Robotic-assisted radical prostatectomy (RARP) is an operation to remove the whole prostate gland, together with the seminal vesicles and, when needed, nearby lymph nodes, for Prostate Cancer. It is now one of the most widely performed robotic cancer operations in the world.
This article explains who is suitable, how the operation is done, what "nerve-sparing" means, what the risks are and what to ask your surgeon. For what recovery looks like week by week, see Recovery after robotic prostatectomy.
Who is suitable for RARP?
RARP is usually considered for men with Prostate Cancer that is confined to the prostate or has grown just outside it, who are fit for surgery and expected to live long enough to benefit, often more than ten years. It may be advised for:
- Intermediate-risk cancer, for example Grade Group 2 or 3
- High-risk localised or locally advanced cancer, often as part of a plan that may include radiation or hormone therapy later
- Younger men and men who prefer surgery to radiation
It is not usually the first choice for low-risk cancer that can be safely monitored (see Active surveillance for Prostate Cancer), or for men with other illnesses that make a major operation unsafe, or when cancer has spread widely. Radiation therapy is an equally valid option for many men; the right choice depends on your cancer, your health and your priorities.
Related: Prostate Cancer treatment options · Why treatment should be individualised
How to prepare
- A prostate MRI and your biopsy report help plan the operation, including whether nerves can be spared.
- Learn pelvic floor (Kegel) exercises two to four weeks before surgery.
- Stop smoking, keep walking and review blood thinners and other medicines with your surgeon.
- Discuss your goals openly: bladder control, erections, and how important each is to you.
What happens during the operation?
RARP is done under general anaesthesia through several small cuts. The surgeon controls the robotic instruments from a console. The main steps are:
- Access. Ports are placed and the robot docked. The space behind the pubic bone is entered.
- Free the prostate. The bladder neck and the seminal vesicles are dissected, and the prostate is separated from the rectum.
- Protect the nerves. The bundles of nerves that run beside the prostate and control erections are carefully dissected away from the gland when it is safe to do so.
- Remove the prostate. The gland is divided from the urethra and placed in a bag. Pelvic lymph nodes are removed if your risk of spread justifies it.
- Reconnect. The bladder is joined to the urethra with fine stitches so that urine flows normally.
- Check and close. A catheter is left in the bladder; a drain is placed only if needed.
Most operations take about two to four hours. Most men go home within two to three days.
What does "nerve-sparing" mean?
The nerves that control erections lie right next to the prostate. Nerve-sparing surgery means separating them from the gland and leaving them in place, on one or both sides.
Whether nerves can be spared depends on the cancer: if the tumour is touching or growing through the edge of the prostate on one side, the nerves on that side may need to be removed to clear the cancer. Cancer control comes first. Your MRI, biopsy and your erections before surgery help predict how likely it is that function will return.
Even with nerve-sparing surgery, erections often take months to recover and may need treatment such as tablets or other aids. This is called penile rehabilitation.
What are the risks?
- Urinary leakage (incontinence). Common at first and usually improves over months. A small proportion of men have long-term leakage that needs a pad or further treatment.
- Erectile dysfunction. Common after surgery, even with nerve sparing; recovery can take six to 24 months and is not guaranteed.
- Changes to ejaculation and fertility. After prostatectomy there is no semen; orgasm is still possible but dry. Discuss sperm storage beforehand if you wish to father children.
- Other effects, which may include a small reduction in penile length, narrowing at the join between bladder and urethra, hernia at a port site, fluid collection (lymphocele) after lymph node removal, bleeding, infection and blood clots.
- Cancer not completely removed. The pathology may show cancer at the edge of the specimen (positive margin) or in lymph nodes; PSA monitoring and sometimes additional treatment follow.
Your surgeon's own experience matters. It is reasonable to ask how many prostatectomies they perform each year and what their continence and margin outcomes are.
After the operation
About one to two weeks later the pathology report gives the final Gleason score, stage, margins and node status. The first PSA is checked about six to eight weeks after surgery and should be undetectable. After that PSA is checked regularly, often every three months in the first year or two.
Guidelines
This article is consistent with the EAU Prostate Cancer guidelines and the AUA guidance on localised Prostate Cancer.
Consultation
Dr. Anshuman Singh, Uro-Oncologist & Robotic Surgeon, performs robotic radical prostatectomy in Lucknow and sees patients at the Uro-Oncology OPD, Chandan Hospital (10 AM – 4 PM) and at Uro-Onco Connect, Gomti Nagar (6 – 9 PM), Monday to Friday, and by teleconsultation. Biopsy reports, MRI and PSMA scans can be shared in advance. Book a consultation.
Frequently asked questions
What does RARP stand for?
Robot-assisted radical prostatectomy: removal of the prostate, seminal vesicles and, when needed, pelvic lymph nodes, using a robotic surgical system controlled by the surgeon.
Is robotic prostatectomy better than open prostatectomy?
Cancer control is generally similar in experienced hands. Robotic surgery usually means less blood loss, smaller wounds and a shorter stay. Surgeon experience matters more than the platform.
How long does the operation take and when can I go home?
About two to four hours, and most men go home in two to three days with a catheter.
Will I be able to have erections after RARP?
Many men do, especially with nerve-sparing surgery and good erections before. Recovery can take six to 24 months, and rehabilitation helps.
Will I leak urine after the operation?
Some leakage is common at first. Most men are dry or need at most one light pad within three to twelve months, and pelvic floor exercises help.
Will I still be able to father children?
No semen is produced after the prostate is removed. If you wish to have children, discuss sperm storage before surgery.
Treatment in Lucknow
Dr. Anshuman Singh is a Uro-Oncologist and Robotic Surgeon in Lucknow. Read about Prostate Cancer treatment in Lucknow and Robotic Surgery for Urological Cancers, or book a consultation in person or by teleconsultation.
This article is for general education and does not replace a personal medical consultation.