Perioperative Rehabilitation After Radical Prostatectomy: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.75.76044Keywords
Prostate cancer, radical prostatectomy, Prehabilitation, rehabilitation, pelvic floor muscle training, urinary incontinence, erectile dysfunction, Quality of lifeAbstract
Background. Prostate cancer is one of the most frequently diagnosed malignancies in men worldwide. Radical prostatectomy is the standard treatment for localized disease, providing excellent oncological control. However, postoperative complications, including urinary incontinence, erectile dysfunction, impaired physical function, and psychological distress, significantly reduce quality of life. Evidence indicates that perioperative rehabilitation improves functional recovery and facilitates return to daily activities.
Aim. To summarize evidence on perioperative rehabilitation after radical prostatectomy, focusing on pelvic floor muscle training, physical exercise, erectile dysfunction management, nutritional optimization, psychological support, and multimodal prehabilitation, and their effects on functional outcomes and quality of life.
Materials and Methods. A narrative literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Original studies, systematic reviews, meta-analyses, and international guidelines on perioperative rehabilitation were included.
Results. Preoperative pelvic floor muscle training accelerates urinary continence recovery. Multimodal prehabilitation, including exercise, nutritional counseling, and psychological support, improves physical fitness and may reduce postoperative complications. Early mobilization, structured rehabilitation, and individualized erectile dysfunction management enhance functional recovery and support sexual function. Multidisciplinary care and patient education further improve postoperative outcomes.
Conclusions. Perioperative rehabilitation should be integral to radical prostatectomy care. Early implementation of evidence-based strategies improves functional recovery and quality of life, while further high-quality randomized controlled trials are needed to establish standardized protocols.
References
1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–263 https://doi.org/10.3322/caac.21834
2. European Association of Urology. EAU Guidelines on Prostate Cancer. Arnhem: EAU; 2025.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2026.
4. Eastham JA, Auffenberg GB, Barocas DA, et al. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline. J Urol. 2022. https://doi.org/10.1097/JU.0000000000002757
5. Haglind E, Carlsson S, Stranne J, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy. Eur Urol. 2015;68(2):216–225. https://doi.org/10.1016/j.eururo.2015.02.029
6. Resnick MJ, Koyama T, Fan KH, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368(5):436–45. https://doi.org/10.1056/nejmoa1209978
7. Santa Mina D, Clarke H, Ritvo P, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014 Sep;100(3):196-207. https://doi.org/10.1016/j.physio.2013.08.008
8. Mungovan SF, Carlsson SV, Gass GC, et al. Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nat Rev Urol. 2021 May;18(5):259-281. https://doi.org/10.1038/s41585-021-00445-5
9. Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin. 2015;33(1):17–33. https://doi.org/10.1016/j.anclin.2014.11.002
10. Cerantola Y, Valerio M, Persson B, et al. Guidelines for perioperative care after radical cystectomy and radical prostatectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2013;32(6):879–87. https://doi.org/10.1016/j.clnu.2013.09.014
11. Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CMA. Conservative management for post-prostatectomy urinary incontinence. Cochrane Database Syst Rev. 2015 Jan 20;1(1):CD001843. https://doi.org/10.1002/14651858.cd001843.pub5
12. Zhou, L., Chen, Y., Yuan, X., Zeng, L., Zhu, J., & Zheng, J. (2023). Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis. Front Public Health 2023 Jul 31:11:1186067 https://doi.org/10.3389/fpubh.2023.1186067
13. Santa Mina, D., Matthew, A.G., Hilton, W.J. et al. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surg 14, 89 (2014). https://doi.org/10.1186/1471-2482-14-89
14. D Santa Mina, WJ Hilton, AG Matthew, R Awasthi, et al. (2018). Prehabilitation for radical prostatectomy: a multicentre randomized controlled trial. Surgical Oncology Volume 27, Issue 2, June 2018, Pages 289-298 https://doi.org/10.1016/j.suronc.2018.05.010
15. Ploussard G, Almeras C, Beauval J-B, Gautier J-R, Garnault V, Frémont N, Dallemagne S, Loison G, Salin A, Tollon C. A combination of enhanced recovery after surgery and prehabilitation pathways improves perioperative outcomes and costs for robotic radical prostatectomy. Cancer. 2020: 126: 4148-4155. https://doi.org/10.1002/cncr.33061
16. Bilyk A, Bruska N, Kołodziej P, Hebda P, Cemaga R, Patalong MF, et al. The Role of Prehabilitation on Functional Outcomes After Radical Prostatectomy: A Scoping Review. Qual Sport. 2026 Jan. 27. https://doi.org/10.12775/QS.2026.50.68112
17. Paul W. Hodges, Ryan E. Stafford, Leanne Hall, Patricia Neumann, Shan Morrison, Helena Frawley, Stuart Doorbar-Baptist, Irmina Nahon, Jason Crow, Judith Thompson, Anne P. Cameron (2020). Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Urologic Oncology: Seminars and Original Investigations, Volume 38, Issue 5. https://doi.org/10.1016/j.urolonc.2019.12.007
18. Milios JE, Ackland TR, Green DJ. Pelvic floor muscle training in radical prostatectomy: a randomized controlled trial of the impacts on pelvic floor muscle function and urinary incontinence. BMC Urol. 2019 Nov 15;19(1):116. https://doi.org/10.1186/s12894-019-0546-5
19. Milios JE, Ackland TR, Green DJ. Pelvic Floor Muscle Training and Erectile Dysfunction in Radical Prostatectomy: A Randomized Controlled Trial Investigating a Non-Invasive Addition to Penile Rehabilitation. Sex Med. 2020 Sep;8(3):414-421. https://doi.org/10.1016/j.esxm.2020.03.005
20. Sayılan AA, Özbaş A. The effect of pelvic floor muscle training on incontinence problems after radical prostatectomy. Am J Mens Health. 2018;12(4):1007–1015. https://doi.org/10.1177/1557988318757242
21. Laurienzo CE, Magnabosco WJ, Jabur F, Faria EF, Gameiro MO, Sarri AJ, et al. Pelvic floor muscle training and electrical stimulation as rehabilitation after radical prostatectomy: a randomized controlled trial. J Phys Ther Sci. 2018;30(6):825–831. https://doi.org/10.1589/jpts.30.825
22. Pan LH, Lin MH, Pang ST, Wang J, Shih WM. Improvement of urinary incontinence, life impact, and depression and anxiety with modified pelvic floor muscle training after radical prostatectomy. Am J Mens Health. 2019;13(3). https://doi.org/10.1177/1557988319851618
23. Strączyńska A, Weber-Rajek M, Strojek K, Piekorz Z, Styczyńska H, Goch A, et al. The impact of pelvic floor muscle training on urinary incontinence in men after radical prostatectomy: a systematic review. Clin Interv Aging. 2019;14:1997–2005. https://doi.org/10.2147/CIA.S228222
24. Ma ZZ, Zhang H, Xu H, Ding YH, Zhou Y, Yang Q, et al. Construction of pelvic floor muscle rehabilitation training program for patients undergoing laparoscopic radical prostatectomy. Transl Cancer Res. 2022;11(2):365–374. https://doi.org/10.21037/tcr-21-2738
25. Steenstrup B, Cartier M, Nouhaud FX, Kerdelhue G, Gilliaux M. A systematic review of supervised comprehensive functional physiotherapy after radical prostatectomy. Prog Urol. 2022;32(7):525–539. https://doi.org/10.1016/j.purol.2022.04.008
26. Razdan S, Pandav K, Altschuler J, et al. Impact of exercise on continence in prostate cancer patients post robotic assisted radical prostatectomy: a systematic review. Am J Clin Exp Urol. 2023;11(4):320–327.
27. Singh, F., Newton, R.U., Taaffe, D.R. et al. Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy. J Cancer Res Clin Oncol 149, 16563–16573 (2023). https://doi.org/10.1007/s00432-023-05409-3
28. Ashton, R.E., Aning, J.J., Tew, G.A. et al. Supported progressive resistance exercise training to counter the adverse side effects of robot-assisted radical prostatectomy: a randomised controlled trial. Support Care Cancer 29, 4595–4605 (2021). https://doi.org/10.1007/s00520-021-06002-5
29. Santa Mina, D., Guglietti, C.L., Alibhai, S.M.H. et al. The effect of meeting physical activity guidelines for cancer survivors on quality of life following radical prostatectomy for prostate cancer. J Cancer Surviv 8, 190–198 (2014). https://doi.org/10.1007/s11764-013-0329-z
30. Ouchi, M., Kitta, T., Chiba, H., Higuchi, M., Abe-Takahashi, Y., Togo, M., Kusakabe, N., Murai, S., Kikuchi, H., Matsumoto, R., Osawa, T., Abe, T. and Shinohara, N. (2024). Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial. BJU Int, 134: 398-406. https://doi.org/10.1111/bju.16369
31. Terek-Derszniak M, Gąsior-Perczak D, Biskup M, Skowronek T, Nowak M, Falana J, et al. Continence recovery after radical prostatectomy: personalized rehabilitation and predictors of treatment outcome. Diagnostics. 2025;15(22):2881. https://doi.org/10.3390/diagnostics15222881
32. de Santana Santos NA, Saintrain MVL, Regadas RP, da Silveira RA, de Menezes FJC. Assessment of physical therapy strategies for recovery of urinary continence after prostatectomy. Asian Pac J Cancer Prev. 2017;18(1):81–86. https://doi.org/10.22034/APJCP.2017.18.1.81
33. Terzoni S, Ferrara P, Bellati G, Mora C, Pinna H, Borelli S, et al. Maintenance exercises for urinary continence after rehabilitation following radical prostatectomy: follow-up study. Int J Urol Nurs. 2022;16(1):40–47. https://doi.org/10.1111/ijun.12299
34. Capogrosso P, Salonia A, Briganti A, Montorsi F. Are we improving erectile function recovery after radical prostatectomy? Analysis of patients treated over the last decade. Eur Urol. 2019;75(2):221-228. https://doi.org/10.1016/j.eururo.2018.08.039
35. Bratu O, Oprea I, Marcu D, Spinu D, Niculae A, Geavlete B, et al. Erectile dysfunction post-radical prostatectomy: a challenge for both patient and physician. J Med Life. 2017;10(1):13-18.
36. Saleh A, Abboudi H, Ghazal-Aswad MB, Mayer EK, Vale JA. Management of erectile dysfunction post-radical prostatectomy. Res Rep Urol. 2015;7:19-33. https://doi.org/10.2147/RRU.S58974
37. Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post-prostatectomy erectile dysfunction. Transl Androl Urol. 2015;4(4):421-437. https://doi.org/10.3978/j.issn.2223-4683.2013.09.10
38. Gandaglia G, Suardi N, Cucchiara V, Bianchi M, Shariat SF, Roupret M, et al. Penile rehabilitation after radical prostatectomy: does it work? Transl Androl Urol. 2015;4(2):110-123. https://doi.org/10.3978/j.issn.2223-4683.2015.02.01
39. Sopko NA, Burnett AL. Erection rehabilitation following prostatectomy—current strategies and future directions. Nat Rev Urol. 2016;13(4):216-225. https://doi.org/10.1038/nrurol.2016.47
40. Liu C, Lopez DS, Chen M, Wang R. Penile rehabilitation therapy following radical prostatectomy: a meta-analysis. J Sex Med. 2017;14(12):1496-1503. https://doi.org/10.1016/j.jsxm.2017.09.020
41. Feng D, Tang C, Liu S, Yang Y, Han P, Wei W. Current management strategy of treating patients with erectile dysfunction after radical prostatectomy: a systematic review and meta-analysis. Int J Impot Res. 2022;34(1):18-36. https://doi.org/10.1038/s41443-020-00364-w
42. Jo JK, Jeong SJ, Oh JJ, Lee SW, Lee S, Hong SK, et al. Effect of starting penile rehabilitation with sildenafil immediately after robot-assisted laparoscopic radical prostatectomy on erectile function recovery: a prospective randomized trial. J Urol. 2018;199(6):1600-1606. https://doi.org/10.1016/j.juro.2017.12.060
43. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. 2026
44. Baccaglini W, Monteiro L, Rached RYS, Navas A, Glina S. The role of low-intensity extracorporeal shockwave therapy on penile rehabilitation after radical prostatectomy: a randomized clinical trial. J Sex Med. 2020;17(4):688-694. https://doi.org/10.1016/j.jsxm.2019.12.024
45. Porst H. Review of the current status of low-intensity extracorporeal shockwave therapy in erectile dysfunction, Peyronie’s disease, and sexual rehabilitation after radical prostatectomy. Sex Med Rev. 2021;9(1):93-122. https://doi.org/10.1016/j.sxmr.2020.01.006
46. Fode M, Serefoglu EC, Albersen M, Sønksen J. Sexuality following radical prostatectomy: is restoration of erectile function enough? Sex Med Rev. 2017;5(1):110-119. https://doi.org/10.1016/j.sxmr.2016.07.005
47. Baguley BJ, Bolam KA, Wright ORL, Skinner TL. The effect of nutrition therapy and exercise on cancer-related fatigue and quality of life in men with prostate cancer: a systematic review. Nutrients. 2017;9(9):1003. https://doi.org/10.3390/nu9091003
48. Hackshaw-McGeagh LE, Sutton E, Persad R, et al. Acceptability of dietary and physical activity lifestyle modification for men following radiotherapy or radical prostatectomy for localised prostate cancer: a qualitative investigation. BMC Urol. 2017;17:94. https://doi.org/10.1186/s12894-017-0284-5
49. Souroujon Torun A, Sundaresan V, Golos A, Leapman M, Gomez-Santamaría O, Casilla-Lennon M. The role of nutrition in prostate cancer risk, progression, and mortality: a comprehensive review. Clin Nutr ESPEN. 2026;72:102914. https://doi.org/10.1016/j.clnesp.2026.102914
50. Du G, Zhang Y. The impact of nutritional management on postoperative recovery outcomes in prostate cancer patients undergoing radical prostatectomy: a retrospective study. J Multidiscip Healthc. 2025;18:6079–6090. https://doi.org/10.2147/JMDH.S549544
51. Mandair D, Rossi RE, Pericleous M, Whyand T, Caplin ME. Prostate cancer and the influence of dietary factors and supplements: a systematic review. Nutr Metab (Lond). 2014;11:30. https://doi.org/10.1186/1743-7075-11-30
52. Lin PH, Aronson W, Freedland SJ. Nutrition, dietary interventions and prostate cancer: the latest evidence. BMC Med. 2015;13:3. https://doi.org/10.1186/s12916-014-0234-y
53. Cipolla BG, Mandron E, Lefort JM, et al. Effect of sulforaphane in men with biochemical recurrence after radical prostatectomy. Cancer Prev Res (Phila). 2015;8(8):712–719. https://doi.org/10.1158/1940-6207.CAPR-14-0459
54. Hackshaw-McGeagh LE, Penfold C, Shingler E, et al. Phase II randomised control feasibility trial of a nutrition and physical activity intervention after radical prostatectomy for prostate cancer. BMJ Open. 2019;9(11) https://doi.org/10.1136/bmjopen-2019-029480
55. Yuan Y, Hu Y, Cheng J-X, Ding P. Psychological nursing approach on anxiety and depression of patients with severe urinary incontinence after radical prostatectomy – a pilot study. Journal of International Medical Research. 2019;47(11):5689-5701. https://doi.org/10.1177/0300060519878014
56. Köhler N, Friedrich M, Gansera L, Holze S, Thiel R, Roth S, et al. Psychological distress and adjustment to disease in patients before and after radical prostatectomy: results of a prospective multi-centre study. Eur J Cancer Care (Engl). 2014;23(6):795-802. https://doi.org/10.1111/ecc.12186
57. Kollberg KS, Wilderäng U, Thorsteinsdottir T, Hugosson J, Wiklund P, Bjartell A, et al. Psychological well-being and private and professional psychosocial support after prostate cancer surgery: a follow-up at 3, 12, and 24 months after surgery. Eur Urol Focus. 2016;2(4):418-425. https://doi.org/10.1016/j.euf.2015.10.005
58. Eymech O, Brunckhorst O, Deacon M, James C, Bowie J, Dasgupta P, et al. The impact of radical prostatectomy on the social well-being of prostate cancer survivors: a qualitative meta-synthesis. Eur J Cancer Care (Engl). 2022;31(4):e13630. https://doi.org/10.1111/ecc.13630
59. Li Y, Yu D, Wang D, Wu X, Cheng H, Liu J, et al. Sexual health distress and needs after radical prostatectomy: a scoping review. Sex Med Rev. 2026;14(1) https://doi.org/10.1093/sxmrev/qeaf077
60. Vyas N, Brunckhorst O, Fox L, Van Hemelrijck M, Muir G, Stewart R, et al. Undergoing radical treatment for prostate cancer and its impact on wellbeing: a qualitative study exploring men’s experiences. PLoS One. 2022;17(12). https://doi.org/10.1371/journal.pone.0279250
61. Mungovan SF, Huijbers BP, Hirschhorn AD, Patel MI. What makes men leak? An investigation of objective and self-report measures of urinary incontinence early after radical prostatectomy. Neurourol Urodyn. 2016;35(2):225-229. https://doi.org/10.1002/nau.22701
62. Pedersen MB, Saxton JM, Villumsen BR, Jensen JB, Birch S. Detailed description of multidisciplinary prehabilitation in patients admitted to nerve sparing radical prostatectomy: a randomized feasibility study protocol. Contemp Clin Trials Commun. 2024;10:40:101319. https://doi.org/10.1016/j.conctc.2024.101319
63. Pedersen MB, Villumsen BR, Saxton JM, Birch S, Jensen JB, Nielsen AH. Prostate cancer patient experience of prehabilitation prior to radical prostatectomy - A hermeneutical phenomenological study. Eur J Oncol Nurs. 2025 Apr;75:102810. https://doi.org/10.1016/j.ejon.2025.102810
64. Tay SS, Zhang F, Neo EJR. The use of technology in cancer prehabilitation: a systematic review. Front Oncol. 2024 Apr 19;14:1321493. https://doi.org/10.3389/fonc.2024.1321493
65. Amparore D, De Cillis S, Sica M, Piramide F, Checcucci E, Piana A, Quara A, Cisero E, Pini F, Gatti C, Manfredi M, Fiori C, Porpiglia F. Enhancing postoperative functional recovery: Impact of the MAIA™ telerehabilitation platform in robot-assisted radical prostatectomy patients. Asian J Urol. 2025 Jul;12(3):366-374. https://doi.org/10.1016/j.ajur.2024.07.005
66. Buhas BA, Uleri A, Katzendorn O, Salin A, Lesourd M, Almeras C, Loison G, Tollon C, Pradère B, Beauval JB, Malavaud B, Ploussard G. Transition to a digital perioperative pathway for robot-assisted radical prostatectomy: impact on patient outcomes and adherence. BJU Int. 2026 Mar;137(3):473-479. https://doi.org/10.1111/bju.70102
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