Prostatectomy: What Surgical Removal of the Prostate Involves

Whether it's being done to treat prostate cancer or a severely enlarged prostate that hasn't responded to other treatments, prostatectomy is a well-established procedure with several modern surgical approaches. Here's what to expect.

What Is a Prostatectomy?

Prostatectomy refers to the surgical removal of all or part of the prostate gland. It's performed for two broad reasons: as a treatment for localized prostate cancer (radical prostatectomy, removing the entire gland along with surrounding tissue), or to relieve severe urinary blockage caused by an enlarged prostate (simple prostatectomy or transurethral procedures like TURP, which remove only the obstructing portion of tissue). The right approach depends heavily on the underlying diagnosis, the size of the prostate, and your overall health.

Types of Prostatectomy

• TURP (Transurethral Resection of the Prostate): Performed entirely through the urethra with no external incision; removes excess tissue causing blockage in cases of benign prostate enlargement.
• HoLEP (Holmium Laser Enucleation of the Prostate): A laser-based technique that removes obstructing tissue with less bleeding, often suited to larger prostates.
• Open/simple prostatectomy: Reserved for very large prostates where a scope-based approach isn't practical; involves a lower abdominal incision.
• Radical prostatectomy (open, laparoscopic, or robotic): Removes the entire prostate gland along with nearby tissue, used to treat localized prostate cancer.

Who Needs a Prostatectomy?

For non-cancerous (benign) enlargement, prostatectomy is generally considered when symptoms are severe, medications haven't provided adequate relief, or complications like recurrent urinary retention, bladder stones, or kidney impact have developed. For prostate cancer confined to the gland, radical prostatectomy is one of several established treatment options, alongside radiation therapy and active surveillance, and the choice depends on cancer characteristics, age, and personal preference discussed with your oncologic urologist.

How the Procedure Works

Transurethral approaches (TURP, HoLEP) involve no external cut at all — a scope is passed through the urethra to remove tissue directly, typically under spinal or general anesthesia, taking around 60 to 90 minutes. Radical or open prostatectomy involves either a lower abdominal incision or several small laparoscopic/robotic ports, with the entire gland carefully dissected free and removed, generally taking two to three hours. In all cases, a urinary catheter is placed afterward to support healing while the urethra recovers.

Recovery

• Hospital stay: 1–2 days for transurethral procedures; 1–3 days for radical prostatectomy.
• Catheter period: Typically 3–10 days depending on the procedure type.
• Return to normal activity: A few days to a few weeks for scope-based procedures; 4–6 weeks for open or robotic radical prostatectomy.
• Follow-up care: Regular check-ins to monitor urinary function and, for cancer surgery, PSA levels over time.

The Takeaway

Prostatectomy techniques have advanced considerably, offering options ranging from incision-free transurethral procedures to precise robotic surgery for cancer. Your urologist will walk you through which approach fits your specific diagnosis, prostate size, and health goals.