Before prostate surgery, there are several things you need to stop or avoid in the days and weeks leading up to your procedure. Some of these, like fasting, are standard for any surgery under general anesthesia. Others are specific to prostate procedures, where controlling bleeding risk and keeping the surgical area clean are top priorities. Here’s what to know, organized by when you need to start paying attention.
Medications That Increase Bleeding
Blood-thinning medications are among the most important things to stop well before your surgery date. The exact timeline depends on which medication you take. Standard anticoagulants like warfarin and dabigatran are typically stopped 5 days before the procedure. Newer direct-acting blood thinners (other than dabigatran) are usually stopped 3 days before. Aspirin guidelines vary by surgeon, so ask your surgical team whether to continue or pause it.
Erectile dysfunction medications like sildenafil (Viagra) and tadalafil (Cialis) also need to be stopped. These drugs lower blood pressure and can interact dangerously with anesthesia. The standard recommendation is to skip them starting the day before surgery.
Never stop a prescribed medication on your own. Your surgeon and anesthesiologist will give you a specific plan for which medications to hold and which to keep taking. Bring a complete list of everything you take to your pre-operative appointment so nothing gets missed.
Herbal Supplements and Vitamins
Many common supplements increase bleeding risk during surgery, and this is an area where patients often don’t realize the danger. The general recommendation is to stop all nonessential supplements at least two weeks before your procedure.
Garlic and hawthorn supplements have the strongest evidence linking them to surgical bleeding, even in patients not taking blood thinners. Echinacea, cordyceps, and aloe vera supplements also carry some risk. If you take any blood-thinning medication, the list of concerning supplements grows longer: ginkgo biloba, chondroitin-glucosamine, turmeric, melatonin, chamomile, fenugreek, milk thistle, bilberry, and peppermint have all been linked to increased bleeding in people on anticoagulants.
Interestingly, fish oil, ginseng, and saw palmetto (which many men with prostate issues take) have not been associated with surgical bleeding in the current evidence. Still, mention every supplement you use to your surgical team so they can advise you individually.
Smoking and Alcohol
If you smoke, stopping at least four weeks before surgery can meaningfully lower your risk of complications like poor wound healing and respiratory problems. Even 24 hours without smoking starts clearing nicotine and carbon monoxide from your blood, but the real improvements in lung function take about two smoke-free months. The earlier you quit, the better your recovery will go.
Alcohol should also be stopped two to four weeks before surgery. Short-term abstinence in that window is linked to fewer postoperative complications. Even moderate drinking affects how your body processes anesthesia, handles bleeding, and heals tissue. If you drink regularly, a four-week pre-surgery break is the standard advice.
Food and Drink the Day Before
Prostate surgery, particularly robotic-assisted or open prostatectomy, typically requires bowel preparation. This means switching to a clear liquid diet the entire day before your procedure. Clear liquids are anything you can see through: water, apple juice, cranberry juice, black coffee or tea without milk, clear broth, plain gelatin without fruit pieces, and popsicles.
Some surgical teams also prescribe a laxative like magnesium citrate to drink the morning before surgery and a Fleet enema the morning of surgery. These steps empty your bowels to reduce the risk of contamination during the operation and make it easier for the surgeon to work in the pelvic area. Follow your specific surgical team’s instructions, as protocols vary between hospitals.
Fasting Before Anesthesia
The fasting rules before general anesthesia are strict because eating or drinking too close to surgery can cause dangerous aspiration, where stomach contents enter your lungs while you’re unconscious. The American Society of Anesthesiologists sets these minimum windows:
- Clear liquids: Stop at least 2 hours before your procedure time.
- Light meals or milk: Stop at least 6 hours before.
- Heavy, fatty, or fried foods: Stop at least 8 hours before.
Most surgical teams simplify this to “nothing to eat or drink after midnight” the night before, which provides a comfortable margin. If your surgery is scheduled for the afternoon, you may get slightly different instructions, but when in doubt, midnight is the safe cutoff.
Grooming Products and Personal Items
On the morning of surgery, skip your usual grooming routine beyond the basics. Do not wear makeup, perfume, cologne, or hairspray. Lotions and creams should not be applied to your skin, though a light layer of deodorant is usually fine. These products can interfere with surgical equipment, monitoring devices, and skin antiseptics used to prevent infection.
Remove all nail polish before you arrive. Surgeons monitor your oxygen levels during the procedure using a clip on your finger, and polish (especially gel or acrylic nails) blocks the reading. If you can’t remove all of it, at minimum clear the index or middle finger on each hand.
Leave all jewelry at home, including rings, watches, necklaces, and body piercings. Metal items pose a burn risk if electrocautery instruments are used during surgery. Wear your hair loose without clips, pins, or tight bands, and remove wigs or hairpieces before heading to the operating room.
Do Not Shave the Surgical Area
It might seem helpful to shave your lower abdomen or groin before surgery, but this is something you should not do at home. Razors create tiny nicks and cuts in the skin that become entry points for bacteria, increasing your infection risk. If hair removal is needed, the surgical team will do it at the hospital using specialized clippers that cut hair close to the skin without breaking it. Leave the area alone.
Your surgical team may ask you to shower with an antiseptic skin cleanser like chlorhexidine the night before and morning of surgery. This reduces bacteria on your skin and is one of the most effective things you can do to prevent a surgical site infection. Follow the specific washing instructions you’re given, paying attention to the surgical area without scrubbing aggressively.