The steps of a prostatectomy depend on the type of procedure. The most common prostatectomy used to try to cure prostate cancer is radical retropubic prostatectomy. It is performed by a urologic surgeon in a hospital. The surgery, which can last up to four hours, may be done under:

• General anesthesia
  
  
• Spinal anesthesia (injected into the sac of cerebrospinal fluid)
  
  
• Epidural anesthesia (injected outside the cerebrospinal sac)

Lymph nodes near the prostate may be removed and sent to a pathologist for a detailed examination. The operation may be ended at this point if some of these lymph nodes are found to be cancerous, which indicates metastasis (spread) and a poor prognosis (chance of cure). If there is no lymph node involvement, the surgery proceeds and the prostate is removed, along with surrounding tissue, including the seminal vesicles and sometimes lymph nodes.

The surgeon will attempt to spare the nerve fibers that flank the prostate unless they are cancerous. The primary goal of the surgery is to remove all of the cancer possible. For this reason, one or both nerves may need to be cut or completely removed. These nerves control erections and the patient becomes impotent if nerves are removed or severed. Sparing the nerves does not guarantee that a man will avoid impotency.

Following the removal of the gland and necessary surrounding tissues, the incision is then closed with sutures. While the patient is still under anesthesia, a catheter is threaded through the tube-like urethra of the penis into the bladder to allow urination during healing.

The procedure differs slightly in another type of open prostatectomy called perineal prostatectomy. The surgeon makes an incision in the perineum, the area between the scrotum and the anus. This procedure may last as little as an hour and a half and involve less pain during recovery. It is used less often than retropubic, however, because it cannot remove lymph nodes and surgeons cannot easily avoid cutting the nerves that control erections.

In addition to these open prostatectomies, some major medical centers offer laparoscopic radical prostatectomy (LRP). The surgeon makes several shorter incisions and uses a camera and specialized tubular instruments to remove the prostate and surrounding tissues. Laparoscopic surgery is less invasive and usually results in a shorter recovery period. 

Some medical facilities are using robotic-assisted laparoscopy to perform prostatectomies. The procedure is similar to LRP but he surgeon directs the robot rather than directly handling the instruments. Both of these procedures require surgeons with specialized training.

In late-stage cases where radical prostatectomy cannot cure prostate cancer, partial prostatectomy may be used to relieve pain and ease urination. Types of partial prostatectomy:

• Transurethral resection of the prostate (TURP). The surgeon inserts a wire-like instrument called a resectoscope through the urethra and uses electricity to cut out layers of prostate tissue. Spinal or general anesthesia is used, and the surgery takes about an hour. Blood in the urine is common after surgery. A temporary catheter is placed through the urethra to drain urine from the bladder during healing.
  
  
• Transurethral incision of the prostate (TUIP). The surgeon inserts an instrument through the urethra and makes a few small cuts in the prostate to reduce the gland’s constriction of the urethra and improve the flow of urine. This procedure is newer and performed less often than TURP. Advantages of TUIP include less loss of blood and less risk of retrograde ejaculation, where sterility results because the semen flows backward into the bladder. Anesthesia is used, but TUIP sometimes does not require an overnight hospital stay.