If you have been diagnosed with prostate cancer, you may be wondering whether robotic surgery is right for you. It is now the most common way of removing the prostate at experienced centres, yet not every man is a suitable candidate. Understanding how suitability for robotic prostate surgery is decided can help you prepare for the conversation with your specialist.
Who is usually suitable
Robotic prostate surgery is typically recommended for men whose cancer is confined to the prostate or has spread only a short distance beyond it. In these situations, the aim of surgery is to cure the cancer by removing the whole gland. Our robotic prostatectomy page explains what the operation involves.
It is often considered for intermediate-risk cancer and for some higher-risk cases. For low-risk cancer, monitoring is frequently the better first step, as described below.
The factors that guide the decision
The cancer itself
The stage of the cancer and how aggressive it appears are central to the decision. These are judged from your PSA level, MRI scan and biopsy results, which together show where the cancer sits and how likely it is to grow. Your team may also arrange further scans, such as a PSMA PET or bone scan, to check whether it has spread beyond the prostate.
Your general health
Robotic surgery is less invasive than open surgery, but it is still a major operation under general anaesthetic. Men who are fit and well are more likely to be suitable. Conditions affecting the heart or lungs, for example, need careful assessment before surgery is recommended.
Previous treatment or surgery
Earlier operations in the pelvis or abdomen, or previous treatment for an enlarged prostate, can make surgery more complex. They do not always rule it out, but they make a surgeon's experience particularly important.
Your own priorities
Each treatment carries different risks for continence and sexual function. What matters most to you is a legitimate part of the decision. Our guide to nerve-sparing techniques explains how surgeons try to protect these functions where it is safe to do so.
When another option may be better
In some cases, a different approach offers a better balance of benefit and risk:
- Active surveillance is often recommended for low-risk cancer, with regular PSA tests and scans in place of immediate treatment.
- Radiotherapy, sometimes with hormone therapy, is an effective alternative for many men with localised cancer.
- Hormone therapy may be used where the cancer has spread beyond the prostate.
NICE guidance on prostate cancer sets out how these options are matched to different risk groups, and NHS information on treatment summarises each one. Our overview of prostate cancer explains how they fit together.
How the decision is reached
Your case should be reviewed by a multidisciplinary team, including urologists, oncologists, radiologists and pathologists. They consider the clinical findings together and recommend the most suitable options. The final choice is then made by you, with your specialist, based on the evidence and on what you want from treatment.
A specialist consultation is essential for this. It gives you the chance to ask how robotic surgery would compare with the alternatives in your case, and how it differs from open surgery. Our article comparing robotic and open surgery covers that question in more detail.
Taking the next step
For many men, robotic prostate surgery offers an effective, minimally invasive way to treat localised cancer. Even so, the decision should always be tailored to the individual, with time to understand every option.
If you would like Professor Dasgupta to assess whether robotic surgery is suitable for you, please contact the clinic to arrange a consultation.