For men diagnosed with prostate cancer that may be treated with surgery, robotic radical prostatectomy is one of the most commonly used minimally invasive surgical approaches. It involves removing the prostate using instruments controlled by a surgeon through a robotic surgical system.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The word “robotic” can sometimes be misleading. The robot does not make decisions or perform the operation independently. The surgeon controls the instruments throughout the procedure, while the system provides a magnified, three-dimensional view of the prostate and surrounding structures.
Whether robotic radical prostatectomy is appropriate depends on the characteristics of your cancer, your overall health, your urinary and sexual function, and the potential benefits and risks of surgery. For a broader overview of surgical treatment, see our prostate cancer surgery guide.
What Is Robotic Radical Prostatectomy?
A radical prostatectomy is an operation to remove the entire prostate gland. The seminal vesicles, which are glands located behind the prostate and contribute fluid to semen, are also usually removed. Nearby lymph nodes may be removed at the same time when this is appropriate for the patient's cancer risk.
With a robotic approach, the operation is performed through several small incisions in the abdomen. A camera provides the surgeon with a magnified three-dimensional view, while specialised instruments are introduced through the other openings.
The surgeon sits at a console and controls the instruments directly. This allows precise movements within the confined space of the pelvis while the prostate is separated from nearby tissues.
When Is Robotic Radical Prostatectomy Considered?
Radical prostatectomy is generally considered when prostate cancer is suitable for surgical treatment and the patient is fit enough to undergo a major operation. It is most commonly used when the cancer has not spread to distant parts of the body, although surgery may be considered in selected patients with more advanced but still potentially treatable disease.
The decision is based on more than the PSA level alone. Doctors may consider:
- PSA level and its pattern over time
- Biopsy findings and Grade Group
- Clinical stage of the cancer
- MRI and other imaging results
- Whether the cancer appears confined to the prostate
- Age and overall health
- Urinary function before treatment
- Erectile function before treatment
- Personal preferences and priorities
Not every man with prostate cancer needs immediate surgery. Depending on the cancer's risk category, active surveillance, radiation therapy or another treatment approach may be appropriate.
What Actually Happens During the Operation?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The operation can be understood as a series of important steps rather than simply “removing the prostate.”
- Small abdominal incisions are made. These provide access for the camera and surgical instruments.
- The surgical area is visualised. The camera provides a magnified three-dimensional view of the prostate and surrounding structures.
- The prostate is separated from nearby tissues. The surgeon carefully works around structures such as the bladder, urethra and erectile nerves.
- The prostate and seminal vesicles are removed.
- Lymph nodes may be removed. This is performed when indicated by the patient's cancer risk and treatment plan.
- The bladder and urethra are reconnected. This creates a new urinary connection after the prostate has been removed.
- A urinary catheter is placed. It allows urine to drain while the new connection heals.
The removed tissue is then sent for pathological examination. The final pathology provides important information about the cancer and helps determine the next stage of follow-up.
What Does the Robot Add to Prostate Surgery?
The robotic system is designed to help the surgeon perform minimally invasive surgery with enhanced visualisation and instrument control. Its commonly described features include:
- A magnified three-dimensional surgical view
- Small, specialised instruments that can move within the pelvic space
- Precise surgeon-controlled movements
- Ergonomic control from a surgical console
These features can be particularly useful because the prostate lies deep within the pelvis and is surrounded by important structures. However, robotic technology does not replace surgical judgement. The surgeon still decides where to dissect, what tissue can safely be preserved and how the operation should be adapted to the individual cancer.
What Is Nerve-Sparing Robotic Prostatectomy?
One of the most important considerations during prostatectomy is whether the nerves involved in erections can be preserved. The neurovascular bundles responsible for erectile function run close to the prostate. If the cancer's location allows it, the surgeon may perform nerve-sparing surgery to preserve these structures.
Nerve-sparing is not automatically possible simply because the operation is robotic. If cancer is close to or has extended into surrounding tissues, removing or partially sacrificing the affected nerves may be necessary to achieve adequate cancer control. This creates an important balance during surgery: preserving function where it is oncologically safe while ensuring that the cancer is adequately removed.
What Are the Potential Benefits of the Robotic Approach?
Robotic radical prostatectomy is a minimally invasive alternative to open prostatectomy. Evidence and clinical experience show several potential short-term advantages of the robotic approach.
| Potential benefit | What it may mean |
|---|---|
| Smaller incisions | The operation is performed through several small openings rather than one large abdominal incision. |
| Less blood loss | Robotic prostatectomy generally results in less blood loss than open surgery. |
| Less postoperative pain | Smaller incisions may make the early recovery period more comfortable for some patients. |
| Shorter hospital stay | Many patients can leave hospital relatively soon after surgery. |
| Earlier physical recovery | Some patients return to normal daily activities sooner than they would after open surgery. |
These advantages mainly relate to the perioperative and early recovery period. They should not be interpreted as meaning that robotic surgery eliminates the possible long-term effects of prostate removal.
Does Robotic Surgery Improve Cancer Control?
The primary purpose of radical prostatectomy is to treat the cancer, not simply to use a minimally invasive technique. Current evidence does not support describing robotic surgery as automatically providing better cancer control than open prostatectomy.
When performed appropriately, both approaches can provide effective cancer treatment, while the robotic approach has advantages in areas such as blood loss and early recovery. The cancer's stage and grade, the completeness of tumour removal and the quality of surgery remain more important than the presence of robotic technology alone.
What Are the Possible Side Effects?
Robotic prostatectomy is still a major operation, and the possible effects are broadly related to prostate removal rather than simply to the robotic system. The two most important functional concerns are:
Urinary incontinence
Temporary urine leakage is common after the catheter is removed. Bladder control often improves gradually over the following weeks and months. A smaller number of men may experience persistent urinary incontinence that requires additional treatment.
Erectile dysfunction
Erections may be affected because the nerves responsible for erectile function lie close to the prostate. Nerve-sparing surgery may improve the chances of recovery when it is safe from a cancer-control perspective, but it cannot guarantee normal erections. Other possible complications include bleeding, infection, blood clots, urine leakage, lymphocele and injury to nearby organs or tissues.
What Happens to Ejaculation After Surgery?
Radical prostatectomy changes ejaculation permanently because the prostate and seminal vesicles are removed and the normal pathway for semen is interrupted.
You may still be able to experience an orgasm if sexual function recovers, but there is generally no semen released during orgasm. This is often described as a dry orgasm.
Because sperm can no longer travel through the normal reproductive pathway, natural conception through sexual intercourse is no longer possible after radical prostatectomy. If future biological children are important to you, fertility preservation should be discussed before surgery.
How Long Does Recovery Take?
Robotic surgery may allow a relatively quick early physical recovery, but complete recovery is a longer process. In the first days, the priorities are pain control, mobility, eating and drinking normally, and monitoring for complications. The urinary catheter usually remains in place while the bladder-to-urethra connection heals.
After the catheter is removed, urinary leakage may occur. Bladder control can continue improving for several weeks or months. Erectile recovery generally takes longer. Even when the nerves are preserved, erections may take many months to return, and some men may not regain their previous level of erectile function.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
This difference is important: being physically recovered from surgery does not necessarily mean that urinary and sexual function have fully recovered.
What Happens After Robotic Prostatectomy?
Once the prostate has been removed, the tissue is examined by a pathologist. The final pathology report can provide information about:
- The final pathological stage
- The tumour grade
- Whether the cancer was confined to the prostate
- Whether the surgical margins are clear
- Whether lymph nodes contain cancer, when lymph nodes were removed
These findings help determine whether further treatment is needed or whether continued monitoring is appropriate. PSA testing then becomes an important part of long-term follow-up. Because the prostate has been removed, PSA should fall to a very low or undetectable level after successful surgery. A pattern of detectable or subsequently rising PSA may require further evaluation.
Robotic vs Open Radical Prostatectomy: What Is the Difference?
The main difference is how the surgeon reaches the prostate, rather than the fundamental goal of the operation.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
| Feature | Robotic radical prostatectomy | Open radical prostatectomy |
|---|---|---|
| Access | Several small incisions | One larger incision |
| Visualization | Magnified three-dimensional camera view | Direct surgical view |
| Blood loss | Generally lower | Generally higher |
| Early recovery | Often faster | Generally longer |
| Cancer treatment goal | Removal of the prostate and cancer | Removal of the prostate and cancer |
| Long-term functional outcomes | Influenced by cancer characteristics, baseline function, nerve preservation and surgical expertise | |
Robotic surgery is not necessarily the right choice for every patient. The best surgical approach depends on the individual circumstances and the expertise available.
The Bottom Line
Robotic radical prostatectomy is a minimally invasive approach to removing the prostate for selected men with prostate cancer. The surgeon—not the robot—controls the operation, using robotic instruments and a magnified three-dimensional view to work precisely within the pelvis. The approach can offer advantages such as smaller incisions, less blood loss and an easier early recovery compared with open surgery, but it does not eliminate the potential effects of prostate removal. Urinary incontinence and erectile dysfunction remain important considerations, and nerve-sparing is only possible when it is safe from a cancer-control perspective. The most suitable approach should therefore be based on the stage and characteristics of the cancer, overall health, pre-existing urinary and sexual function, treatment goals and the experience of the surgical team. After surgery, the final pathology report and ongoing PSA monitoring help determine whether additional treatment is needed and how follow-up should proceed.
