A radical prostatectomy is surgery to remove the entire prostate gland and seminal vesicles to treat prostate cancer confined to the gland. It is usually done through keyhole incisions with robotic assistance, aiming to clear the cancer while sparing nearby nerves that control continence and erections.
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Next: read your own biopsy report like an oncologist would
Prostate cancer treatment is chosen from three numbers, not one: your PSA, the ISUP grade group from the biopsy (the old Gleason score) and the clinical stage on MRI. Together they place you in a risk group — and the risk group, not the diagnosis, decides whether surgery, radiation or surveillance is right.
All three values appear on standard reports: PSA on the blood test, the grade group or Gleason score on the biopsy, and the stage on the MRI. This tool is educational and never replaces a uro-oncologist reading the whole study.
Curable by surgery, by radiation and in some carefully selected men by focal therapy, with near-identical long-term survival. This is where the choice genuinely belongs to you: surgery front-loads the side effects then improves, radiation is gentler at first with later bowel and bladder risk. Ask for both opinions from the same centre.
Get this staged free in 4 hoursA real tumour board weighs your risk group against your age, your other illnesses and your urinary baseline. This mirrors that conversation — an honest leaning, not a verdict.
Your PSA, grade group and stage from the section above feed straight into this. Change them and watch the leaning move — that is genuinely how the decision behaves.
Will I be dry, and will I be able to have sex? Continence and potency recover on completely different clocks. Set your own situation and see both curves honestly.
Age is taken from the slider above. These curves are modelled on published high-volume series — indicative for a man of your profile, never a prediction for you personally.
Cancer control is similar across approaches in expert hands. What changes is blood loss, pain, catheter time and how quickly you get your life back.
Where it shines: 10x magnified 3D vision and wristed instruments in a deep, narrow pelvis — which is exactly where nerve-sparing and the urethral reconstruction happen. Lowest blood loss, least pain, fastest return to work, and the best published continence recovery curves. This is the reference approach worldwide.
What to watch: Outcomes track the console surgeon's case volume, not the machine. Ask for their personal annual number and their positive-margin rate before you ask about the robot model.
Five keyhole ports across the lower abdomen — illustrative, not to scale.
Across every published series, the console surgeon's annual case volume tracks positive margins, continence recovery and complications more closely than the hospital's brand or the robot's model. Ask for the personal number — a good surgeon answers immediately.
We only route prostatectomy cases to surgeons above the high-volume threshold, and we will name the surgeon and their annual volume in writing before you book anything.
Next: what a robotic prostatectomy actually costs
Set your situation below for an instant indicative range. Your exact figure comes back within 1 hour of us seeing the PSA, biopsy and MRI.
Indicative ranges only. Robotic console consumables and the pathology workload are the largest single line items. Final cost depends on the approach, whether lymph nodes are removed, gland size, previous abdominal surgery, PSMA PET staging and any hormone or radiation therapy added afterwards. We share a written, itemised estimate before you travel and flag anything that could change it.
Once the gland is out, nothing in your body should be making PSA. That makes the test extraordinarily sensitive — far more useful than any scan — and it is why testing every three months for two years matters. A rise caught at 0.2 is treatable with salvage radiation; a rise caught at 2.0 is a much harder conversation.
Send my PSA reports for reviewExpected by 6 weeks in roughly 90–95%. Keep testing 3-monthly for two years, then 6-monthly.
Not recurrence yet. It changes the testing interval to 6–8 weeks and puts salvage radiation on the table early.
Confirmed on two readings. Early salvage radiation at a low PSA cures a substantial share of these men — timing is everything.
Doubling in under 6–9 months prompts PSMA PET to look for a target, and usually hormone therapy alongside radiation.
Next: the six things men are wrongly told about this surgery
Almost every man leaks on the day the catheter comes out, and almost none of them stay that way. With pelvic floor training started before surgery, 85–95% are pad-free or on one light pad at a year. Permanent severe incontinence needing a sling or artificial sphincter runs at roughly 1–3% at high-volume centres.
Orgasm remains, and desire is unchanged — ejaculation does not, because the prostate and seminal vesicles are gone. Erections depend on how much of the neurovascular bundle can be spared, your age and your function before surgery. In men under 60 having bilateral nerve-sparing, 60–80% regain intercourse-quality erections, most between 6 and 24 months.
The robot has no autonomy whatsoever. Every movement is made by a surgeon at a console two metres away. The reason to choose a robotic centre is the surgeon's case volume and margin rate — the platform only makes precise hands more precise.
Grade group 1 disease almost never spreads. Immediate surgery there is over-treatment, and international guidelines recommend active surveillance with repeat PSA, MRI and biopsy. An honest surgeon will sometimes talk you out of the operation — that is the sign you are in the right place.
Cure rates are comparable in localised disease; the trade-offs differ. Surgery front-loads the risk — incontinence and erectile difficulty that then improve — and gives true pathological staging plus a clean PSA to follow. Radiation is gentler initially but carries late bowel and bladder irritation, and salvage surgery afterwards is far harder than salvage radiation after surgery.
PSA rises with benign enlargement, infection, inflammation and even cycling. Even at 20 ng/ml, disease is often still confined. Grade group and MRI matter more than the absolute number, and PSMA PET now stages high-risk disease with far greater accuracy than older scans.
Drag through the timeline. The catheter week surprises most men — knowing what it looks like in advance takes the fear out of it.
Five small port wounds, closed with dissolvable sutures. Sips of water within hours, sitting up the same evening. A catheter drains the bladder while the new join heals.
From the first WhatsApp message to your two-year PSA at home.
The PSA value with its date, the biopsy report with the Gleason score or grade group and how many cores are positive, the multiparametric MRI report with the PI-RADS score, plus a note on your erections and urinary flow before treatment. Photos of the printed reports are fine.
A uro-oncologist confirms your risk group, whether surgery, radiation or surveillance genuinely fits, how much nerve-sparing looks safe on your MRI, and whether PSMA PET staging is needed first. Complex cases go to a tumour board.
An itemised estimate naming the approach and whether lymph node dissection is included, plus a hospital invitation letter for the medical visa, usually issued in 2–4 hours, covering you and your attendants together.
PSMA PET-CT or a bone scan where the risk group requires it, blood tests, ECG, anaesthetic review and a baseline continence and erectile function score. Pelvic floor exercises are taught before, not after, the operation — this matters.
Robot-assisted removal of the prostate and seminal vesicles under general anaesthesia, nerve-sparing to the extent your imaging allows, lymph node dissection if indicated, then a watertight bladder-to-urethra reconstruction. A catheter is left in place.
Walking the same evening or the next morning, eating normally, on tablet painkillers. Most men are surprised at how little the keyhole surgery hurts. The catheter stays and you go home or to the hotel with it.
The specimen report gives the definitive grade, stage, margin status and node status — the real prognosis, more accurate than the biopsy. The catheter comes out at the same visit and pelvic floor rehab begins in earnest.
Wound check, continence review and clearance to fly. First PSA at 6 weeks — it should be undetectable. Then video reviews and PSA every 3 months for two years, with your local reports read by your surgeon.
These are typical figures at high-volume partner centres where the console surgeon performs 100+ robotic prostatectomies a year. Your own result depends on your risk group, gland size, age, baseline erectile function and how much nerve tissue can be safely spared.
Not an optional extra. Taught before surgery, restarted the day the catheter is out, three sets a day for three months. Men who do it properly regain continence months earlier than men who do not.
Nerves that are not used for months recover worse. Low-dose daily tadalafil, a vacuum erection device from week 4–6, and honest conversation about interim injections keep tissue healthy while the nerves regrow.
After the gland is removed, PSA should be undetectable. A confirmed rise to 0.2 ng/ml is biochemical recurrence and is highly treatable with salvage radiation — which is exactly why 3-monthly testing for two years matters more than any scan.
There is no ejaculate afterwards, so fatherhood needs sperm banking before surgery if that is on the table. Orgasm sensation persists for most men, sometimes different in intensity. This should be discussed before the operation, not discovered after.
No forms, no payment, no obligation. A high-volume robotic prostate surgeon reads your PSA, biopsy and MRI and tells you honestly whether you need surgery at all, how much nerve-sparing is realistic, what your continence odds are, and what it will cost.
We reply on WhatsApp — usually within an hour, in your language.
You will be flying home with a recent pelvic operation and possibly still on a catheter, so the details matter: enough recovery days before departure, an aisle seat, and an attendant beside you. We arrange all of it along with the paperwork.
"PSA 14, Gleason 4+3, and two hospitals at home wanted to start hormones. The surgeon here said it was operable, took it out with the robot, and my PSA has read undetectable for two years."
"Home on the third day with the catheter, out on day six. I was dry at night within a month and using one pad in the day by week five. Nobody hid the erection part from me either."
"They talked me out of surgery. Gleason 6, and they put me on surveillance with a scan plan instead. That honesty is why my brother came here for his own operation."
Radical prostatectomy removes the whole prostate gland together with the seminal vesicles, then rejoins the bladder to the urethra. Because the prostate sits wrapped in the nerves that control erections and immediately above the muscle that controls urine, the operation is not judged on removing the gland — anyone can do that — but on three things at once: clear margins, a continence-sparing reconstruction of the bladder neck and urethra, and preserving as much of the neurovascular bundle as the cancer safely allows. That is why the surgeon's personal case volume changes your outcome more than the brand of robot. Today the great majority of these operations are done robot-assisted through five keyhole ports, with magnified 3D vision and instruments that move more precisely than a human wrist inside the pelvis.
No forms, no payment, no obligation. A high-volume robotic prostate surgeon reads your PSA, biopsy and MRI and tells you honestly whether you need surgery at all, how much nerve-sparing is realistic, what your continence odds are, and what it will cost.