Robotic-assisted radical prostatectomy
Radical prostatectomy is surgical removal of the prostate gland and seminal vesicles, with lymph node assessment in selected cases. It is one of the established curative-intent treatments for localised prostate cancer, alongside radiation-based approaches.
Robotic assistance is commonly used for prostatectomy. It can offer advantages in visualisation and instrument precision — particularly for the nerve-sparing steps, where working around delicate tissue requires controlled dissection, and for the reconstruction of the bladder-urethral join. These are the parts of the operation where magnification and fine instrument movement are most relevant. That said, outcomes depend primarily on cancer factors, patient anatomy, and surgical judgement. The platform supports good decision-making; it does not replace it.
For a full overview of the prostate cancer pathway — including active surveillance, how surgery compares with radiation, and how treatment decisions are made — see the Prostate Cancer page. For more on what fellowship training in robotic prostatectomy involves and what questions are worth asking, see Robotic Surgery Training.
A consultation about prostatectomy is not simply a pre-operative appointment. It is an opportunity to work through whether surgery is the right option, what the specific trade-offs are in your case — cancer control, continence, sexual function, recovery — and what matters most to you. For many patients, making the right decision is just as important as performing the operation well.
When is radical prostatectomy recommended?
Prostatectomy is considered for patients with localised or locally advanced prostate cancer where surgery is an appropriate curative-intent option. The decision involves weighing:
Cancer risk category — low, intermediate or high risk, based on PSA, grade group and staging
Whether the cancer appears confined to the prostate or has features suggesting local extension
Baseline urinary and sexual function, and how these may be affected by surgery
Overall health and fitness for a major operation
Patient priorities — including what side effects matter most and how recovery fits with work and life
For many patients, particularly those with intermediate or high-risk disease, the choice between surgery and radiation is genuinely close and benefits from multidisciplinary discussion. Prostatectomy is not the only option, and a good consultation should make that clear. Some patients arrive assuming surgery is automatically the most definitive choice — the more useful question is which treatment best fits the biology of the cancer and what matters most to the individual.
Nerve-sparing — how decisions are made
The neurovascular bundles — two collections of nerves running alongside the prostate — are responsible for the nerve signals that trigger erections. Preserving them during prostatectomy is possible in some patients, but the decision depends on cancer location and extent, not on a default preference for sparing.
If the tumour is close to or involving the nerve bundles, attempting to spare them risks leaving cancer behind. Cancer control takes priority. In some cases, nerve-sparing is possible on one side but not the other. In high-risk disease, nerve-sparing is often limited or not appropriate.
Functional outcomes — including urinary continence and erectile function — depend on baseline function before surgery, anatomy, age, comorbidities, and whether nerve-sparing was technically feasible and oncologically safe. Recovery of erections, where nerve-sparing is performed, is measured in months, not weeks.
For a detailed explanation of nerve-sparing decisions, see Nerve-Sparing Prostatectomy: When It's Safe, When It Isn't.
The procedure
Robotic radical prostatectomy is performed under general anaesthesia through small keyhole incisions in the lower abdomen. The prostate gland and seminal vesicles are removed, and the bladder is reconnected to the urethra. Pelvic lymph nodes may be removed at the same time depending on the risk profile.
An assistant surgeon is present at the bedside throughout. The procedure typically takes two to four hours depending on complexity.
After surgery — what to expect
A urinary catheter is placed during surgery and remains in place for seven to ten days while the bladder-urethral join heals. You will be shown how to manage it before leaving hospital.
Most patients go home one to two days after surgery. Return to desk work is usually possible within two to three weeks; strenuous activity and heavy lifting are restricted for six weeks.
Urinary continence — some degree of urinary leakage after catheter removal is expected and normal. Most patients improve significantly over the first few months. Pelvic floor exercises, started before surgery and continued afterwards, support recovery. A continence physiotherapist referral is part of standard preparation.
Erectile function — where nerve-sparing has been performed, recovery of erections takes time — often many months, and sometimes longer. Penile rehabilitation, which may include medications or devices in the early post-operative period, is commonly recommended to support recovery. This will be discussed at your consultation.
PSA monitoring — after successful prostatectomy, PSA should fall to an undetectable level. Regular PSA checks form the basis of ongoing surveillance. The final pathology report also helps guide next steps — whether surveillance alone is appropriate, or whether additional treatment such as radiotherapy should be discussed. A rising PSA after surgery warrants prompt assessment and a clear conversation about options.
Risks and considerations
Radical prostatectomy carries risks that should be understood before proceeding. These include urinary incontinence (usually temporary, occasionally longer-term), erectile dysfunction (the pattern and likelihood depend on nerve-sparing and individual factors), bleeding, infection, injury to surrounding structures, hernia at port sites, and — in a small proportion of cases — positive surgical margins requiring further treatment.
These will be discussed in detail at your consultation. The goal is a clear and honest understanding of what surgery involves, what recovery looks like, and what the plan is if pathology reveals unexpected findings.
If you have been diagnosed with prostate cancer and are weighing whether surgery is the right option, contact the rooms to arrange a consultation. I will help you understand the trade-offs, what recovery is likely to involve in your specific case, and whether prostatectomy fits your situation — or whether another pathway may serve you better. For more on the prostate cancer pathway, including how surgery compares with radiation, see Prostate Cancer.
Clinical note: This page provides general information and is not a substitute for individual medical advice. Treatment decisions should be based on personalised assessment, staging and discussion of options.
Last reviewed: April 2026