Prostate Cancer Surgery

You’ll have lab testing and imaging to prepare for your surgery. These may include:

At-Home Bowel Prep

The day before surgery, you will begin bowel preparation at home. You do this to cleanse the bowel.

The prep consists of a medication called magnesium citrate. You will drink one 10-ounce bottle. You will receive a letter with detailed instructions as to when and how to take this medication. This is a routine preparation before many types of major abdominal surgery.

The day before surgery, you only may drink clear liquids; you cannot eat any solid food. These are acceptable in a clear liquid diet:

You must stop all food and fluid intake by midnight the night before your surgery. Your care team will advise you of any other special pre-surgery preparation. They’ll let you know if you need to stop taking any of your regular mediations before the procedure.

For this procedure, the surgeon makes multiple small incisions. Then, we place a camera and long thin instruments through these incisions. In robotic surgery, the surgeon uses the surgical robot to help control the surgical instruments.

The surgeon removes the seminal vesicles (glands next to the prostate that produce the fluid in semen) because cancer can invade these organs.

If you have aggressive prostate cancer, the surgeon also will remove the pelvic lymph nodes. This is because the pelvic lymph nodes are often the first place prostate cancer spreads to once it is outside the prostate.

Additional Testing After Surgery

Once your surgeon removes the prostate and seminal vesicles — and in some cases takes tissue samples from pelvic lymph nodes — we send them to our genitourinary pathology team. There, they evaluate the prostate to determine the final Gleason grade. The Gleason grading system is based on the growth pattern and aggressiveness of the prostate cancer cells.

The pathologists also determines how much of the prostate gland has cancer and whether the marginal tissue of the prostate also has cancerous cells. The pathologists determine whether the cancer has started to migrate outside the gland, which is called extra-prostatic extension. If the surgeon removed the pelvic lymph nodes, the pathologists will determine whether they contain cancer cells.

This process can take up to two weeks. The results provide your cancer care team with key details about your care plan after surgery.

After surgery, a member of your care team brings you to the recovery area. They monitor you as you wake from anesthesia. Recovery is typically two to three hours long. After that, your care team takes you to the hospital unit where we care for our urology patients.

For the first night, you’ll have IV pain medication through a pump that you control. This is called patient-controlled analgesia (PCA). You’ll be expected to walk the night of your surgery, if possible. You can drink sips of clear liquids.

The day after surgery, you’ll be on oral (taken by mouth) pain medication. You will need to get up and walk around four to six times that day. You’ll have a drain in place from surgery. Your care team typically removes the drain the day you leave the hospital.

You will have a Foley catheter in place for seven to 10 days after surgery. Your care team will teach you how to care for it. A member of your care team will remove the catheter in our urology office during a follow-up visit.

Most men are able to go home from the hospital in the afternoon the day after surgery. In order to go home, you must:

• Be able to tolerate liquids and a little food
• Have good pain control with oral pain medication
• Be able to walk on your own

You will receive three prescription medications at discharge:

• Vicodin is for pain. You should take Vicodin only when over-the-counter Tylenol or ibuprofen are not enough to manage your pain. Do not take Vicodin with Tylenol.
• Colace is a stool softener. You can get it as an over-the-counter medicine, or we can prescribe it. 
• Ciprofloxacin is an antibiotic that you should start taking the day before your catheter is removed and then for three more days.

Diet After Prostate Removal 

Constipation is a common side effect of narcotic pain medication such as Vicodin. You may eat and drink whatever you wish. However, you should adjust your diet to avoid constipation until your normal bowel function returns (up to three to five days).

Avoid these foods that cause constipation:

We recommend these steps to promote health bowel function:

If you become constipated you may take milk of magnesia, which you can buy over the counter without a prescription.

Do not use an enema or suppository for the first three months after surgery. This is because your rectal wall is very thin and you may injure yourself. You may consume alcohol in moderation as long as you are not taking pain medication.

Activity Instructions

After you are discharged from the hospital, you can take long walks and go up and down stairs. However, you must avoid lifting more than 15 pounds and exercising vigorously (such as calisthenics, golf or tennis) for three weeks from the day of surgery. It takes at least three weeks for firm scar tissue to develop in your wound and the area where you had surgery.

During your first three weeks at home, do not sit upright in a firm chair for more than one hour. We prefer having you sit in a semi-recumbent position (in a reclining chair, on a sofa or in a comfortable chair with a foot stool). This position accomplishes two goals:

1. It elevates your legs, thereby improving drainage from the veins in your legs and reducing the chance of a clot forming.
2. It avoids placing weight on the area of your surgery in the perineum (the space between the scrotum and the rectum.)

There are no other serious restrictions. Three weeks following surgery you may resume all the same activities you were enjoying before surgery.

Pain After Prostate Removal

One of the advantages of robotic surgery is less pain after the procedure. However, you’ll have some pain and discomfort for at least a week or two after surgery. This pain can be from the incisions as well as the catheter.

In most cases, over-the-counter medicine will be strong enough to manage your pain. This can be ibuprofen (600 mg every six hours as needed, taken with meals) or extra strength Tylenol (1000 mg every six hours as needed, not to exceed 4000 mg in 24 hours).

Most men are pain-free within three to four weeks. To decrease friction and discomfort, you can use a lubricating gel (such as K-Y Jelly) on the tip of the penis and on the catheter where it enters the penis.

Catheter

A member of your care team usually removes your catheter during a follow-up office visit seven to 10 days after surgery. One day prior to catheter removal, you should begin taking Ciprofloxacin and continue it for three more days.

On the day we are going to remove your catheter, drink a lot of fluids before you arrive at the office. On that day, our biggest concern is whether or not you are urinating with a strong stream. Recovering control of your urine takes longer. We’ll give you more details about urinary function at your one-week follow-up visit.

Return to Work

You can begin to drive three weeks from the surgical date.

Most men who have sedentary jobs — such as being seated in an office chair most of the day — can return to work gradually beginning two weeks after surgery. Your energy level and appetite will be low, so don't try to do too much.

If you do strenuous work — such as lifting items or being on your feet all day — you’ll need to wait at least three weeks. If you travel, you also should wait at least three weeks.

You will return to our urology office one week after surgery for these steps:

• Catheter removal
• Discuss urinary and sexual function moving forward
• Review your pathology results

Your next scheduled visit will be three months after your surgery. You’ll need to have a prostate-specific antigen (PSA) test one week before this visit with us.

The PSA becomes extremely specific and sensitive to prostate cancer after a prostatectomy. We will continue to closely monitor this for the rest of your life. BIDMC also offers supportive cancer services after your surgery.

For the first year, we’ll see you every three months for a PSA test. If your PSA remains undetectable — meaning it measures 0.0 or <0.1 — and you are comfortable, you may continue follow up with your primary care doctor or urologist after the first year. We ask that you have your PSA drawn every six months during the second year and, if it remains undetectable, once a year after that.

If your PSA should ever elevate to 0.2 after prostatectomy, you should call us to schedule an appointment right away.

If you have a more aggressive disease, your care team may follow you closely with more frequent PSA tests for a longer period of time. Your surgeon and care team will recommend a follow-up care plan that makes sense for you.