About Your Prostate Surgery

This guide will help you get ready for your prostate surgery at MSK. It will also help you know what to expect as you recover.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.

About your prostate surgery

About your prostate

Your prostate is a walnut-shaped gland located below your bladder and lies above your rectum (see Figure 1). It surrounds your urethra, which is the tube that carries urine out of your body). Your prostate works with other glands in your body to make semen.

Seminal vesicles are the small glands near your prostate that make the fluid in semen (see Figure 1).

Lymph nodes are small bean-shaped structures found throughout the body. They make and store cells that fight infection.

About your prostate surgery

Surgery to remove your prostate is called a prostatectomy (PROS-tuh-TEK-toh-mee). This surgery can be done using different techniques. Your surgeon will talk with you about which one is right for you. Depending on the type of surgery you have, your surgeon will make several small incisions (surgical cuts).

Laparoscopic or robotic-assisted radical prostatectomy

A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. This is the most common technique used to remove the prostate. Your surgeon may also remove some of the lymph nodes in your pelvis. This is done to check if cancer cells have spread from your prostate to other parts of your body.

During a laparoscopic or robotic-assisted radical prostatectomy, your surgeon will make several small incisions in your abdomen (belly) (see Figure 2). They will insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. A laparoscope is a tube-like instrument with a camera.

Your surgeon will insert surgical tools into the other incisions to remove your prostate. They may use a robot to help them use the surgical tools. This is called robotic-assisted laparoscopic prostatectomy. Your surgeon will talk with you about the best surgery option for you.

Before your prostate surgery

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read this section, write down questions to ask your healthcare provider.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.

• I take an anticoagulant (blood thinner), such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven®, Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
• I take an SGLT2 inhibitor, such as:
  • Canagliflozin (Invokana®)
  • Dapagliflozin (Farxiga®)
  • Empagliflozin (Jardiance®)
  • Ertugliflozin (Steglatro®)
• I take any prescription medicines, including patches and creams. A prescription medicine is one you can only get with a prescription from a healthcare provider.
• I take any over-the-counter medicines, including patches and creams. An over-the-counter medicine is one you can buy without a prescription.
• I take any dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I have had a problem with anesthesia (A-nes-THEE-zhuh) in the past. Anesthesia is medicine to make you sleep during a surgery or procedure.
• I’m allergic to certain medicines or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
• I use recreational drugs, such as marijuana.

About drinking alcohol

It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medicine to help prevent them.

Here are things you can do before your surgery to keep from having problems.

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
  • Get a headache.
  • Feel nauseous (like you’re going to throw up).
  • Feel more anxious (nervous or worried) than usual.
  • Cannot sleep.

These are early signs of alcohol withdrawal and can be treated.

• Tell your healthcare provider if you cannot stop drinking.
• Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.

Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

Ask about medicines

We recommend taking medicine to help you get an erection. This is to promote blood flow to your penis to keep these tissues healthy.

Most insurance companies, including Medicare, do not cover sildenafil citrate (Viagra^®) or tadalafil (Cialis^®) prescriptions. Check with your insurance provider before surgery to see what your policy covers. If these medicines are not covered, affordable options may be available. Work with your doctor and nurse to get this process started before your surgery.

Within 30 days of your surgery

Presurgical testing (PST)

You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location. Visit www.msk.org/parking for parking information and directions to all MSK locations.

You can eat and take your usual medicines the day of your PST appointment.

It’s helpful to bring these things to your appointment:

• A list of all the medicines you’re taking, including prescription and over-the-counter medicines, patches, and creams.
• Results of any medical tests done outside of MSK in the past year, if you have them. Examples include results from a cardiac stress test, echocardiogram, or carotid doppler study.
• The names and telephone numbers of your healthcare providers.

You’ll meet with an advance practice provider (APP) during your PST appointment. They work closely with MSK’s anesthesiology (A-nes-THEE-zee-AH-loh-jee) staff. These are doctors with special training in using anesthesia during a surgery or procedure.

Your APP will review your medical and surgical history with you. You may have tests to plan your care, such as:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your APP may recommend you see other healthcare providers. They’ll also talk with you about which medicine(s) to take the morning of your surgery.

You may also have urine tests to help plan your care.

Identify your caregiver

Your caregiver has an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers to learn more.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• To learn about health care proxies and other advance directives, read Advance Care Planning for People With Cancer and Their Loved Ones.
• To learn about being a health care agent, read How to Be a Health Care Agent.

Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.

Sperm banking

This surgery will make you infertile. While you will still be able to have an orgasm, you will not be able to have biological children. You should consider sperm banking before your surgery. Ask your nurse to tell you more about this process.

To learn more, read Building Your Family After Cancer Treatment: For People Born With Testicles and Sperm Banking.

Male Sexual and Reproductive Medicine Program

Most people will have difficulty achieving an erection right after surgery. Consider making an appointment with an expert to discuss the effects of this surgery on your sexual health. You can reach MSK’s Male Sexual and Reproductive Medicine Program by calling 646-888-6024.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. To learn more, read How To Use Your Incentive Spirometer.

Do physical activity

Doing physical activity will help your body get into its best condition for your surgery. It will also make your recovery faster and easier.

Try to do physical activity every day. Any activity that makes your heart beat faster, such as walking, swimming, or biking, is a good choice. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Do pelvic floor muscle (Kegel) exercises

These exercises will strengthen the muscles that will be weakened from the surgery. Practice Kegel exercises before your surgery, so that you’ll know how it should feel. To learn more, read Pelvic Floor Muscle (Kegel) Exercises for Males.

‌  Do not do pelvic floor muscle (Kegel) exercises while you have a Foley catheter in place.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser, such as Hibiclens®

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

Buy a saline enema, such as a Fleet® saline enema

You also need to buy a saline enema for your bowel preparation. You can buy this at your local pharmacy without a prescription.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

Aspirin can cause bleeding. If you take aspirin or a medicine that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil. 

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

1 day before your surgery

Follow a light diet

Follow a light diet the day before your surgery. A light diet includes things such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink. Avoid fried foods and foods with a lot of seasoning.

Do your bowel preparation

The night before your surgery, give yourself a saline enema. Follow the instructions on the box.

Note the time of your surgery

A staff member will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.

This will be one of these locations:

The Josie Robertson Surgery Center (JRSC)
1133 York Ave. (between East 61^st and East 62^nd streets)
New York, NY 10065

The Presurgical Center (PSC) at Memorial Hospital
1275 York Ave. (between East 67^th and East 68^th streets)
New York, NY 10065
Take the B elevator to the 6^th floor.

Visit www.msk.org/parking for parking information and directions to all MSK locations.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you go to bed the night before your surgery.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Instructions for eating

‌ 
Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.

If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.

The day of your surgery

Instructions for drinking

Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.

• Water.
• Clear apple juice, clear grape juice, or clear cranberry juice.
• Gatorade or Powerade.
• Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
  • Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
  • Do not add honey.
  • Do not add flavored syrup.

If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.

It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.

‌ 
Stop drinking 2 hours before your arrival time. This includes water.

Take your medicines as instructed

A member of your care team will tell you which medicines to take the morning of your surgery. Take only those medicines with a sip of water. Depending on what you usually take, this may be all, some, or none of your usual morning medicines.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
• Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
• Leave valuable items at home.

What to bring

• A pair of loose-fitting pants, such as sweatpants.
• Brief-style underwear that is 1 to 2 sizes bigger than you usually wear.
• Sneakers that lace up. You may have some swelling in your feet after surgery.
• Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
• Your incentive spirometer, if you have one.
• Your Health Care Proxy form and other advance directives, if you filled them out.
• Your cell phone and charger.
• Only the money you may want for small purchases, such as a newspaper.
• A case for your personal items, if you have any. Eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal items.
• This guide. You’ll use it to learn how to care for yourself after surgery.

Once you’re in the hospital

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

We’ll give you a hospital gown, robe, and nonskid socks to wear when it’s time to change for surgery.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist (A-nes-THEE-zee-AH-loh-jist) will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

• Review your medical history with you.
• Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll get.
• Answer questions you have about anesthesia.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

During your surgery

After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.

Your surgeon will close your incisions with sutures (stitches) once they finish your surgery. They may also place Steri-Strips^™ (thin pieces of surgical tape) or Dermabond^® (surgical glue) over your incisions. They’ll cover your incisions with a bandage.

Your care team will usually take out your breathing tube while you’re still in the operating room.

After your prostate surgery

This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.

As you read this section, write down questions to ask your healthcare provider.

In the hospital

When you wake up after your surgery, you’ll be in the Post Anesthesia Care Unit (PACU) or recovery room. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask over your nose and mouth. You’ll also have compression boots on your lower legs.

If you are in a hospital room, you’ll meet one of the nurses who will care for you during your stay. A nurse will help you out of bed and into your chair soon after you get there.

Your care team will teach you how to care for yourself while you’re healing from your surgery.

You will have a urinary catheter in your bladder (see Figure 3). This is to keep track of how much urine you’re making. You may also have a Jackson Pratt (JP) drain to draw out fluid that collects under your incisions.

You’ll still have the urinary catheter when you go home. Your nurse will teach you how to care for it and will give you supplies to take home. Your healthcare provider will usually remove the catheter 7 to 14 days after your surgery.

You may have blood, stringy pieces of tissue, and blood clots in your urine while you have your catheter in. This is normal. It happens because the incisions inside your body are healing and the scabs are coming off. Drink 1 (8-ounce) cup of water every hour while you’re awake to help pass the blood.

You may also have blood or urine leaking from the tip of your penis around the catheter when you’re walking or having a bowel movement (poop). As long as you’re seeing urine draining into your drainage bag, this is normal. If you don’t see urine in your drainage bag, call your healthcare provider.

Taking care of your catheter is a big part of taking care of yourself after surgery. Keep the tip of your penis clean and dry. Apply the lubricating gel your nurse gave you around the tip of your penis. This will prevent irritation.

To learn more, read About Your Urinary (Foley) Catheter: How To Clean and Care for It.

Pain medicine

If you’re getting IV pain medicine, it will be put into your bloodstream through your IV line.

Your nurse will tell you how to recover from your surgery. Below are examples of ways you can help yourself recover safely.

• You will be encouraged to walk with the help of your nurse or physical therapist. We will give you medicine to relieve pain. Walking helps reduce the risk for blood clots and pneumonia. It also helps to stimulate your bowels so they start working again.

Use your incentive spirometer. This will help your lungs expand, which prevents pneumonia. To learn more, read How To Use Your Incentive Spirometer.

Managing your pain

You’ll have some pain after your surgery. Common pain after prostate surgery includes:

• Pain in your abdomen around your incisions.
• Gas pains.
• Pain in another part of your body, such as your back and shoulders.
• Pressure in your rectum, as if you need to have a bowel movement. The prostate gland lies just above the rectum, so this feeling is common. This will go away with time.

We will ask you about your pain often and give you medicine as needed. Tell one of your healthcare providers if your pain is not relieved. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain can help you recover faster.

Gas pain

If you had laparoscopic or robotic-assisted laparoscopic surgery, you may have pain in your shoulder. This is called referred pain and is common. It’s caused by the gas that was put into your abdomen during your surgery. This will go away after a few days.

If you have pain in your shoulder, tell one of your healthcare providers. They’ll bring you a hot pack to put on your shoulder to help with the pain. Walking around will help your body absorb the gas faster and reduce your pain.

You’ll get a prescription for pain medicine before you leave the hospital. Talk with your healthcare provider about possible side effects. Ask them when to start switching to over-the-counter pain medicine.

Bladder spasms

You may have bladder spasms after surgery. These can feel like sudden and intense cramping pains in your lower abdomen and penis. You may also feel an urgent need to urinate (pee). These spasms get better with time.

Bruising

You will have some bruising on your abdomen, upper thighs, penis, and scrotum. This will go away within 1 to 2 weeks after your surgery.

Bloating

You may have bloating in your abdomen for several days. Walking can help relieve gas and bloating. Avoid carbonated (fizzy) drinks until you start to pass gas.

Moving around and walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.

To learn more about how walking can help you recover, read Frequently Asked Questions About Walking After Your Surgery.

To learn what you can do to stay safe and keep from falling while you’re in the hospital, read Call! Don't Fall!.

Exercising your lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

• Use your incentive spirometer 10 times every hour you’re awake. Read How To Use Your Incentive Spirometer to learn more.
• Do coughing and deep breathing exercises. A member of your care team will teach you how.

Eating and drinking

There are no dietary restrictions after surgery. You can eat or drink whatever you like, but your appetite may not be very good. This may last a few days. It may be helpful to snack rather than have a full meal.

Do not force yourself to eat or drink if you’re not hungry or thirsty. Eat only if you’re hungry eat. Do not eat if you’re not hungry.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Caring for your tubes and drains

You will go home with a urinary (Foley) catheter). Taking care of your catheter is a big part of taking care of yourself after surgery. Keep the tip of your penis clean and dry. Apply the lubricating gel your nurse gave you around the tip of your penis. This will prevent irritation.

To learn more, read About Your Urinary (Foley) Catheter: How To Clean and Care for It.

It’s helpful if your caregiver also learns how to care for your catheter. This will make it easier for them to help you care for yourself at home.

Showering

You can shower 24 hours after your surgery. Taking a warm shower is relaxing and can help decrease muscle aches. Do not take tub baths until you talk with your doctor at the first appointment after your surgery.

Use soap when you shower and gently wash your incision. Pat the areas dry with a towel after showering, and leave your incision uncovered (unless there is drainage). Call your doctor if you see any redness or drainage from your incision.

Leaving the hospital

Before you leave, look at your incision with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital around 11 a.m. Your healthcare provider will write your discharge order and prescriptions before you leave. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.

If your ride isn’t at the hospital when you’re ready to leave, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.

Getting your pathology results

Your surgeon will receive your results 10 to 14 business days after your surgery. If you don’t receive a phone call after 14 business days, call your surgeon’s office. Talk to your doctor about:

• Your final pathology report.
• Your PSA results.
• Any problems with your recovery.

Any other treatment that you may need.

At home

Read What You Can Do to Avoid Falling to learn what you can do to keep from falling at home and during your appointments at MSK.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us care for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions.

To learn more, read Common Questions About MSK's Recovery Tracker.

Managing your pain

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medicine. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong.

Follow these guidelines to help manage your pain at home.

• Take your medicines as directed and as needed.
• Call your healthcare provider if the medicine prescribed for you does not help your pain.
• Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
• You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
  • Follow your healthcare provider’s instructions for stopping your prescription pain medicine.
  • Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.
  • Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.
• Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
• Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medicines, such as opioids, may cause constipation. Constipation is when you poop less often than usual, have a harder time pooping, or both.

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow these guidelines.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. But if you feel like you need to go, don’t put it off.
• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
• Exercise, if you can. Walking is a great type of exercise that can help prevent and manage constipation.
• Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose water, juices (such as prune juice), soups, and milkshakes. Limit liquids with caffeine, such as coffee and soda. Caffeine can pull fluid out of your body.
• Slowly increase the fiber in your diet to 25 to 35 grams per day. Unpeeled fruits and vegetables, whole grains, and cereals contain fiber. If you have an ostomy or recently had bowel surgery, ask your healthcare provider before changing your diet.
• Both over-the-counter and prescription medicines can treat constipation. Ask your healthcare provider before taking any medicine for constipation. This is very important if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medicines for constipation are:
  • Docusate sodium (Colace®). This is a stool softener (medicine that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Do not take it with mineral oil.
  • Polyethylene glycol (MiraLAX®). This is a laxative (medicine that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
  • Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.
  If any of these medicines cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if you need to.

You may not have a bowel movement for up to 5 days after your surgery. This is normal. If you’re passing gas and haven’t had a bowel movement by the second evening you’re home from the hospital, take MiraLAX. Do this until your bowel movements are back to normal. Call your healthcare provider if you haven’t had gas in 2 days, or a bowel movement in 4 days.

Do not use an enema or a suppository for at least 6 weeks after your surgery.

Caring for your incision

The location of your incision will depend on the type of surgery you had.

It’s normal for the skin below your incision to feel numb. This happens because some of your nerves were cut during your surgery. The numbness will go away over time.

Look at your incision with your nurse before you leave the hospital, so you know what it looks like. By the time you’re ready to leave the hospital, your incision will have started to heal. If any liquid is draining from your incision, write down the amount and color. Call your doctor’s office and talk with the nurse about any drainage from your incision.

Call your healthcare provider’s office if:

• The skin around your incision is very red or getting more red.
• The skin around your incision is warmer than usual.
• The area around your incision is starting to swell or getting more swollen.
• You see drainage that looks like pus (thick and milky).

Change your bandages at least once a day and more often if they get wet with drainage. When there is no longer any drainage coming from your incision, you can leave them uncovered.

If you go home with Steri-Strips on your incision, they will loosen and fall off by themselves. You can take them off if they haven’t fallen off within 10 days.

If you go home with glue over your sutures, it will loosen and peel off on its own. Do not pick at the glue or try to peel it off.

Reducing swelling in your penis and scrotum

You will have swelling and bruising of your penis and scrotum. Your scrotum may get as big as a grapefruit. This is normal and will gradually go away. You can help reduce the swelling by raising your scrotum on a rolled towel while you’re sitting or lying down. It also helps to wear brief style underwear instead of boxer shorts.

Caring for your uncircumcised penis

After your surgery, you might pull your foreskin (the loose skin that covers the head of your penis) back to clean or lubricate the tip of your penis. Always put your foreskin back over the head of your penis after cleaning or lubricating.

If you leave your foreskin pulled back, it can get stuck behind the head of your penis and keep blood from flowing through your penis. Putting it back over the head of your penis will prevent serious problems.

Controlling your urine

You may have trouble controlling your urine after your catheter is removed. This is because the muscles that hold urine in your bladder will be weak.

Other reasons you may have urinary leakage include:

• Your bladder is full.
• You’re tired.
• You drink alcohol or drinks that have caffeine.

It may take several months to get back full control of your bladder.

Once your catheter is removed, you can do exercises to strengthen your muscles. These are the pelvic floor muscle (Kegel) exercises you practiced before your surgery.

You may have some leakage when you strain, cough, or lift things. This is called stress incontinence.

At first, you may notice that your bladder control is better at night. This is because there is less pressure on your bladder when you’re lying down. For the first few months after your surgery, you may feel the urge to urinate often. Your bladder will take time to expand after your catheter has kept it empty.

For most people, urinary control will not be a problem. Your muscle strength will continue to improve for up to 12 months after surgery. Talk with your surgeon if you’re having problems controlling your urine after 12 months. Surgical procedures such as a urethral sling or an artificial urinary sphincter may help. Visit the National Association for Continence website www.nafc.org for more information.

Call your doctor right away if:

• You have severe (very bad) pain in your lower abdomen when you urinate
• You cannot urinate.

They may need to have the catheter put back in.

Eating and drinking

The first few days after your surgery, you should have light foods, such as a sandwich, yogurt, soup, and liquids. Avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower. Do this until you have your first bowel movement. Once you have your first bowel movement, you can go back to your regular diet, as tolerated.

Drink plenty of liquids while your catheter is in place after your surgery. Soups and broth are good choices until you your appetite comes back.

Physical activity and exercise

Your incision may look like it’s healed on the outside when you leave the hospital. It will not be healed on the inside. For 1 month after your surgery:

• Do not lift anything heavier than 10 pounds (4.5 kilograms).
• Do not do any high-energy activities, such as jogging and tennis.
• Do not play any contact sports, such as football.

Doing physical activity, such as walking and stair climbing, will help you gain strength and feel better. Try to get 20 to 30 minutes of physical activity at least 2 to 3 times a day. For example, you can walk outside or indoors at your local mall or shopping center.

It’s common to have less energy than usual after surgery. Recovery time is different for everyone. Do more activity each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.

Sexual activity

You may resume sexual activity after your urinary catheter is removed.

Driving

Ask your healthcare provider when you can drive. Most people can start driving again once their catheter is removed. Do not drive while you’re taking pain medicine that may make you drowsy.

You can ride in a car as a passenger at any time after you leave the hospital.

Do not ride on a bicycle or motorcycle for at least one month after your surgery.

Going back to work

Talk with your healthcare provider about your job. They’ll tell you when it may be safe for you to start working again based on what you do.

Most people can go back to work about 2 to 4 weeks after surgery. If you move around a lot or lift heavy objects, you may need to stay out a little longer. You may be comfortable with desk or office work once your catheter is taken out.

Traveling

You can travel as you normally would after surgery.

You are at higher risk for a blood clot for about 3 months after surgery. Remember to stay active. Flex your ankles and knees if you need to sit for a while during travel.

Managing your feelings

You may have new and upsetting feelings after a surgery for a serious illness. Many people say they felt weepy, sad, worried, nervous, irritable, or angry at one time or another. You may find that you cannot control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help. We can also reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. We’re here to help you and your family and friends handle the emotional aspects of your illness. We can help no matter if you’re in the hospital or at home.

Drink less liquid

After your catheter is removed, drink less liquid than you would normally drink each day. You should drink 4 to 6 (8-ounce) cups of liquid every day.

• Limit the amount of liquids you drink after 7 p.m. and empty your bladder before you go to bed. This might prevent your having to get up at night.
• Limit how much alcohol and caffeinated liquids you drink if you’re having a lot of urine leakage.
• Speak with your healthcare provider before you resume your Kegel exercises.

Getting an erection

Erectile dysfunction, usually called ED, means not being able to get an erection. It will take time for your erectile function to recover after your prostate surgery. This can take weeks to months.

In the first few weeks after having your catheter removed, you may not be able to get erections hard enough for sex. This can happen even if you take medicine, such as sildenafil citrate (Viagra). Your healthcare team will talk with you about your options to try to improve your ability to get an erection.

Options for treating ED

We recommend taking medicine for ED every day. This is to promote blood flow to your penis to keep these tissues healthy.

Many insurance companies do not cover sildenafil citrate (Viagra) prescriptions. Check with your insurance provider before surgery to see what your policy covers.

Your doctor or nurse will give you information about your medicine plan. Keep following this plan until your see your surgeon during your post-operative (post-op) visit.

Your plan may be one of the following:

About the challenge dose

• When you take the challenge dose, take the medicine on an empty stomach. Take it about 2 hours before your evening meal.
• The medicine takes 30 to 60 minutes to start working. It will last in your system for up to 8 hours. At any time during these 8 hours, try to become sexually aroused through contact with a partner or yourself. Write down what happened and tell your doctor during your next visit.
• If you haven’t had any response after trying the challenge dose for 4 weeks, call your doctor’s office. Your doctor may refer you to our Sexual Medicine team.

What to do if the pills aren’t working

You may not be able to get erections hard enough for sex right away, even with pills like Viagra. This will take time. Taking prescribed medicine can help improve your ability to get an erection, but this may not work for everyone.

If the medicine isn’t working for you, there are other things you can do to get an erection.

To learn more about other treatment options for erectile dysfunction, talk with our Male Sexual and Reproductive Medicine Program. Call 646-888-6024 to make an appointment.

Follow-up care

You will need to have prostate-specific antigen (PSA) blood tests done after your surgery. PSA is a normal protein made by your prostate gland. PSA levels typically increase when cancer is present. If the cancer has been completely removed, the PSA level should not be detectable.

Have a PSA blood test done at the following times:

• 6 to 8 weeks after surgery.
• 3 to 6 months after surgery.
• 12 months after surgery.
• Starting 12 months after your surgery, have a PSA blood test done every 6 months. Do this until 5 years following your surgery.
• Starting 5 years after your surgery, have a PSA blood test done every 12 months. Do this for life.
• Your doctor may ask you to have PSA blood tests done more often. If they do, your nurse will give you more information.

If possible, have your PSA blood test done at a MSK location. If you can’t have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK doctor’s office.

Continuing follow-up care at MSK

Our Survivorship Program offers comprehensive follow-up care for people who were treated for prostate cancer at MSK. Your doctor will help you decide when you’re ready for this step. The program will help support you as you recover from the physical and emotional effects of prostate cancer. It will also watch for any signs of the cancer coming back.

An APP will work closely with your doctor and will be responsible for your care. The APP is a member of the prostate cancer treatment team at MSK. They are an expert in the care of cancer survivors.

Your APP will:

• Look for signs of the cancer coming back.
• Manage any effects of treatment, such as pain and fatigue (feeling more tired or weak than usual).
• Recommend screening tests for other cancers.
• Provide counseling about living a healthy lifestyle, such as diet, exercise, and quitting smoking.

During visits with your APP, you will:

• Talk with you about your medical history.
• Do a physical exam.
• Order tests, such as x-rays, scans, and blood tests.
• Make referrals to other healthcare providers, if needed.
• Prescribe medicine, if needed.

Talk with your doctor or nurse or visit our Survivorship Center online at www.msk.org/experience/living-beyond-cancer for more information about our Survivorship program.

When to call your healthcare provider

Call your healthcare provider right away if:

• You have a fever of 101° F (38.3° C) or higher.
• You have severe pain in your lower abdomen (belly) when you’re urinating.
• You cannot urinate.
• You have swelling or tenderness in your calves or thighs, especially if 1 leg is more swollen than the other.
• You become short of breath or are coughing up blood.

Contact information

If you have questions or concerns, contact your healthcare provider. A member of your care team will answer Monday through Friday from 9 a.m. to 5 p.m. Outside those hours, you can leave a message or talk with another MSK provider. There is always a doctor or nurse on call.

If you’re not sure how to reach your healthcare provider, call 212-639-2000.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read this section, write down questions to ask your healthcare provider.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems such as premature menopause or fertility issues. Ask a member of your MSK care team for a referral or call 646-888-5076 to learn more.
• Our Male Sexual and Reproductive Medicine Program can help with sexual health problems such as erectile dysfunction (ED). Ask a member of your care team for a referral or call 646-888-6024 to learn more.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call to learn more.

Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
646-929-8032
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medicine that’s part of the Good Days formulary.

HealthWell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medicines and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medicines.

NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.

Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medicines they have trouble affording.

Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.

Prostate cancer support services

The American Urologic Association Foundation
www.auafoundation.org
866-746-4282
Offers free information about prostate diseases.

MSK Incontinence Specialist
646-497-9068
If you think you’d benefit from a consultation with a urologic surgeon specializing in incontinence, talk with your surgeon for a referral.

MSK Prostate Cancer Support Group
646-888-8106
This is a monthly meeting for men who have been treated for prostate cancer. Call for more information or to register.

National Association for Continence
www.nafc.org
Provides information and support for people dealing with incontinence.

National Comprehensive Cancer Network (NCCN)
www.nccn.org
215-690-0300
Has information and resources for people living with cancer and their caregivers, including support groups and education. The publication Prostate Cancer Guidelines for Patients may be helpful.

Prostate Cancer Foundation
www.pcf.org
800-757-CURE (800-757-2873)
Provides prostate cancer education and support programs.

US TOO
www.ustoo.org
800-808-7866
Provides prostate cancer education and support programs. Meetings are open to people living with cancer and their caregivers. US TOO has a monthly newsletter called Hotsheet.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read these resources, write down questions to ask your healthcare provider.

• A Guide for Caregivers
• About Your Urinary (Foley) Catheter: How To Clean and Care for It
• Advance Care Planning for People With Cancer and Their Loved Ones
• Building Your Family After Cancer Treatment: For People Born With Testicles
• Call! Don't Fall!
• Frequently Asked Questions About Walking After Your Surgery
• Herbal Remedies and Cancer Treatment
• How to Be a Health Care Agent
• How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil
• How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
• How To Use Your Incentive Spirometer
• Patient-Controlled Analgesia (PCA)
• Pelvic Floor Muscle (Kegel) Exercises for Males
• Sperm Banking
• What You Can Do to Avoid Falling