After a diagnosis, many men assume their next step is to find a surgeon and book an operation. In fact, prostate cancer surgery is only one of several options, and it is not right for everyone. A good specialist helps you decide whether an operation is the best choice before discussing how it should be done. This article explains what a prostate cancer surgeon does and why an open discussion of every option matters.
What a prostate cancer surgeon does
A prostate cancer surgeon is a consultant urologist with specialist training in urological cancer. Their main operation is radical prostatectomy, which removes the whole prostate gland along with the cancer inside it. Today this is most often performed with robotic assistance, using small incisions. Our robotic prostatectomy page describes the operation in detail.
A surgeon's role starts well before any operation, though. They review your results, explain your diagnosis and help you weigh up the options with the wider team. They also follow your progress afterwards, checking PSA results and supporting your recovery of continence and sexual function over the months that follow.
When surgery is usually considered
Prostate cancer surgery is most often recommended for men whose cancer is confined to the prostate, or has spread only just beyond it, and who are fit enough for an operation. It is commonly considered for intermediate-risk disease and for some higher-risk cancers. Many men value the fact that surgery removes the cancer completely and allows the removed tissue to be examined in detail. This gives precise information about the grade and extent of the cancer, which helps guide any further treatment if it is needed later.
When other options may suit you better
Several alternatives exist, and each suits different situations:
- Active surveillance involves regular monitoring rather than immediate treatment, and is often recommended for low-risk cancer.
- Radiotherapy, sometimes with hormone therapy, is an alternative to surgery for many men with localised disease.
- Hormone therapy may be used for cancer that has spread or alongside radiotherapy.
NHS information on prostate cancer treatment gives a clear summary of each. Our overview of prostate cancer explains how they fit together.
How the decision is made
Every case should be reviewed by a multidisciplinary team, as set out in NICE guidance on prostate cancer. This team includes urologists, oncologists, radiologists and pathologists, who together recommend the most suitable options. The final decision is then made by you, with your surgeon, based on your results, general health and personal priorities. Your GP and specialist nurse can also help you think through the choices.
Signs of a balanced specialist
A specialist you can rely on will:
- explain all reasonable options, not only surgery
- describe the risks and benefits of each honestly
- consider what matters most to you, such as continence or sexual function
- support you if you want time to think or a second opinion
Our article on seeking a second opinion explains when another view can help.
If surgery is the right choice
If you and your team decide that prostate cancer surgery is the best option, the next step is choosing an experienced surgeon. Useful questions cover their annual caseload, their continence and erectile function results and the support available during recovery. Our list of questions to ask your surgeon covers these areas in detail.
Taking the next step
The right specialist helps you reach a decision you feel confident about, whether or not that involves an operation. Clear information, honest advice and time to reflect all play their part.
Professor Dasgupta offers consultations to discuss every option, including when surgery is not needed. Please contact the clinic to arrange an appointment.