Prostate cancer surgery can cause side effects, with urinary leakage and erectile dysfunction being the two most important long-term concerns for many men. Other possible effects include changes in orgasm and ejaculation, infertility, urinary problems, lymphoedema and, less commonly, bowel or surgical complications.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Most men experience some changes during the early recovery period, but the severity and duration vary considerably. Some problems improve gradually over weeks or months, while others may persist and require treatment or rehabilitation. The type of surgery, the patient's age and health, urinary and sexual function before treatment, and whether the surgeon can preserve the nerves around the prostate all influence the likelihood of side effects.
For an overview of the procedure and the different surgical approaches, see our main guide to prostate cancer surgery.
The Two Side Effects Patients Usually Worry About Most
Radical prostatectomy removes the prostate gland and seminal vesicles. Because these structures sit close to the muscles and nerves responsible for urinary control and erections, surgery can affect both functions.
1. Urinary Leakage or Incontinence
Urinary incontinence means urine leaks unintentionally. After prostate removal, some men experience leakage when coughing, sneezing, standing, walking or exercising. Others may have more continuous leakage. Early urinary leakage is common because the urinary sphincter and surrounding support structures need time to recover after surgery.
Fortunately, urinary control often improves as healing progresses. Pelvic-floor muscle exercises are commonly recommended as part of recovery. If significant leakage continues, additional treatments are available, depending on its severity and cause.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Current European guidelines report wide variation in continence outcomes because studies use different definitions of incontinence. At around 12 months, reported continence rates after robot-assisted radical prostatectomy generally range from approximately 89% to 100%, although individual outcomes can differ substantially.
2. Erectile Dysfunction
Erectile dysfunction (ED) is another major possible side effect of prostate cancer surgery. The nerves and blood vessels responsible for erections run very close to the prostate and can be affected during its removal.
If the cancer is not close to these nerve bundles, a nerve-sparing prostatectomy may be possible. Preserving these nerves can improve the likelihood of recovering erectile function. However, nerve-sparing surgery is not always safe from a cancer-control perspective. If cancer extends into or lies very close to the nerves, the surgeon may need to remove some or all of the affected nerve tissue.
Erectile recovery can also take considerably longer than urinary recovery. Some men begin to see improvement within months, while others continue recovering for one to two years or longer. Age and erectile function before surgery are important predictors of recovery.
Can Prostate Cancer Surgery Cause Infertility?
Yes. Radical prostatectomy causes permanent infertility because the prostate and seminal vesicles are removed and the normal pathway for semen to leave the body is interrupted. This is different from erectile dysfunction.
A man may still have erections and experience orgasm after surgery but will not be able to father a child through natural ejaculation. Men who may want biological children in the future should discuss fertility preservation, such as sperm banking, before treatment.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Other Urinary Changes Can Occur
Urinary leakage is not the only possible change after prostatectomy. Some men experience:
- Urinary urgency
- Increased urinary frequency
- Difficulty emptying the bladder
- A weak or interrupted urinary stream
- Temporary urinary retention
Most of these problems improve with recovery, but persistent difficulty passing urine can sometimes indicate narrowing at the bladder neck or the connection between the bladder and urethra. A bladder-neck contracture is an uncommon complication in which scar tissue narrows this area and interferes with urine flow.
What About Bleeding, Infection and Other Early Surgical Risks?
Like any major operation, radical prostatectomy has short-term surgical risks in addition to its longer-term functional effects. Possible complications include:
- Bleeding
- Infection
- Blood clots in the legs or lungs
- Injury to nearby organs
- Urine leakage from the surgical connection
- Temporary bowel slowing or ileus
Serious complications are uncommon, but the risk varies with the patient's health, the complexity of surgery and the surgical approach. If pelvic lymph nodes are removed during the operation, a lymphocele—a collection of lymphatic fluid—can occasionally develop in the pelvis and may require drainage.
Can Prostate Cancer Surgery Affect the Bowel?
Bowel problems are generally less prominent after radical prostatectomy than after prostate radiotherapy, but the bowel can still be affected during or immediately after surgery. Rarely, the rectum or another nearby intestinal structure may be injured during the operation.
Temporary constipation, bloating or slowed bowel movement can also occur during recovery because of anaesthesia, reduced activity, pain medicines and changes in diet. Persistent bowel symptoms should be assessed rather than automatically attributed to prostatectomy.
What Can Happen to Penile Length?
Some men report a perceived reduction in penile length after radical prostatectomy. This can be influenced by changes in erectile function, blood flow and the physical changes that occur during recovery. The reported frequency varies between studies, and the degree of change is not the same for every patient. Discussing this possibility before surgery can help set realistic expectations about sexual recovery.
Which Side Effects Usually Improve With Time?
Recovery is not the same for every man, but there is an important difference between early postoperative effects and long-term functional changes. Urinary leakage often improves substantially during the first several months as the urinary sphincter and surrounding tissues recover.
Erectile recovery is usually slower. Nerves affected during surgery may take many months to recover, and some men require treatment for erectile dysfunction while this process occurs. Some effects—such as loss of ejaculation and infertility—are expected permanent consequences of removing the prostate and seminal vesicles.
What Makes Side Effects More or Less Likely?
There is no way to predict the exact side effects one person will experience, but several factors influence the risk.
Age: Older men generally have a higher risk of postoperative urinary and erectile problems.
Preoperative function: Men who have strong urinary control and good erections before surgery generally have a better chance of maintaining or recovering these functions.
Cancer location: If the tumour is close to the nerves responsible for erections, preserving those nerves may not be oncologically safe.
Surgical technique: Open, laparoscopic and robot-assisted approaches may have different short-term recovery profiles, but no approach eliminates the possibility of urinary or sexual side effects.
Surgeon's experience: Surgical expertise and careful preservation of healthy structures can influence functional outcomes.
Does Robotic Surgery Prevent Side Effects?
No surgical approach can guarantee freedom from side effects. Robot-assisted radical prostatectomy can provide advantages such as enhanced visualisation and precise instrument movement, and studies show some advantages in early continence and erectile recovery compared with conventional laparoscopic surgery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
However, long-term differences are less pronounced, and urinary incontinence and erectile dysfunction can still occur after robotic surgery. The most appropriate surgical approach depends on the cancer, patient's anatomy, surgeon expertise and available resources—not simply on whether a robot is used.
Can These Side Effects Be Treated?
Yes. Persistent side effects should not automatically be accepted as something that cannot be improved.
For urinary leakage: pelvic-floor rehabilitation is commonly used. Persistent moderate or severe incontinence may sometimes be treated with procedures such as a male sling or artificial urinary sphincter.
For erectile dysfunction: treatment may include oral PDE5 inhibitors, vacuum erection devices, intracavernosal injections and, in selected cases, penile implants.
The Bottom Line
The most important side effects of prostate cancer surgery are urinary incontinence and erectile dysfunction, but they do not affect every man in the same way. Urinary control often improves during the months after surgery, while recovery of erections can take considerably longer. Nerve-sparing surgery can improve the likelihood of preserving erectile function when it is oncologically appropriate.
Loss of ejaculation and infertility are expected permanent consequences of radical prostatectomy, although sexual pleasure and orgasm may still be possible. Other complications—including infection, bleeding, blood clots, urinary narrowing, lymphocele and rare bowel injury—can occur but are generally less common.
Side effects should be discussed before surgery because many can be managed or treated, and understanding the likely recovery process can make the transition after prostatectomy much easier.
