A prostate cancer diagnosis brings with it a whirlwind of emotion shock, fear, confusion, and a flood of questions that seem to demand immediate answers. Among the most pressing is one that can define a man’s future health: Do I need surgery?
Radical prostatectomy, the complete removal of the prostate gland, remains one of the most common and potentially curative treatments for localized prostate cancer. But it’s not the only option, and it isn’t the right path for every patient. Some men do well with radiation therapy. Others are candidates for active surveillance. And in some cases, less invasive options like HIFU or focal therapies may be appropriate.
So how do you know when it’s time to consider prostatectomy and when it might be better to wait or look elsewhere?
This article walks through the key medical, emotional, and lifestyle factors that shape the decision to undergo prostatectomy. Because the right treatment choice isn’t just about cancer. It’s about you.
Not All Diagnoses Are the Same
Prostate cancer is unique among cancers in one major way: it grows slowly in many men. That’s why not every diagnosis requires immediate or aggressive treatment. In fact, for some men especially those with small, non-aggressive tumors the best initial approach might be to do nothing at all, aside from careful monitoring.
Your urologist will likely categorize your cancer using several key factors:
- PSA level (prostate-specific antigen)
- Gleason score (how aggressive the cancer cells appear)
- Tumor stage (how far the cancer has spread)
- Imaging results (MRI, CT, or bone scan)
These indicators help define the risk level of your cancer:
- Low risk: PSA <10, Gleason 6 or lower, tumor confined to prostate
- Intermediate risk: PSA 10–20 or Gleason 7
- High risk: PSA >20, Gleason 8–10, or cancer outside the prostate
Each risk category opens different doors when it comes to treatment and prostatectomy is most commonly recommended for intermediate and high-risk cases.
When Is Prostatectomy the Preferred Option?
While treatment decisions should always be personalized, certain criteria make radical prostatectomy more likely to be the best course of action:
1. The Cancer Is Localized or Locally Advanced
If the cancer is confined to the prostate or has just begun to grow into nearby tissue (e.g., the seminal vesicles), surgery may offer the best chance for complete removal and long-term cure.
2. You’re Relatively Young and Healthy
Prostatectomy is a major surgery. It’s best suited for patients under 70 (though older men in good health can still be candidates). The longer your expected lifespan, the more benefit you’ll get from removing the cancer rather than monitoring or radiating it.
3. You Want a One-Time, Definitive Treatment
Some men feel anxious about long-term hormone therapy or radiation side effects. Others prefer the certainty of physically removing the cancer. For these patients, prostatectomy can provide both peace of mind and a clear treatment endpoint.
4. You Have High-Risk Features
If your cancer is aggressive high PSA, high Gleason score, or rapid growth surgery may be the only curative path forward. It also allows for thorough sampling of surrounding lymph nodes, which helps clarify staging.
5. You’re a Good Candidate for Nerve-Sparing Surgery
Modern prostatectomy techniques aim to preserve the nerves that control erectile function and urinary continence. If your cancer isn’t invading those areas, your surgeon may be able to spare them, improving quality of life after surgery.
When Might Prostatectomy Not Be the Right Choice?
Surgery isn’t the right fit for everyone. In fact, many men can safely postpone or even avoid prostatectomy altogether.
1. Your Cancer Is Very Low-Risk
Men with Gleason 6 tumors, low PSA, and small tumors may do well with active surveillance. This means regular monitoring (PSA, imaging, occasional biopsy) with no immediate intervention.
2. You Have Significant Medical Conditions
If you have heart disease, diabetes, or are frail due to age or other illnesses, the stress of surgery and anesthesia may pose more risk than benefit. In such cases, radiation or even watchful waiting may be safer.
3. You Prefer a Non-Surgical Approach
Some patients simply don’t want surgery for personal, cultural, or emotional reasons. That’s valid. Radiation therapy, brachytherapy (seed implants), or focal treatments like HIFU may provide excellent alternatives with different side effect profiles.
Surgery Is a Mental Decision, Too
The road to prostatectomy isn’t paved only with lab results and MRI scans. It’s also shaped by the emotional readiness of the patient.
- Are you prepared for a recovery period that could include temporary incontinence or erectile dysfunction?
- Do you have support at home during your recovery?
- Are you mentally ready to go through a major operation?
For many men, the emotional impact of prostate cancer is more profound than they expected. A strong doctor-patient relationship, counseling, and open communication with loved ones are key to navigating this path.
How the Procedure Works
If you and your surgeon decide to move forward with prostatectomy, here’s a brief overview of what to expect:
- Procedure Type: Can be open (traditional incision), laparoscopic, or robotic-assisted.
- Anesthesia: General anesthesia is required.
- Duration: 2 to 4 hours
- Hospital Stay: Usually 1–3 nights
- Catheter: Worn for 7–14 days post-surgery
- Recovery Time: Most men return to light activity in 2–3 weeks; full recovery may take 6–8 weeks
Advanced centers like Erdem Hospital in Istanbul offer both open radical prostatectomy and robotic/laparoscopic techniques, led by experienced urologists like Prof. Dr. Necmettin Atsü. The hospital’s integrated care approach ensures international patients receive coordinated support before, during, and after surgery.
Key Questions to Ask Before Choosing Surgery
Before making your decision, ask your urologist the following:
- What is my cancer’s risk level?
- Will you perform nerve-sparing surgery?
- What are the risks of incontinence or erectile dysfunction in my case?
- Do I need additional treatment after surgery?
- What are my non-surgical options, and how do their outcomes compare?
The goal isn’t just to get answers but to feel confident that your choice reflects your personal values, not just clinical guidelines.
What Comes Next?
Once you decide on prostatectomy, preparation begins. This includes pre-op testing, stopping certain medications, and lifestyle adjustments. After surgery, you’ll go through a recovery period that includes:
- Catheter management
- Pelvic floor therapy for continence
- Gradual return to activity
- PSA testing every 3–6 months
Emotionally, you may also go through stages of vulnerability, frustration, and renewal. Many men report that it’s only months later when their energy returns and their PSA stays at zero that they truly feel the weight of cancer lifted.
It’s Your Body, Your Cancer, Your Decision
The choice to undergo prostatectomy is one of the most personal medical decisions a man can face. It requires courage, clarity, and above all, information.
By working closely with your healthcare team, asking hard questions, and listening to your own instincts, you’ll be better equipped to make a choice that supports not only your physical health but your peace of mind.
At Erdem Hospital, patients are not treated as numbers, but as individuals with stories, families, and futures worth protecting. Whether you’re considering prostatectomy, exploring other treatment options, or simply seeking a second opinion, the first step is always the same: be informed, be proactive, and don’t delay the conversation.