The prostate gland is a small structure in the male reproductive system, roughly the size of a walnut, located just beneath the bladder and in front of the rectum. It is not considered an organ necessary for maintaining core life processes, such as the heart or lungs. Survival without the prostate gland is possible and is a common outcome for many men who undergo a radical prostatectomy, the surgical removal of the entire gland, typically performed to treat prostate cancer.
The Prostate’s Essential Functions
The prostate serves a dual purpose, impacting both the reproductive and urinary systems. Its primary reproductive function is the production of seminal fluid, a milky, slightly alkaline liquid that contributes about 20% to 30% of the total volume of semen. This fluid contains enzymes and nutrients that help nourish and protect sperm, enhancing their motility and viability.
In its urinary role, the prostate surrounds the urethra, the tube that carries urine out of the body. The muscular tissue within the prostate helps regulate the flow of urine from the bladder. During ejaculation, the prostate and the bladder’s internal sphincter muscle contract to prevent semen from traveling backward into the bladder, a process called retrograde ejaculation.
Answering the Question: Immediate Survival
Survival is assured after a successful radical prostatectomy, the procedure used to remove the prostate gland. The surgery is most often performed to treat localized prostate cancer, though it is occasionally used for severe benign prostatic hyperplasia (BPH). Since the gland is not responsible for circulatory, respiratory, or nervous system function, its removal does not immediately compromise life.
The procedure, frequently performed using robotic-assisted techniques, involves disconnecting the prostate from the bladder and urethra. The surgeon then reconnects the bladder directly to the urethra to restore the urinary tract. The 30-day mortality rate associated with this surgery is minimal, historically around 0.3%, confirming its safety profile.
Immediately following the operation, a patient typically has a catheter in place for one to three weeks to allow the surgical connection to heal. Hospital stays are generally short, often lasting only one or two days. The first few weeks focus on managing the catheter and beginning the process of regaining bladder control.
Post-Surgical Life: Managing Functional Changes
Life without the prostate requires managing the functional consequences of losing the gland and surrounding structures. The two most significant functional changes relate to urinary control and sexual function, which are addressed through comprehensive post-operative rehabilitation programs. Recovery is gradual, and patient dedication is a significant factor in the long-term outcome.
Urinary incontinence is a common initial side effect because prostate removal affects the internal sphincter mechanism that aids in urine retention. This often manifests as stress incontinence, where leakage occurs during physical activities like coughing, laughing, or lifting. The first line of recovery is conservative management, which includes pelvic floor muscle training, specifically Kegel exercises.
These exercises strengthen the muscles that support the urethra, often speeding up the recovery of continence. While many men require absorbent pads in the first six months after surgery, this figure improves substantially by one year. For the small percentage of men with persistent or severe leakage, surgical options are available, such as the male urethral sling for milder cases or the artificial urinary sphincter for more significant incontinence.
Sexual function is consistently altered after a radical prostatectomy, primarily due to potential damage to the cavernous nerves. These nerves run along the sides of the prostate and are necessary for achieving a natural erection. Even with nerve-sparing techniques, temporary nerve disruption or swelling is common, leading to erectile dysfunction (ED) immediately following surgery.
Penile rehabilitation programs are often initiated soon after surgery to promote blood flow and tissue health, helping to prevent scar tissue formation. These programs use phosphodiesterase type 5 (PDE5) inhibitor medications, such as sildenafil or tadalafil, as a first-line therapy to increase blood flow to the penis. Other options include vacuum erection devices or intracavernosal injections, which bypass nerve signaling to create an erection. A second consequence is the loss of ejaculation, resulting in a “dry orgasm,” because the seminal fluid glands have been removed.