to speak with former patients and caregivers.

Patient Billing
646-227-3378
Call Patient Billing with any questions regarding preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have any questions about the Health Care Proxy Form or if you have any concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have any questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for more information.

For additional online information, visit LIBGUIDES on MSK’s library website at http://library.mskcc.org or the prostate cancer section of www.mskcc.org. You can also contact the library reference staff at 212-639-7439 for help.

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External Resources

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who are unable to take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

The American Urologic Association Foundation
www.auafoundation.org
866-746-4282
Offers free information about prostate diseases.

Cancer and Careers
www.cancerandcareers.org
A comprehensive resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for those who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

fertileHOPE
www.fertilehope.org
855-220-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance,meet the income criteria, and be prescribed medication that is part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including a online support groups and a database of LGBT friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National Cancer Institute (NCI)
www.cancer.gov
800-4-CANCER (800-422-6237)
Provides education and support to cancer patients and their families.

National Association for Continence
www.nafc.org
Provides information and support for people dealing with incontinence.

National Comprehensive Cancer Network (NCCN)
www.nccn.org
215-690-0300
Has information and resources for people living with cancer and their caregivers, including support groups and education. Publications that may be helpful include:

Prostate Cancer Guidelines for Patients
www.nccn.org/patients/guidelines/prostate/files/assets/common/downloads/files/prostate.pdf

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

Prostate Cancer Foundation
www.pcf.org
800-757-CURE (800-757-2873)
Provides prostate cancer education and support programs.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people obtain medications that they have trouble affording.

SHARE
www.sharecancersupport.org
866-891-2392
Offers support groups for survivors of breast, metastatic breast, and ovarian cancer in Manhattan, Queens, Brooklyn, and Staten Island.

US TOO
www.ustoo.org
800-808-7866
Provides prostate cancer education and support programs. Meetings are open to people living with cancer and their caregivers. US TOO has a monthly newsletter called Hotsheet.

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