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Originally published November 4, 2026
Last updated November 4, 2026
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Congratulations, you’ve made it through the hard days of confronting your cancer, talking about options with your doctor, choosing your treatment and having your surgery. Now there’s a new uncertainty: What comes next?
For prostate cancer that has not spread beyond the prostate, a radical prostatectomy is the standard of care. After the surgery, men are understandably concerned about how their lives will be affected in terms of bladder control, sexual function and fertility, says Kian Asanad, MD, director of the USC Fertility and Men’s Sexual Health Center, part of USC Urology and Keck Medicine of USC. “Treating your prostate cancer is the first step. Now, my focus is on helping you regain confidence, restore function and maximize your quality of life. Life after prostate cancer should be about more than surviving — it should be about thriving.”
A robot-assisted radical prostatectomy is the most common surgery to treat prostate cancer in the United States, according to the American Cancer Society.
A radical prostatectomy involves removing the entire prostate gland and the seminal vesicles — the small glands next to the prostate that help make and transport semen. If necessary, the pelvic lymph nodes may be removed as well. It’s often a robotic-assisted laparoscopic procedure, meaning the doctor makes small incisions and uses robotic instruments to guide precise movements.
Removing the prostate can have an impact on bladder control and sexual function and eliminates the ability to achieve a pregnancy through natural conception.
The prostate sits below the bladder and surrounds part of the urethra, which carries urine. Nearby, there’s a urinary sphincter that helps keep the urethra tightly closed, controlling the flow of urine. The pelvic floor muscles provide a layer of support and also help control urination. Removing the prostate can weaken the sphincter and the pelvic floor, making it harder to control involuntary leaks when you cough, sneeze, laugh or exercise — anything that puts pressure on the bladder.
For that reason, after surgery most men will leak urine temporarily while the sphincter and pelvic floor muscles recover. A physical therapist will work with patients to do pelvic floor exercises to build and strengthen the musculature. Most men regain bladder control in three to six months.
During those months of recovery, men might need pads and/or diapers, which are helpful but also can be limiting: it’s hard to return to your full life if you’re worried about leaking.
“Overall, incontinence is a short-term side effect that improves with time,” Dr. Asanad says. “One year from surgery, approximately 90% of men regain urinary control.”
Another question men have is how removing the prostate will affect sexual function. A radical prostatectomy may or may not include removing one or both of the nerve bundles that control erections. There are many techniques to help spare the nerves, but sometimes it’s not possible depending on the extent of the disease. If both bundles are removed, natural erections are not possible. But even when some or all of the nerves are spared, they can be injured (a condition called neurapraxia) and will need time to recover.
“Most men experience a decline in erectile function following radical prostatectomy, with studies showing that approximately 50% to 70% experience erectile dysfunction after surgery,” Dr. Asanad says. “But recovery is possible, and with the right treatment options, our goal is to help men regain sexual function, confidence and quality of life.”
The functions that control erections differ from those that enable orgasm, so the ability to feel sexual pleasure can remain — though orgasms might be harder to achieve or they might feel different.
After radical prostatectomy, men typically continue to produce sperm in their testicles, but they can no longer ejaculate semen or conceive naturally through intercourse. During surgery, both vas deferens are divided, interrupting the pathway for sperm, while removal of the prostate and seminal vesicles eliminates the primary sources of seminal fluid. Although men can still experience orgasms, these are typically “dry orgasms, without ejaculation,” Dr. Asanad explains.
“It will not be possible after surgery to achieve a pregnancy through natural means,” Dr. Asanad says. “When fertility is important to patients, I advise them that they can freeze sperm before surgery.”
Men who wish to have biological children after radical prostatectomy may still have options, such as surgical sperm retrieval combined with in vitro fertilization, to achieve a pregnancy.
“There are good treatment options, and we work with each patient to choose the path that is right for them,” Dr. Asanad says. “We’ll work to get you dry and to get your sex life going. You’ll regain confidence and vitality.”
In terms of getting dry, there are several surgical options for the 10% of men who don’t regain full continence after a year, even after doing physical therapy. The goal is to support the pelvic muscles and sphincter to regain control over the flow of urine.
One option for those with mild to moderate leaking is a urethral sling. It is a surgically implanted strip of mesh that provides support to the urethra, so the urinary sphincter can close more tightly and reduce leaks.
Another option, especially for those with more severe leaks, is to implant an artificial urinary sphincter, a prosthesis that is customized to the size of the urethra. It maintains a closed position so there are no leaks. It’s attached to a pump that sits in the scrotum.
“You squeeze the pump to open the cuff when you want to empty your bladder, and it automatically closes on its own a few minutes later,” Dr. Asanad says. “This option has the highest rates of continence recovery and of satisfaction among patients.”
When it comes to restoring sexual function, there are several options.
First, if your nerves were spared, erections can improve with time. “To recover function as soon as possible and as much as possible, I’ll have patients do prehabilitation before the surgery and rehabilitation after surgery,” Dr. Asanad says. “Many men will need some help with erections after prostate cancer surgery, whether that’s with medications or other treatments. Age and erectile function before surgery play a big role, but the good news is we have excellent options to help men get back to a satisfying sex life.”
For those who can’t regain a natural erection, options include a mechanical device, injections or an implant:
“An implant restores the ability to have an on-demand erection, meaning it restores spontaneity with your partner,” Dr. Asanad says. “This is a great option if you’re not responding to erectile dysfunction medications. Within two to three weeks, you’re able to use the device and completely restore ability to be on demand.”
Many patients are cured from surgery alone. Those with higher-risk cancers might need other treatments after surgery, like radiation. But for those who only need surgery, follow-up care will include a blood test to measure your prostate-specific antigen (PSA) level every three to six months throughout the first year. Dr. Asanad says he wants to make sure PSA stays undetectable.
For anyone avoiding a radical prostatectomy because of the side effects, there are other treatment options available to you, depending on the specifics of your diagnosis.
“But every treatment option for prostate cancer generally affects quality of life in some way,” Dr. Asanad says. “We’ll help you make a decision. First, we make sure you’re a good candidate for surgery. Then we’ll talk through the risks and side effects of all the options, so you can decide which ones you are willing to accept.”
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