Frequently asked questions
These questions are frequently asked
These questions are common before and after prostate cancer treatment. The answers are general and do not replace a personalised consultation.
Treatment decisions should be based on PSA, MRI, biopsy results, staging, general health, urinary and sexual function, and patient priorities.
Diagnosis and treatment decisions
Do I need treatment straight away?
Not always.
Some prostate cancers can be safely monitored with active surveillance. Others need treatment because they have features that make progression more likely.
The key is to understand the cancer risk. PSA, MRI, biopsy grade, cancer volume and staging all matter.
Treatment should be timely when needed, but panic is not a treatment plan.
How soon should prostate cancer surgery be done?
This depends on the risk and stage of the cancer.
Many men do not need surgery within days. There is usually time to understand the diagnosis, consider options, optimise fitness and plan the operation properly.
Higher-risk cancers should not be left indefinitely. Timing should be discussed based on Grade Group, PSA, MRI stage, biopsy findings, general health and treatment availability.
Should I get a second opinion?
A second opinion can be helpful if the decision is difficult.
It may be useful if you are unsure between surgery and radiotherapy, considering focal therapy, have high-risk disease, have a positive margin, have a rising PSA after treatment, or feel you have not fully understood the options.
A good second opinion should clarify the facts, not simply repeat the same uncertainty in different words.
Surgery and surgeon questions
Are you a good surgeon?
This is a fair question.
A good surgeon is not defined by one thing. It is not just speed, confidence, number of operations or technical ability.
In prostate cancer surgery, good surgery depends on the whole chain of care: decision-making, counselling, preparation, technical skill, team working, complication management, outcomes and follow-up.
The operation is not only about removing the prostate. It is about cancer control, continence recovery, sexual function where possible, safety and long-term monitoring.
Is a good surgeon a fast surgeon?
Not necessarily.
Efficiency matters. A smooth operation may reduce anaesthetic time, blood loss and unnecessary tissue handling.
But speed by itself is not the goal. The goal is controlled surgery.
A good surgeon knows when to move efficiently and when to slow down. Difficult anatomy, bleeding, inflammation, obesity, tumour position or a narrow pelvis may all require patience and adjustment. A good bedside assistant can make a big difference.
Good surgery is technically efficient and fluent.
What makes a good prostate cancer surgeon?
A good prostate cancer surgeon combines judgement, technical skill, anatomical knowledge, honest counselling, team working, outcome awareness and follow-up.
Important questions include:
Does this man need surgery at all?
Is active surveillance possible?
Is radiotherapy more appropriate, if there are competing health risks?
Is nerve-sparing safe?
Should lymph nodes be removed?
Has the patient understood the trade-offs?
Are continence and erectile function expectations realistic?
Is the surgeon using their own data to guide counselling where possible?
Is the surgeon continuing to train thier skills, simulate, review and improve?
A technically good operation can still have a bad outcome because surgery is affected by cancer biology, anatomy, age, baseline urinary and sexual function, obesity, diabetes, smoking and other factors.
That is why honest counselling matters.
A good surgeon should not promise perfection. He should use judgement, skill, data and honesty to give each patient the best chance of the best possible outcome.
Where should prostate cancer surgery be done?
Prostate cancer surgery should be done in a setting with the right surgeon, theatre team, robotic equipment, anaesthetic support, nursing care, pathology services, emergency backup and follow-up pathway.
The hospital matters. The surgeon matters. The team matters. The recovery pathway matters.
A good operation is not just what happens at the robotic console. It is the system around the patient.
Who should do my surgery?
Your surgeon should be someone who regularly performs prostate cancer surgery, understands prostate MRI and biopsy findings, can explain the trade-offs clearly, and can discuss continence, erectile function, margins, PSA follow-up and complications honestly.
The surgeon should be able to explain why surgery is appropriate, what the alternatives are, what the operation involves, and what recovery may look like for you.
You should not feel pushed into surgery without understanding why.
Nursing and allied health professionals
Is a prostate cancer nurse important?
Yes. A prostate cancer clinical nurse specialist is often one of the most important people in the patient’s care.
A specialist nurse can help explain the pathway, answer practical questions, support decision-making, help with catheter and continence advice, discuss sexual recovery, and act as a point of contact between the patient, surgeon, oncologist, hospital and wider team.
Good prostate cancer care is not only about the operation. It is also about preparation, recovery and support.
Who else may be involved in my care?
Depending on the situation, care may involve:
Consultant urological surgeon
Clinical nurse specialist
Oncologist
Radiologist
Pathologist
Anaesthetist
Theatre team
Ward nurses
Pelvic floor physiotherapist
Erectile dysfunction or andrology specialist
Dietitian
Exercise specialist or physiotherapist
Psychosexual therapist or counsellor
GP
Palliative care team in advanced disease where appropriate
Not every patient needs every professional. The team depends on the cancer, treatment choice, baseline health and recovery needs.
Results after surgery
What is a positive surgical margin?
A positive surgical margin means cancer cells are seen at the edge of the removed tissue under the microscope.
It does not automatically mean the cancer will return. It does increase recurrence risk in some patients, depending on Grade Group, tumour stage, margin length, margin location, lymph node status and PSA after surgery.
The most important early test is the post-operative PSA. If PSA becomes undetectable, some patients can be monitored carefully. If PSA remains detectable or rises later, radiotherapy or oncology input may be considered.
A positive margin is not ideal, but it is not a disaster by itself. It is one part of the whole picture.
What if I have a positive lymph node after surgery?
A positive lymph node means prostate cancer cells have been found in one or more lymph nodes removed during surgery.
This changes the risk profile and usually means follow-up needs to be more careful.
Next steps depend on the number of positive nodes, size of nodal disease, PSA after surgery, margin status, prostate pathology, imaging findings and general health.
Options may include close PSA monitoring, oncology review, radiotherapy, hormone therapy or a combination of treatments.
There is not one automatic answer.
What if my PSA does not become undetectable after surgery?
After prostate removal, PSA should usually fall to an undetectable or very low level.
If PSA remains detectable, this may suggest persistent prostate cancer cells somewhere in the body. The next step depends on the PSA level, trend, pathology and imaging.
This may lead to closer monitoring, PSMA PET imaging in selected cases, oncology review, radiotherapy or systemic treatment.
The pattern matters more than one isolated number.
What if my PSA rises later after surgery?
A rising PSA after prostatectomy may suggest biochemical recurrence.
This does not always mean visible cancer will immediately appear on scans. It means the PSA needs to be interpreted in context: how high it is, how quickly it is rising, what the original pathology showed and whether imaging is likely to help.
Further treatment may include radiotherapy to the prostate bed, pelvic nodal treatment, hormone therapy or monitoring depending on the case.
Complex disease
Can I have surgery if I have metastatic prostate cancer?
Sometimes, but it depends on the situation.
Traditionally, prostatectomy is mainly used for localised or locally advanced prostate cancer. In metastatic prostate cancer, treatment usually focuses on systemic therapy such as hormone therapy, newer androgen receptor pathway drugs, chemotherapy, radiotherapy to the prostate in selected cases, and treatment to metastatic sites where appropriate.
Surgery in metastatic disease is not routine for every patient.
It may be considered in selected circumstances, research settings, symptom-control situations or carefully chosen low-volume metastatic cases after multidisciplinary discussion.
The key question is: what is the purpose of surgery?
Is there benefit to hormone therapy before surgery?
For most men, hormone therapy before radical prostatectomy is not routine standard practice.
Hormone therapy can shrink the prostate and lower PSA, but it has not clearly improved long-term outcomes enough to be used routinely before surgery in most patients.
There may be exceptions in research settings or highly selected cases, but this should be discussed carefully. Hormone therapy has side effects and may affect tissue planes and pathology interpretation.
Diet, exercise and lifestyle
Can diet cure prostate cancer?
No.
There is no proven diet that cures prostate cancer. Any website claiming that should be treated with caution.
But diet still matters. Good nutrition can support general health, fitness, treatment tolerance, recovery and weight control.
The aim is not a miracle diet. The aim is resilience.
What should I eat after a prostate cancer diagnosis?
For most men, sensible advice is best:
Eat plenty of vegetables
Include fruit in moderation
Choose wholegrains and high-fibre foods
Include beans, lentils, nuts and seeds
Maintain adequate protein
Reduce ultra-processed foods
Limit sugary drinks
Moderate red meat
Avoid processed meat where possible
Limit alcohol
Stay hydrated
Do not crash diet before treatment. If weight loss is needed, it should be steady and sensible.
Does obesity matter?
Yes.
Obesity can make surgery technically harder and may increase risks around anaesthesia, wound healing, blood clots, continence recovery and general recovery.
It is also linked with diabetes, high blood pressure, sleep apnoea and cardiovascular disease, all of which matter before major treatment.
The target is not rapid weight loss. The target is better health, better fitness and better recovery.
Should I stop smoking?
Yes.
Stopping smoking is one of the most useful things a patient can do before surgery or radiotherapy.
Smoking affects circulation, lung function, wound healing, anaesthetic risk, erections and cardiovascular health.
Even short-term stopping may help. Long-term stopping is better.
Should I reduce alcohol?
Yes. Alcohol is a toxin at any dose. Heavy alcohol intake can worsen sleep, blood pressure, liver function, weight, mood and recovery. It can also increase surgical and anaesthetic risk if intake is high.
Before major treatment, reducing alcohol is usually sensible.
Should I exercise before surgery?
Yes, where safe.
Fitness before treatment helps. Walking, resistance training and general activity can improve recovery, strength, mood and cardiovascular health.
The aim is not to suddenly train like an athlete. The aim is to go into treatment steadier and stronger.
Patients with heart disease, bone disease, severe arthritis, frailty or major symptoms should seek tailored advice.
What exercise should I do during hormone therapy?
Exercise is particularly important during androgen deprivation therapy because ADT can cause weight gain, muscle loss, fatigue, bone thinning and metabolic changes.
A good programme usually includes walking or cycling, resistance training, balance work and stretching.
The routine should be adjusted to age, fitness, bone health and other medical conditions.
Are pelvic floor exercises important?
Yes, especially before and after prostatectomy.
Learning pelvic floor exercises before surgery can help patients understand the muscles involved in urinary control. After catheter removal, pelvic floor training supports continence recovery.
Pelvic floor exercises help, but they are not magic. Recovery still varies.
Supplements
Should I take supplements for prostate cancer?
Not automatically.
Supplements should be used to correct a deficiency or meet a specific need, not as a substitute for evidence-based treatment.
Some supplements are harmless. Some are expensive and useless. Some interact with medication. Some may increase bleeding risk around surgery.
Tell your medical team about all supplements and herbal products.
Is vitamin D important?
Vitamin D may be important, especially for men at risk of bone thinning or those receiving long-term hormone therapy.
Testing and personalised advice are better than guessing.
Should I take calcium?
Calcium is important for bone health, but high-dose calcium supplements should not be started casually.
Some men get enough calcium from diet. Others, especially men on long-term hormone therapy or with osteoporosis risk, may need specific advice.
What about lycopene, green tea, turmeric or pomegranate?
These compounds are often discussed in prostate cancer.
Some have interesting biological or observational data, but that is not the same as proven clinical benefit.
They may form part of a healthy diet, but they should not replace proper diagnosis, surveillance or treatment.
Food first. Supplements second. Evidence always.
Should I stop supplements before surgery?
You should tell the surgical team about all supplements, herbal products and over-the-counter preparations.
Some may increase bleeding risk or interact with anaesthesia or medication. This may include fish oil, garlic capsules, ginkgo, ginseng, turmeric or curcumin, high-dose vitamin E and herbal blends.
The safe rule is simple: disclose everything.
Practical questions
Can I self-pay?
Yes. Self-pay patients can arrange private consultation and treatment through Prostatology.
Can I use private medical insurance?
Yes, depending on the insurer, policy and authorisation requirements.
Patients should contact their insurer before booking to confirm cover and obtain an authorisation code where needed.
Can I have a video consultation?
Yes, where clinically appropriate.
Remote consultations can be useful for raised PSA, MRI review, biopsy results, second opinions and treatment discussions.
Some situations still require face-to-face assessment.
Need personal advice?
If you would like help understanding your PSA, MRI, biopsy results, treatment options, positive margin, lymph node result or PSA follow-up, private consultations are available through Prostatology.
Book a consultation through Prostatology
[Link to: https://www.prostatology.co.uk/consultations]
Surgical volume: why does it matter?
What does surgical volume mean?
Surgical volume means how often a surgeon, unit or hospital performs a particular operation.
For prostate cancer surgery, this usually refers to how many radical prostatectomies are performed over a period of time.
It can apply to:
The individual surgeon
The robotic theatre team
The hospital unit
The wider prostate cancer pathway
Why is surgical volume important?
Surgery is a craft as well as a science.
Operations that are performed regularly tend to become more familiar to the surgeon and the whole team. That can improve planning, theatre flow, recognition of difficult anatomy, management of complications and recovery pathways.
For robotic prostatectomy, experience matters because the operation involves fine dissection around the prostate, bladder neck, urethra, continence structures, nerves and rectum.
Does higher volume always mean better outcomes?
Not automatically.
A high-volume surgeon or centre is not guaranteed to have better outcomes for every patient. Case complexity, patient selection, cancer stage, anatomy, team experience and follow-up all matter.
But volume is still useful because it is one marker of experience.
A surgeon who regularly performs prostatectomy is more likely to have seen a wide range of anatomy, difficult cases, complications and recovery patterns.
Is surgeon volume or hospital volume more important?
Both matter.
The surgeon’s individual experience is important because they perform the operation and make the key technical decisions.
Hospital and team volume also matter because prostatectomy is not a solo act. Anaesthetists, scrub staff, assistants, ward nurses, catheter teams, pelvic floor support, radiology, pathology and oncology links all contribute to the pathway.
Good outcomes come from the surgeon and the system.
What outcomes may be affected by experience?
Experience may influence:
Cancer clearance
Margin rates
Blood loss
Operating time
Complication management
Catheter and discharge pathways
Continence recovery
Erectile function recovery
Recognition of when nerve-sparing is safe
Recognition of when wider excision is safer
Management of difficult anatomy
None of these can be guaranteed, but they are all influenced by judgement and repetition.
Should I ask my surgeon how many prostatectomies they do?
Yes. It is a reasonable question.
You can ask:
How many robotic prostatectomies do you perform each year?
How long have you been performing robotic prostatectomy?
Do you regularly perform nerve-sparing surgery?
Do you perform lymph node dissection when needed?
Do you use continence-preserving techniques where appropriate?
Do you audit your own outcomes?
How do you counsel men about continence and erectile function?
A good surgeon should not be offended by these questions.
Is speed the same as experience?
No.
Operating time can reflect experience, but speed alone is not the goal.
A smooth, efficient operation may reduce anaesthetic time and unnecessary tissue handling. But difficult cases sometimes require patience and adaptation.
Good surgery is controlled, accurate and appropriate to the case.
What matters besides volume?
Volume is only one part of the picture.
Other important factors include:
Decision-making
Patient selection
MRI interpretation
Biopsy review
Understanding tumour location
Technical skill
Team familiarity
Use of appropriate robotic platform
Pre-operative counselling
Pelvic floor preparation
Post-operative support
Honest outcome tracking
Complication management
A high-volume surgeon who gives poor counselling is not enough. A technically good operation still needs the right decision before it and the right support after it.
Does a high-volume surgeon guarantee continence or erectile function recovery?
No.
No surgeon can guarantee continence or erectile function recovery.
Recovery depends on age, baseline urinary and sexual function, prostate size, urethral length, tumour location, anatomy, diabetes, vascular health, smoking, obesity, nerve-sparing safety and healing.
Volume and experience may improve the chance of good decision-making and careful technique, but they cannot remove all risk.
How should patients think about surgical volume?
Think of surgical volume as one useful signal, not the whole answer.
The better question is:
Does this surgeon regularly perform this operation, understand my cancer properly, explain the risks honestly, use appropriate techniques, work within a strong team and track outcomes carefully?
That is a more complete measure of quality.
The bottom line
Surgical volume matters because repeated experience builds judgement, technical familiarity and team reliability.
But good prostate cancer surgery is not just about doing a lot of operations. It is about doing the right operation, for the right patient, in the right setting, with clear counselling and proper follow-up.
That is what patients should look for.
Not all prostatectomy cases are the same.
“What are your outcomes in men like me?”
Not all prostatectomy cases are the same.
Some men have lower-risk cancer that is more likely to be contained within the prostate. Others have high-risk disease, where the cancer may be higher grade, more extensive, closer to the edge of the prostate, or more likely to involve lymph nodes or surrounding tissues.
High-risk surgery is often more technically demanding. It may require wider excision, pelvic lymph node dissection, more cautious nerve-sparing decisions, and a more detailed discussion about margin risk, recurrence risk and possible additional treatment after surgery.
When judging a surgeon’s outcomes, it is therefore important to understand the case mix. A surgeon who mainly operates on lower-risk, straightforward cases may appear to have very favourable continence, erectile function and margin results. A surgeon who takes on more high-risk, bulky, locally advanced or complex disease may have outcomes that need interpreting in that context.
My own outcomes are best understood alongside the risk profile of the men I operate on, including Grade Group, PSA, MRI stage, tumour location, prostate volume, nerve-sparing suitability, lymph node risk and previous treatments.
The honest question is not simply:
“What are your outcomes?”
It is:
“What are your outcomes in men like me?”
How can I tell if a surgeon avoids difficult cases?
This is hard for patients to know, but there are clues.
A surgeon who avoids difficult cases may have excellent-looking results because they mainly operate on favourable cancers, smaller prostates, slimmer patients, lower-risk disease or men with better baseline function.
That does not mean the results are false. It means they need context.
Useful questions to ask include:
Do you operate on high-risk prostate cancer?
What proportion of your cases are high-risk at final pathology staged at pT3a or pT3b?
Do you perform pelvic lymph node dissection when needed?
Do you operate on large prostates (Over 100cc)?
Do you operate on men with difficult anatomy, obesity or previous prostate surgery?
Do you perform salvage surgery after radiotherapy or focal therapy, or refer those cases on?
How often do you decide not to spare nerves because cancer control is more important?
How do you balance positive margin risk against continence and erectile function?
Do you audit your outcomes by cancer risk group?
Can you explain my personal risk rather than quoting a general result?
A good surgeon should be comfortable with these questions.
Why case mix matters
Case mix means the type of patients and cancers a surgeon treats.
Important case-mix factors include:
Low-risk, intermediate-risk or high-risk disease
Grade Group / Gleason score
PSA level and PSA density
MRI stage
Suspected extracapsular extension
Seminal vesicle involvement
Lymph node risk
Prostate size
Tumour location
Baseline continence
Baseline erectile function
Age
Obesity
Diabetes and vascular health
Previous prostate surgery
Previous radiotherapy or focal therapy
A high-risk case may require a wider excision to remove the cancer safely. That may reduce the chance of nerve preservation or early functional recovery.
So outcomes should always be interpreted against the difficulty of the work being done.
Are lower positive margin rates always better?
A low positive margin rate is generally desirable, but it should not be interpreted in isolation.
If a surgeon only operates on favourable, organ-confined cancers, the positive margin rate should be low. If a surgeon treats many high-risk or locally advanced cancers, the margin rate may be higher because the disease is more difficult.
Equally, an extremely low margin rate combined with poor functional outcomes may suggest very wide excision in all patients. That may be appropriate for high-risk cancer, but not necessarily for every man.
The better question is:
Was the surgical plan appropriate for the cancer risk?
Are continence and erectile function outcomes enough to judge a surgeon?
No.
Continence and erectile function are extremely important, but they are not the whole picture.
A surgeon could preserve nerves aggressively and have good erectile function results, but if that increases the risk of leaving cancer behind, that is not good surgery.
Another surgeon may remove tissue more widely in high-risk cases and have lower erectile function recovery, but that may be the correct oncological decision.
Good prostate cancer surgery means balancing:
Cancer control
Continence recovery
Erectile function where safe
Margin risk
Lymph node assessment
Patient priorities
Long-term PSA follow-up
The best operation is not always the most nerve-sparing operation. It is the operation that fits the cancer and the patient.
What should I ask instead of “Are you good?”
Ask:
How many robotic prostatectomies do you perform each year?
Can you do Retzius, clipless prostatectomy and modified Retzius hood sparing? Can you do a high release nerve spare ?
What proportion of your cases are high-risk or complex?
Do you audit your own outcomes?
How do you decide whether nerve-sparing is safe?
What is my personal risk of incontinence and erectile dysfunction?
What is my risk of positive margins or needing further treatment?
How does my MRI change the surgical plan?
Would you recommend surgery if I were not a good surgical candidate?
A good surgeon will explain your risk using their data.