This guide will help you get ready for your prostate surgery at MSK. It will also help you know what to expect as you recover.
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.
About your prostate surgery
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.
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.
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.
Before your prostate surgery
This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.
As you read this section, write down questions to ask your healthcare provider.
Getting ready for your surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.
I take an anticoagulant (blood thinner), such as:
These are examples of medicines. There are others.
Be sure your healthcare provider knows all the medicines you’re taking.- Aspirin
- Heparin
- Warfarin (Jantoven®, Coumadin®)
- Clopidogrel (Plavix®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
- I take an SGLT2 inhibitor, such as:
- Canagliflozin (Invokana®)
- Dapagliflozin (Farxiga®)
- Empagliflozin (Jardiance®)
- Ertugliflozin (Steglatro®)
- I take prescription medicine(s), including patches and creams. A prescription medicine is one you can only get with a prescription from your healthcare provider.
- I take over-the-counter medicine(s), including patches and creams. An over-the-counter medicine is one you can buy without a prescription.
- I take dietary supplements, such as herbs, vitamins, minerals, or 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 (A-nes-THEE-zhuh) in the past. Anesthesia is medicine to make you sleep during a surgery or procedure.
- I’m allergic to certain medicines or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
- I use recreational drugs, such as marijuana.
About drinking alcohol
It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medicine to help prevent them.
Here are things you can do before your surgery to keep from having problems.
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- Feel nauseous (like you’re going to throw up).
- Feel more anxious (nervous or worried) than usual.
- Cannot sleep.
These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you cannot stop drinking.
- Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.
About smoking
If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.
Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.
About sleep apnea
Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.
OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.
Using MyMSK
MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.
If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.
Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal (www.mskcc.org/pe/enroll_mymsk) to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.
Ask about medicines
We recommend taking medicine 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 medicines 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)
You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location.
You can eat and take your usual medicine(s) the day of your PST appointment.
It’s helpful to bring these things to your appointment:
- A list of all the medicines you’re taking, including prescription and over-the-counter medicines, patches, and creams.
- Results of any medical tests done outside of MSK in the past year, if you have them. Examples include results from a cardiac stress test, echocardiogram, or carotid doppler study.
- The names and telephone numbers of your healthcare providers.
You’ll meet with an advance practice provider (APP) during your PST appointment. They work closely with MSK’s anesthesiology (A-nes-THEE-zee-AH-loh-jee) staff. These are doctors with special training in using anesthesia during a surgery or procedure.
Your APP will review your medical and surgical history with you. You may have tests to plan your care, such as:
- An electrocardiogram (EKG) to check your heart rhythm.
- A chest X-ray.
- Blood tests.
Your APP may recommend you see other healthcare providers. They’ll also talk with you about which medicine(s) to take the morning of your surgery.
Identify your caregiver
Your caregiver has an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.
For caregivers
Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers (www.mskcc.org/pe/guide_caregivers) to learn more.
Fill out a Health Care Proxy form
If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.
- To learn about health care proxies and other advance directives, read Advance Care Planning for People With Cancer and Their Loved Ones (www.mskcc.org/pe/advance_care_planning).
- To learn about being a health care agent, read How to Be a Health Care Agent (www.mskcc.org/pe/health_care_agent).
Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.
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.
To learn more, read Building Your Family After Cancer Treatment: For People Born With Testicles (www.mskcc.org/pe/building_family_born_testicles) and Sperm Banking (www.mskcc.org/pe/sperm_banking).
Male Sexual and Reproductive Medicine Program
Most people will have difficulty achieving an erection right after surgery. Consider making an appointment with an expert to discuss the effects of this surgery on your sexual health. You can reach MSK’s Male Sexual and Reproductive Medicine Program by calling 646-888-6024.
Do breathing and coughing exercises
Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. To learn more, read How To Use Your Incentive Spirometer (www.mskcc.org/pe/incentive_spirometer).
Do physical activity
Doing physical activity will help your body get into its best condition for your surgery. It will also make your recovery faster and easier.
Try to do physical activity every day. Any activity that makes your heart beat faster, such as walking, swimming, or biking, is a good choice. If it’s cold outside, use stairs in your home or go to a mall or shopping center.
Follow a healthy diet
Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.
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. To learn more, read Pelvic Floor Muscle (Kegel) Exercises for Males (www.mskcc.org/pe/kegels_males).
Do not do pelvic floor muscle (Kegel) exercises while you have a Foley catheter in place.
Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser, such as Hibiclens®
4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.
Buy a saline enema, such as a Fleet® saline enema
You also need to buy a saline enema for your bowel preparation. You can buy this at your local pharmacy without a prescription.
7 days before your surgery
Follow your healthcare provider’s instructions for taking aspirin
Aspirin can cause bleeding. If you take aspirin or a medicine that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.
To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil (www.mskcc.org/pe/check-med-supplement).
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read Herbal Remedies and Cancer Treatment (www.mskcc.org/pe/herbal_remedies).
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.
To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil (www.mskcc.org/pe/check-med-supplement).
1 day before your surgery
Follow a light diet
Follow a light diet the day before your surgery. A light diet includes things such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink. Avoid fried foods and foods with a lot of seasoning.
Do your bowel preparation
The night before your surgery, give yourself a saline enema. Follow the instructions on the box.
Note the time of your surgery
A staff member will call you after the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by , call 212-639-5014.
The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.
Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens
Shower with a 4% CHG solution antiseptic skin cleanser before you go to bed the night before your surgery.
- Wash your hair with your usual shampoo and conditioner. Rinse your head well.
- Wash your face and genital (groin) area with your usual soap. Rinse your body well with warm water.
- Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
- Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area.
- Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
- Dry yourself off with a clean towel.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Instructions for eating and drinking: 8 hours before your arrival time
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The day of your surgery
Remember, starting 8 hours before your arrival time, do not eat or drink anything except the things listed above.
Instructions for drinking: 2 hours before your arrival time
 | Stop drinking 2 hours before your arrival time. This includes water. |
Take your medicines as instructed
A member of your care team will tell you which medicines to take the morning of your surgery. Take only those medicines with a sip of water. Depending on what you usually take, this may be all, some, or none of your usual morning medicines.
Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
- Leave valuable items at home.
What to bring
- A pair of loose-fitting pants, such as sweatpants.
- Brief-style underwear that is 1 to 2 sizes bigger than you usually wear.
- Sneakers that lace up. You may have some swelling in your feet after surgery. Lace-up sneakers can fit over this swelling.
- Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
- Your incentive spirometer, if you have one.
- Your Health Care Proxy form and other advance directives, if you filled them out.
- Your cell phone and charger.
- Only the money you may want for small purchases, such as a newspaper.
- A case for your personal items, if you have any. Eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal items.
- This guide. You’ll use it to learn how to care for yourself after surgery.
Once you’re in the hospital
Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.
We’ll give you a hospital gown, robe, and nonskid socks to wear when it’s time to change for surgery.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist (A-nes-THEE-zee-AH-loh-jist) will do it in the operating room.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer questions you have about anesthesia.
Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give you pain medicine after your surgery.
Get ready for surgery
When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.
You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.
Your surgeon will close your incisions with sutures (stitches) once they finish your surgery. They may also place Steri-Strips™ (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incisions. They’ll cover your incisions with a bandage.
Your care team will usually take out your breathing tube while you’re still in the operating room.
After your prostate surgery
This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.
As you read this section, write down questions to ask your healthcare provider.
What to expect
When you wake up after your surgery, you’ll be in the Post Anesthesia Care Unit (PACU) or recovery room. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask over your nose and mouth. You’ll also have compression boots on your lower legs.
You will have a urinary catheter in your bladder to keep track of how much urine you’re making. You may also have a Jackson Pratt (JP) drain to draw out fluid that collects under your incisions.
You’ll get pain medicine through your IV line. You may have a pain pump called a patient-controlled analgesia (PCA) device. To learn more, read Patient-Controlled Analgesia (PCA) (www.mskcc.org/pe/pca).
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. To learn more, read How To Use Your Incentive Spirometer (www.mskcc.org/pe/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 medicine as needed. If your pain isn’t relieved, tell your doctor or nurse.
Typical pain after prostate surgery includes:
- Pain in your abdomen around 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 these guidelines to help manage your pain at home.
- Take your medicines as directed and as needed.
- Call your healthcare provider if the medicine prescribed for you does not help your pain.
- Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
- You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
- Follow your healthcare provider’s instructions for stopping your prescription pain medicine.
- Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.
- Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.
- Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
- Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.
Some prescription pain medicines, such as opioids, may cause constipation. Constipation is when you poop less often than usual, have a harder time pooping, or both.
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 start working again.
- Drink 8 (8-ounce) cups (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 started to heal.
- You 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 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, 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.
Do not 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’ll 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. To learn more, read About Your Urinary (Foley) Catheter: How To Clean and Care for It (www.mskcc.org/pe/caring_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) cup 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 healthcare provider.
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.
Caring for your uncircumcised penis
After your surgery, you might pull your foreskin (the loose skin that covers the head of your penis) back to clean or lubricate the tip of your penis. Always put your foreskin back over the head of your penis after cleaning or lubricating.
If you leave your foreskin pulled back, it can get stuck behind the head of your penis and keep blood from flowing through your penis. Putting it back over the head of your penis will prevent serious problems.
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) cups of liquid every day.
- Limit the amount of liquids you drink after 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:
- Can’t urinate.
- Have severe (very bad) 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. Visit the National Association for Continence website www.nafc.org for more information.
Call your doctor right away if you have severe pain in your lower abdomen when you are urinating or if you cannot urinate. The catheter may need to be put back in.
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 achieve an erection?
Erectile dysfunction, usually called ED, means not being able to achieve 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 ED?
We recommend taking medication for ED every day. This is to promote blood flow to your penis 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 a 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 a week. |
| sildenafil citrate (generic) | Take 1 (20 mg) pill 6 nights a week. | Take 5 (20 mg) pills 1 night a 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 a week. | Take 4 (5 mg) pills 1 night a 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.
- 3 to 6 months after surgery.
- 12 months after surgery.
- 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.
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.
Talk with your doctor or nurse or visit our Survivorship Center online at www.mskcc.org/experience/living-beyond-cancer/survivorship/adult-survivorship to learn more.
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.
When to call your healthcare provider
Call your healthcare provider right away if:
- You have a fever of 101° F (38.3° C) or higher.
- Have severe pain in your lower abdomen (belly) when you’re urinating.
- You cannot urinate.
- You have swelling or tenderness in your calves or thighs, especially if 1 leg is more swollen than the other.
- You become short of breath or are coughing up blood.
Contact information
If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from to Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call.
If you’re not sure how to reach your healthcare provider, call 212-639-2000.
Support services
This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.
As you read this section, write down questions to ask your healthcare provider.
MSK support services
Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.
Anesthesia
212-639-6840
Call if you have questions about anesthesia.
Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.
Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.
Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.
Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.
Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.
You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.
MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.
Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.
Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.
Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.
Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.
Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.
- Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
- An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.
Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.
This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems such as premature menopause or fertility issues. Ask a member of your MSK care team for a referral or call 646-888-5076 to learn more.
- Our Male Sexual and Reproductive Medicine Program can help with sexual health problems such as erectile dysfunction (ED). Ask a member of your care team for a referral or call 646-888-6024 to learn more.
Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.
Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.
Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).
MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.
Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call to learn more.
Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.
Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.
External support services
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 can’t 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.
Cancer and Careers
www.cancerandcareers.org
646-929-8032
A 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 people 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.
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 medicine that’s 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 medicines 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
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including 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.
Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)
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 medicines.
NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help 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.
Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.
Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medicines they have trouble affording.
Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.
Prostate cancer support services
The American Urologic Association Foundation
www.auafoundation.org
866-746-4282
Offers free information about prostate diseases.
MSK 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.
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.
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. The publication Prostate Cancer Guidelines for Patients may be helpful.
Prostate Cancer Foundation
www.pcf.org
800-757-CURE (800-757-2873)
Provides prostate cancer education and support programs.
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.
Educational resources
This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.
As you read these resources, write down questions to ask your healthcare provider.
- A Guide for Caregivers (www.mskcc.org/pe/guide_caregivers)
- About Your Urinary (Foley) Catheter: How To Clean and Care for It (www.mskcc.org/pe/caring_foley_catheter)
- Advance Care Planning for People With Cancer and Their Loved Ones (www.mskcc.org/pe/advance_care_planning)
- Building Your Family After Cancer Treatment: For People Born With Testicles (www.mskcc.org/pe/building_family_born_testicles)
- Call! Don't Fall! (www.mskcc.org/pe/call_dont_fall)
- How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil (www.mskcc.org/pe/check-med-supplement)
- Frequently Asked Questions About Walking After Your Surgery (www.mskcc.org/pe/walking_after_surgery)
- Herbal Remedies and Cancer Treatment (www.mskcc.org/pe/herbal_remedies)
- How to Be a Health Care Agent (www.mskcc.org/pe/health_care_agent)
- How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal (www.mskcc.org/pe/enroll_mymsk)
- How To Use Your Incentive Spirometer (www.mskcc.org/pe/incentive_spirometer)
- Patient-Controlled Analgesia (PCA) (www.mskcc.org/pe/pca)
- Pelvic Floor Muscle (Kegel) Exercises for Males (www.mskcc.org/pe/kegels_males)
- Sperm Banking (www.mskcc.org/pe/sperm_banking)
- What You Can Do to Avoid Falling (www.mskcc.org/pe/avoid_falling)