Much of the information about radical robotic prostatectomy focuses on the operation itself. For patients, an equally important part comes afterwards: understanding the results. After surgery, the removed prostate is examined in detail and your PSA is monitored over time. This article explains your results after prostate cancer surgery, what they mean and when further treatment may be considered.
A quick reminder of the operation
A radical robotic prostatectomy removes the whole prostate gland and the seminal vesicles, and sometimes nearby lymph nodes. It is performed through small keyhole incisions, with the surgeon controlling precise instruments from a console. Our guide to what robotic surgery involves explains the procedure in more detail.
The pathology report
After the operation, the prostate is sent to a laboratory where a pathologist examines it under a microscope. The report usually becomes available within a few weeks and is discussed with you at a follow-up appointment. It covers several points.
Grade
The report confirms the Gleason score and grade group of the cancer. This can differ slightly from the biopsy result, because the whole gland can now be examined rather than small samples.
Stage
The report describes whether the cancer was contained within the prostate or had grown into the surrounding tissue or seminal vesicles.
Margins
A margin is the edge of the removed tissue. A negative margin means no cancer cells were found at the edge. A positive margin means cancer cells reached it, which can slightly increase the chance of the cancer returning. A positive margin does not automatically mean more treatment is needed; it is considered alongside the other results.
Lymph nodes
If lymph nodes were removed, the report says whether they contained cancer, and how many were examined.
PSA after surgery
Once the prostate has been removed, PSA should fall to a very low or undetectable level within a few weeks. Regular PSA tests then become the main way of checking that the cancer has been controlled. Tests are usually more frequent in the first years and then spaced out. Many men find the wait for each result stressful at first, and it is worth asking your team how and when results will be shared.
A PSA that stays undetectable is reassuring. A PSA that starts to rise may indicate that some cancer cells remain, and your team will discuss what that means for you. Our article on success rates after robotic surgery explains how PSA is used to measure cancer control.
When further treatment may be recommended
Most men need no further treatment after surgery. For some, particularly where the report shows higher-grade or more advanced disease, the team may recommend additional treatment. This usually means radiotherapy to the area where the prostate was, sometimes with hormone therapy. It may be given soon after surgery or only if PSA starts to rise.
These decisions are made by the multidisciplinary team, following NICE guidance on prostate cancer. Cancer Research UK explains follow-up and further treatment in more detail.
Questions to ask at follow-up
- What did the pathology report show?
- Were the margins clear?
- How often will my PSA be checked?
- What PSA level would prompt further discussion?
- Is any further treatment recommended now?
Recovery continues alongside follow-up
Follow-up appointments also cover continence and sexual function. Our article on erectile function after surgery explains what to expect over the longer term.
Clear information at every stage
Understanding your results helps you feel in control after treatment. Professor Dasgupta discusses every report with his patients and explains what it means for them. Our overview of prostate cancer explains the terms used in diagnosis and staging.
To discuss surgery and follow-up with Professor Dasgupta, please contact the clinic to arrange a consultation.