In the more traditional approach to doing a prostatectomy, the surgeon operates through a single long incision to remove the prostate and nearby tissues.
For the Open radical retropubic prostatectomy operation, the surgeon makes a skin incision from the belly button down to the pubic bone.
If there is a reasonable chance the cancer may have spread to the lymph nodes (based on your PSA level, DRE, and biopsy results), the surgeon may remove lymph nodes in the pelvis at the same time.
When removing the prostate, the surgeon will pay close attention to the 2 bundles of nerves that run on either side of the prostate. These nerves control erections. If you are able to have erections before surgery, the surgeon will try not to injure these nerves (known as a nerve-sparing approach) but if the cancer is growing into or very close to the nerves the surgeon will need to remove them.