When you are considering surgery, it is natural to ask how successful it is likely to be. Robotic prostatectomy success rates are often quoted, but success has several parts, and each is measured in a different way. Knowing what the figures mean will help you understand the data a surgeon shares and how it applies to you.
Success has more than one meaning
For most men, a successful operation achieves three things: the cancer is removed, bladder control returns and, where possible, erectile function recovers. Surgeons sometimes call this combination the "trifecta". Each part is reported separately, so it is worth asking about all three. A surgeon who shares figures for only one may be giving you an incomplete picture of their results.
Our robotic prostatectomy page explains how the operation aims to achieve each of these goals.
Measuring cancer control
Surgical margins
After surgery, the removed prostate is examined under a microscope. If cancer cells reach the edge of the tissue, this is called a positive margin. A lower positive margin rate generally indicates more complete removal. Margins depend partly on the stage of the cancer, so figures should be compared for similar cases.
PSA after surgery
Once the prostate has been removed, PSA should fall to a very low or undetectable level. Regular PSA tests then show whether the cancer has been controlled over time. A rising PSA may indicate that further treatment is needed, which is why follow-up matters.
Measuring urinary continence
Continence is usually reported as the proportion of men who need no pads, or one safety pad, at set times after surgery. Most men regain control within months of robotic surgery, with early improvement common and further progress over time. When comparing figures, check that they refer to the same time points, such as three, six and twelve months.
Measuring erectile function
Erectile function results are usually reported for men who had good function before surgery and nerve-sparing during it. Recovery is gradual, and many men see improvement within the first year, though results vary with age and health. Our article on erectile function after surgery explains the factors involved.
Why results vary
Several things influence outcomes:
- the stage and grade of the cancer
- age, general health and function before surgery
- whether nerve-sparing is possible
- the experience of the surgeon and team
Surgeon experience is one of the most important of these. Our article on why surgeon experience matters explains how results improve with the number of operations performed.
Reading the figures you are given
When a surgeon shares data, ask:
- Are these my surgeon's personal results or the hospital's?
- How many patients are included?
- What time points do the figures refer to?
- How do the results compare for men with a diagnosis like mine?
National context is available from the National Prostate Cancer Audit, which reports outcomes for hospitals in England and Wales. NICE guidance sets out how treatment should be offered and followed up. Our checklist of questions to ask before choosing a surgeon covers outcome data alongside other topics.
Applying the data to you
Published figures describe groups of patients, not individuals. Your own chances depend on your diagnosis and health, so the most useful discussion is about what the data means for someone like you. A good surgeon will put the figures in context and explain both the likely benefits and the risks honestly.
Overall, robotic prostate cancer surgery offers an effective balance between treating the cancer and maintaining quality of life when performed by an experienced team.
To discuss what outcomes you might expect, please contact the clinic to arrange a consultation with Professor Dasgupta.