What can I expect after radical prostatectomy surgery?

I had RP 2 years ago when I was 74, Gleason 9 CR locally advanced PC. The surgery was Ro Bo, no real pain, catheter for a week ( an irritation but no pain) . Only Tylenol for pain for a day or so. Afterward, ADT for 6 months. Again no pain, but little energy and no libido. It was a necessary procedure to deal with a life threatening cancer. I think that the RP was a correct decision and I am hopeful for a long term good result.

RP Aug 2022 at age 72 recovery went well for me. Recovery takes some time, but just take it easy.
Played golf 6 & 10 wks post op, and took a 5 day driving trip to Lake Geneva, NY in 8th week.
PT before and after were critical in regaining continence control.
Walked in the house 1st 10 days; 5 min intervals; 20 mins with catheter bag in a plastic wash bucket. Continued walking after cath came out.
Obey lifting restrictions.
Best wishes for success.

Hello,
You’re tests results are almost identical to mine. My PSA was 4.2. At age 73, I had my surgery in January 2022. The surgeon informed me just before my surgery, that he would have to “cut wide” in order to get all the cancer. There was also a tumor that needed to be removed. Ugh. I was released from the hospital the same day and had my catheter taken out after 7 days. The Mayo Clinic tested 8 lymphs tissues and unfortunately found cancer in one. My recovery: Long story short, a good one, is that I’ve recovered well. I have not been tired and have been able to continue with a passion of mine: running. I was incontinent for 10 months and impotent for 18. I chose not to have the recommended 39 radiation treatments and 24 months of Lupron shots. Instead, I signed up for active surveillance, which included PSA testing every 3 months and switching to a Mediterranean Diet. (One that does not generate testosterone.) So far my oncologist and I have been pleased. My PSA level has been undetectable. Starting in January 2024, I’ll phase back to twice-a-year testing, for two years. Good luck with your surgery and your recovery!

I had my RALP last August at 60 years old. My PSA was also around 4. 2 cores at 4 + 3 and 2 at 3 + 3. My pathology came back clear so no ADT or radiation recommended at the time. So far my PSA is undetectable. My recovery was pain free from the surgery. Had shoulder soreness for a week. Was told that was from the gas pumped into me for surgery. I think it's from being placed on an articulating table for the surgery and being manipulated in a bunch of different locations. Catheter for 8 days. Removal no big deal. I was pretty much continent immediately. I had nerve sparing surgery so everything with that is ok. No loss of sensation. You may need help emptying cath bag your first night home as it was difficult to bend. After 1 day I was fine. I spent 1 night in hospital and started walking in the hall immediately. Do not lift anything heavy until you get the green light. This was my first surgery. Pleasantly surprised by lack of pain. Take all the time you need to recover. I had 8 weeks off from work as I work im a test lab and lifting was part of my job. Went back to gym at 8 weeks also. My doctor prescribed PT for pelvic core after surgery. This basically just taught me how to do Kegels correctly. Good luck with your surgery. You'll be fine and back to your normal routine quicker than you imagine.

Matthew I was 3+3=6 but after prostatectomy surgery was 3+4=7 also high risk 93%. Glad I did surgery. All cancer contained in prostate, no limp node removed. Test during surgery were clean. Surgery was 3 weeks 6 days ago June 12. Lot of pain from catheter and gas it took 5 days not to be miserable all the time, did very little walking, only to relieve gas pain. Catheter was bad for me only wore sweats shorts no underwear. Took 16 of 30 pain pills then just Tylenol only. When catheter is removed make sure you relax I did not. Lack of communication with nurse, I did yell my fault as nurse said I was only man that said it hurt. There were many unexpected emotions I experienced. Yesterday was first day to sit in regular chair and be able to lean forward. Leaning back was much better for me , bed or recliner till yesterday. Not all is bad, continuance is getting better. Morning till about 4pm is good after that more leaking but not bad. @ 2 max pads during day. Night very 1 to 3 pads. Pull up used till yesterday now in boxer briefs with pads. Now great news inter course with wife last night, it was great . Did so with help of vacuum pump but was half way errect before pump. I did get several half way errections in last 2 weeks. I don’t know if all had this but 2 to 3 day after catheter was removed I had to sit to pee. Penis became a innie and nothing sticking out to grab so made a mess. But day 4 all was much better and has been ever since. The unknown was what was bad for me. If I knew then what I known now about all these little details would have helped me. Good luck it is not as bad as you are expecting but there are tough times. I am happy to be where I am now and with decision to do surgery well worth it to be currently cancer free. Again wishing and praying for you.

I had RALP 3 months ago with a similar diagnostic profile. I'm 74, was very active prior to surgery. There are four areas to be aware of:

1. Immediate post-op recovery issues. I had minimal pain, no narcotics after I went home 24 hours after leaving OR. The shoulder tip pain mentioned is a possibility, caused by diaphragmatic irritation by the gas used to distend the abdomen so the surgeon can see all the way down there. There will be lower abdominal and penile/scrotal swelling and bruising which lasted 10-12 days for me.
2. Bladder. Yes, there's a catheter, and it is irritating, but should not be painful. It will come out after 5-7 days, so just resign yourself. More important, SEE A PHYSICAL THERAPIST NOW to begin Kegel's pelvic floor muscle training IMMEDIATELY. This will help speed the return of continence post-op. E.g., after 10-12 weeks, most men will have little leakage (maybe a tablespoon a day).
3. Sexual function. You will NOT lose the ability to have an orgasm - different nerve pathways not affected by surgery. I was able to stimulate one within a day after cath removal. But no fluid comes out! Erections, however, are lost for 6-24 months. It is imperative to keep the blood flow filling the penis on a regular basis, though. Talk to your doc about that. Methods: pills, pumps, stimulation. If your doc seems unconcerned, be aware there are many online resources to provide more in-depth answers. Google "penile rehabilitation after prostate cancer surgery.
4. Most important, "curing" the cancer. PSA tests will be done @ 6-12 weeks after surgery, periodically thereafter. Even if undetectable, it can "come back" years later. I tried not to explore the possibilities until AFTER the results came back. Each case is unique, and I think it's best to focus on what I actually know, not what might be.

I walked daily immediately after surgery. Began lifting light weights (no core muscle straining!) after two weeks. Started swimming and running after 4, and biking after 12. I was TIRED, to the point of 2 x 30 minute naps a day plus an extra 30-40 minutes of sleep a night. The body is doing a LOT of work to repair the damage, even if it doesn't hurt. Feed it lots of protein.

Good luck!

Very good and detailed advise and I completely agree with you.

I’m 58 years old, PSA 4.2, asymptomatic. Checked PSA every 6 month only because my dad has had PC for the last 5 years (he is under hormone therapy). My PSA slowly increasing from 3.0 in 2021 to 4.2 this year. I,m pysically active, run 5 km every morning. Discovered Gleason 3+4 in early March 2023.

Just had a radical prostatectomy in June 20, 2023 with Single Port (1 + 1 incisions). Surgery went well. No pain whatsoever since surgery. One night observation in the hospital. The only discomfort was during the catheter (6 days). Not painful, but discomfort. Walked 2 miles everyday during catheter including daily grocery shoppings. Brought the catheter with me around town. During catheter, took tylenol every day for prevention (unnecessary but I did for prevention only).

Removed the catheter on day-6. Removal process was quick and not painful. Gain continence immediately after removal, but I still wear a small pad during day-time for prevention. Day time is okay. But until today I wear diapers every night, as I frequently go to toilet (4-5 times) every night vs 1 time before surgery. My Doctor said this is normal and will be back normal post trauma.

Glad to have the surgery done.

I am just turning 69. I Had my RALP performed on 10/25/23. The surgery went very well. Removed 100% of detectable cancer and my PSA continues to be undetectable at a steady < 0.014. I had a wound in my bladder which took more time to heal than normal. Unfortunately, I got a really bad bacterial, urinary tract infection during the first 10-14 days wearing my FOLEY CATHETER. Ended up requiring a 10 day hospital stay to attend to that. However, after my immediate setbacks were resolved I’ve been fine to date. My continence is almost 100% normal. My erections are NOT. Before my RALP, I had strong erections and enjoyed very satisfying sexual intercourse twice a week with my incredibly gorgeous and sexy wife of 11 years. Occasionally, I would take a 20mg CIALIS tablet if my PEYRONES Disease was adversely affecting the quality of my erection. The CIALIS made me even firmer and harder with an incredibly strong erection. Unfortunately, to date, I can only achieve about 60% of a normal erection. Just enough to barely have intercourse. Post surgery, the CIALIS does absolutely nothing at all and no longer provides any benefits to me. I started using a penile pump about a month ago to increase the total blood flow in my penis as part of my Penile Rehabilitation. Additionally, the pump provides the opportunity to fill my penis with more blood and achieve a full erection. I can now guarantee myself and wife an erection capable of enjoying a pretty normal experience of sexual intercourse. I get very aroused, turned on and sexually stimulated by my wife. However, no matter what we do, I can’t get my normal erection, (without the pump), to exceed the 60% of normal stiffness to really enjoy stimulating penetration for me and my wife. Not sure why the pump gets me almost 100% erect but nothing else will. Obviously, it forces more blood into my penis versus what I can do. Additionally, by placing the penis band at the base of my penis after obtaining a full erection. This prevents all of the the blood from rushing back out of the penis which loses and discontinued your erection. I start consulting with a Penile Rehabilitation Specialist in several months to address these issues in more detail. Thankfully , I had a successful “nerve sparing” surgery and my orgasms are almost as enjoyable as my pre surgical “wet ones”when I could still ejaculate!. However, the “dry orgasms” still feel really good and are quite enjoyable! I realize I am still healing but I was told that whatever state of physical sexuality I had and could attain and perform prior to my surgery would return after my surgery. This has not been the case for me after 9 months following my surgery. I am thankful and grateful to be where I am at but I will need more improvement to really be sexually fulfilled and satisfied. Best wishes and good luck to all of my fellow patients out there who are dealing with the same or similar challenges.

I'm 3 months post RALP now, 74 y/o. My experience with sexual function is similar to yours. My understanding is that return to normal "usually" takes 18-24 months. This was confirmed during my post-op check a week ago. In the interim, daily pump use and every-other-day cialis use are recommended to keep the penile tissues from "scarring" up by inducing expansion of the blood vessels on a regular basis. Penile ring or injection are necessary to mimic more normal, sustained erections during that 2 year wait for nerve function to return. The penile rehab practitioner I consulted acknowledges the frustration of the seeming lack of progress, but insists on persistence nonetheless. The trick for me is to combine orgasm with penetration. Both are possible individually (and my wife will still orgasm), but not yet together.

"Do what you can with what you've got!"