Prostate removal (prostatectomy) is an effective approach for treating localized prostate cancer. A radical prostatectomy is the surgical removal of the whole prostate, the seminal vesicles, and associated pelvic lymph nodes. Not everyone with prostate cancer requires a radical prostatectomy. If your urologist recommends radical prostatectomy to treat your prostate cancer, you will probably have questions. And quality care starts with a conversation. Here are topics to discuss with your doctor before you have a radical prostatectomy. Why Do I Need a Prostatectomy? Cancer cells can grow and spread throughout the entire prostate gland. Urologists perform a radical prostatectomy to ensure they remove all the cancer cells from the prostate gland, nearby tissues, and lymph nodes. Your doctor may recommend a radical prostatectomy based on the extent and aggressiveness of your cancer. Generally, prostate cancer surgery is recommended for otherwise healthy men whose cancer is confined to the prostate and in certain men with prostate cancer that has begun to spread outside the prostate to the seminal vesicles. Ask your doctor to explain why he or she recommends radical prostatectomy for you. Are There Other Treatment Options? A radical prostatectomy is major surgery with serious risks and potential complications. You may have less invasive treatment options. These include procedures that use heat, such as with a laser or electrical current, to destroy prostate tissue. Ask your doctor about all of your treatment options and consider getting a second opinion before having a radical prostatectomy. How Do Doctors Perform a Radical Prostatectomy? There are several ways in which urologists remove the prostate gland. There are three techniques for radical prostatectomy: Open surgery is the removal of the prostate gland and surrounding nodes and tissue through a four-inch incision made in either the abdomen wall (retropubic prostatectomy) or between the scrotum and anus (perineal prostatectomy). Laparoscopic prostatectomy is minimally invasive surgery in which several small incisions are made in the abdomen to access and remove the prostate. Laparoscopic prostatectomy is less traumatic and generally involves a faster recovery, less pain, and a lower risk of complications than open prostatectomy. Robot-assisted laparoscopic prostatectomy is a minimally invasive surgery in which a surgical robotic system is used to remove the prostate gland. The robotic system provides precise prostate removal and the same benefits as laparoscopic prostatectomy. Ask your doctor what surgical technique he or she thinks is right for you. Ask about success rates, side effects, risks, and how long it may take for you to heal. What Are the Possible Side Effects from a Radical Prostatectomy? All surgeries pose certain risks, such as bleeding and blood clots. Erectile dysfunction (ED) and short-term urinary incontinence are the most common side effects associated with having a radical prostatectomy. Many factors influence the risk of side effects, including your age, health, stage of cancer, and sexual function before surgery. ED may be temporary. There are also medications and devices you can use to treat ED. Also, urinary incontinence treatments are available, including medicine, protective pads, and surgery. Your doctor will do as much as possible to limit side effects and remove all of your cancer. This is not a time to be timid. Be candid and ask your doctor about his or her patients’ outcomes in terms of side effects. For example, you might ask, “What percentage of your patients develop ED or urinary incontinence after surgery?” And, “How long does the ED or urinary incontinence last?” Your surgeon has had this conversation with many previous men and nothing you ask will be considered embarrassing. You may be a candidate for nerve-sparing surgery, which has the potential to save some of the nerves that control erection. Talk to your doctor to learn more about your options and individual risks for nerve-sparing surgery. Can Radical Prostatectomy Cure Prostate Cancer? Radical prostatectomy alone can cure prostate cancer that is confined to the prostate. The chance of cure at 10 years is more than 90%. However, if the cancer has spread beyond the prostate, additional treatment, including radiation or hormone treatment may be necessary. Questions to Ask Your Doctor Facing surgery can be stressful. Educating yourself on the procedure can help ease your anxiety. Here are some additional questions you may want to ask your doctor before having a radical prostatectomy. How long will surgery take? When can I go home? What restrictions will I have after the surgery? When can I return to work and other activities? What assistance will I need at home? What type of side effects will I have? How long do I have to wait to have sex after the surgery?