Asking the right questions before your prostate surgery can help you understand the operation, compare your treatment options and prepare for your recovery. Your questions can also help you assess whether your surgeon’s experience and results are relevant to your cancer and personal priorities.
You do not normally need to make your decision during one consultation. You should receive balanced information about every suitable option and enough time to consider how each treatment could affect your cancer control, urinary function, sexual health and quality of life.
Why Should You Prepare Questions?
Your consultation may include unfamiliar terms relating to your cancer grade, stage, treatment outcomes and possible side effects. Preparing your questions helps you focus on the information that is most important to your decision.
You may find it helpful to write down your answers, take notes or bring someone you trust to your appointment. You can then review the information later rather than feeling that you must remember everything during your consultation.
Bring Your Diagnosis Details
You should ask for copies of your PSA results, biopsy report and MRI findings. You should know your Gleason score, Grade Group, clinical TNM stage and Cambridge Prognostic Group when these have been established.
Your Grade Group describes the microscopic growth patterns found in your cancer and provides information about its likely behaviour. Your clinical stage describes its apparent location and extent. If your cancer is localised or locally advanced, your Cambridge Prognostic Group combines your Gleason score or equivalent Grade Group, PSA and clinical T stage to help guide discussions about your prognosis and suitable treatment options.
Decide What Matters Most to You
You should think about your priorities before your consultation so that your surgeon can explain how each suitable option may affect the outcomes that matter most to you. Your priorities may include cancer control, urinary function, sexual health, recovery, work, independence and the possibility of needing further treatment.
Your priorities may change as you learn more about your diagnosis and treatment options. You should not feel that you need to choose one outcome without considering how the possible benefits and harms relate to your overall quality of life.
Your Possible Treatment Priorities
| Your priority | What it may mean to you | Why you should discuss it |
| Your cancer control | Reducing your risk of progression, spread or recurrence | Different options may provide similar or different benefits for your individual cancer |
| Your urinary continence | Maintaining or recovering your bladder control | Surgery and radiotherapy may affect your urinary function differently |
| Your erectile function | Preserving your ability to obtain erections | Your baseline function, cancer location and treatment choice influence your outcome |
| Your recovery | Returning to your usual activities | Your recovery time depends on your treatment, health and any complications |
| Your work and responsibilities | Planning when you can return to work or caring duties | Your job and home circumstances may influence your treatment planning |
| Your risk of further treatment | Understanding whether you may later need radiotherapy, hormone therapy or another treatment | No initial treatment can guarantee that you will never need additional care |
| Your personal preferences | Considering your values, relationships and tolerance of uncertainty | Your treatment decision should reflect what matters most to you |
Question 1: Is Surgery an Appropriate Treatment for You?
You should ask why radical prostatectomy is being recommended for your cancer and how your Grade Group, PSA, clinical stage, imaging, health, life expectancy and treatment priorities affect that recommendation.
You should also ask how surgery compares with every suitable alternative available to you. Depending on your diagnosis, your options may include active surveillance, radical radiotherapy, brachytherapy or another appropriate approach. You should receive a balanced explanation rather than being told that one treatment is automatically best for you.
Question 2: What Is the Aim of Your Surgery?
You should ask whether your operation is being offered with curative intent and what your surgeon believes it can realistically achieve. Surgery aims to remove your prostate, seminal vesicles and the cancer they contain, but it cannot guarantee that your cancer will never return.
You should ask whether your cancer appears localised or locally advanced and how this affects your likelihood of needing further treatment. Surgery may form one part of your treatment if there is a higher risk of cancer extending beyond your prostate.
Question 3: How Many Prostatectomies Does Your Surgeon Perform?
You should ask how many robot-assisted radical prostatectomies your surgeon has performed and how many they currently perform each year. The figures should relate specifically to prostate cancer surgery rather than every robotic operation.
You should consider these numbers alongside your surgeon’s recent results, experience with cancers similar to yours and the expertise of the wider hospital team. No particular case number can guarantee your outcome.
Question 4: What Are Your Surgeon’s Outcomes?
You should ask about your surgeon’s recent results for complications, surgical margins, postoperative PSA, urinary continence and erectile function. You should ask whether the results include every patient treated and whether they have been audited or independently reviewed.
You should also ask how each outcome is defined and when it is measured. Your surgeon’s results may be difficult to compare with another surgeon’s results if their patients, definitions or follow-up periods differ.
Question 5: Can Your Erectile Nerves Be Preserved?
You should ask whether your surgeon expects to preserve both nerve bundles, one nerve bundle or neither bundle. Your MRI, biopsy and tumour location can inform this plan, but they cannot identify every microscopic area of cancer.
Your cancer control must take priority, and your surgeon may need to change the plan according to the findings during your operation. Nerve preservation may improve your chance of recovering erections but cannot guarantee that your previous erectile function will return.
Question 6: Will Your Lymph Nodes Be Removed?
You should ask whether your estimated risk of lymph-node involvement means that pelvic lymph-node dissection should form part of your operation. Your surgeon should explain which risk assessment or nomogram has been used for you and how extensively your lymph nodes would be removed.
Removing your lymph nodes can provide important staging information, but its direct treatment benefit is uncertain. You should understand your risks of lymphocele, leg or genital swelling, bleeding, infection and blood clots.
Question 7: What Are Your Main Surgical Risks?
You should ask about your risks of bleeding, infection, blood clots, anaesthetic problems, injury to nearby structures and leakage or narrowing at the connection between your bladder and urethra.
You should ask how frequently these complications occur within your surgeon’s current practice and hospital. Robot-assisted prostatectomy uses small incisions, but it remains major cancer surgery.
Question 8: What Should You Expect From Continence Recovery?
You should ask how much urinary leakage you may experience after your catheter is removed and how your control is expected to improve. You should confirm whether your surgeon defines continence as using no pads or allows one precautionary pad.
You should also ask about pelvic floor assessment, physiotherapy and access to specialist continence support. You should understand which further treatments could be considered if your leakage remains significant.
Question 9: How Will Surgery Affect Your Sex Life and Fertility?
You should ask how your operation may affect your erections, orgasm, ejaculation, penile changes, sexual confidence and relationships. After radical prostatectomy, you will no longer ejaculate semen, although you may still experience an orgasm. Your orgasm may feel different, and your ability to obtain erections may take time to recover or may remain reduced.
You will not be able to conceive naturally after surgery because sperm can no longer enter an ejaculate. If having biological children may be important to you, you should ask about sperm storage before treatment. You should also discuss which erectile-function treatments, penile-rehabilitation options and specialist sexual support will be available during your recovery.
Question 10: What Will Your Recovery and Follow-Up Involve?
You should ask how long your catheter is expected to remain in place and when you may return to driving, work, exercise, lifting and sexual activity. You should know whom to contact if your catheter stops draining or you develop fever, worsening pain, significant bleeding, wound changes or another concern during your recovery.
You should ask when your pathology will be discussed and when your first PSA will be measured. NICE recommends that your first PSA test should take place no earlier than six weeks after radical treatment, followed by testing at least every six months during your first two years and at least annually afterwards. Your follow-up may need to be adjusted if your PSA rises or your pathology suggests a greater risk of recurrence.
Ask About Non-Surgical Alternatives
Even when you are meeting a surgeon, you should receive balanced information about all suitable treatment options for you, including radiotherapy, active surveillance and other approaches. This helps you understand the full range of choices before deciding on your care.
- Full range of options: You should be informed about both surgical and non-surgical treatments
- Radiotherapy: May be an alternative depending on your cancer stage and overall health
- Active surveillance: Monitoring may be appropriate for slower-growing cancers
- Specialist input: Speaking to a clinical oncologist can help you compare treatments more thoroughly
- Shared decision-making: NICE guidance supports discussing benefits and potential harms of each option
Understanding all available treatments allows you to make a more informed decision based on your preferences and clinical situation. Taking time to explore alternatives can help ensure the approach you choose is right for you.
Ask Who Will Perform Your Operation
You should confirm whether the consultant you meet will perform the principal stages of your operation. You should ask which parts may involve a fellow or trainee, what supervision they will receive and who will be responsible for important decisions during your surgery.
You should also know who will review you if your named consultant is unavailable after your operation. Your care should remain supported by an appropriately experienced team.
Ask What Your Pathology Report May Show
Your pathologist will examine your removed prostate, seminal vesicles and any lymph nodes in detail. Your final report may change your Grade Group or pathological stage and will record findings such as surgical margins, extension beyond your prostate and seminal-vesicle or lymph-node involvement.
You should ask when your report will be available and who will explain it to you. An adverse finding does not automatically mean that you need immediate additional treatment; your postoperative PSA and complete pathology should inform your next steps.
Ask How Long You Have to Decide
You should ask how quickly your cancer requires you to make a treatment decision. If you have localised prostate cancer, you may have time to compare your suitable options, obtain another opinion and consider how each treatment could affect your quality of life.
Your appropriate timescale depends on your Grade Group, PSA, stage, imaging and other clinical findings. You should not delay your decision indefinitely, but you should not feel pressured to proceed before you understand your options and have had the opportunity to ask your questions.
Compare the Quality of Your Answers
You should expect clear, balanced answers that relate to your diagnosis rather than general or unusually optimistic statements. You should be cautious if you are promised complete cancer removal, immediate continence or full recovery of erections.
You should leave your consultation understanding why surgery is being offered to you, which alternatives remain available and how the possible benefits and harms relate to your priorities.
Myth vs Fact
| Myth | What You Should Know |
| You must decide during your first surgical consultation. | You should ask how long you have to compare your suitable options. |
| Your surgeon’s case number proves how good your result will be. | You should consider volume alongside recent outcomes, definitions and case complexity. |
| Your MRI shows exactly where every cancer cell is located. | You should understand that microscopic disease may not be visible on your scan. |
| Nerve-sparing surgery guarantees your erections will return. | You should understand that it improves the possibility of recovery but cannot guarantee it. |
| A positive surgical margin means your cancer will definitely return. | You should discuss your complete pathology and postoperative PSA before drawing conclusions. |
| You need your lymph nodes removed whenever you have prostatectomy. | You should ask whether your estimated nodal risk justifies the procedure. |
| Robotic surgery avoids urinary or sexual side effects. | You should discuss these recognised risks regardless of the surgical platform. |
| You will still be able to conceive naturally after your surgery. | You should discuss sperm storage before your surgery because you will no longer ejaculate semen or be able to conceive naturally afterwards. |
Key Takeaways
- You should understand your Grade Group, PSA, clinical stage and Cambridge Prognostic Group.
- You should ask why surgery is appropriate for your cancer.
- You should compare surgery with every suitable non-surgical option.
- You should ask about your surgeon’s recent prostatectomy experience and clearly defined outcomes.
- You should understand whether nerve-sparing surgery may be appropriate for you.
- You should ask whether you need pelvic lymph-node surgery and why.
- You should discuss how your surgery may affect your urinary control, erections, orgasm, ejaculation and ability to conceive naturally.
- You should know who will perform the principal stages of your operation.
- You should understand when you will receive your pathology and PSA results.
- You should know whom to contact if you experience a problem during your recovery.
Frequently Asked Questions
1. Why should you ask questions before prostate surgery?
You should ask questions so that you understand your diagnosis, suitable treatments, possible outcomes and recovery. Your questions can help you decide whether surgery reflects your cancer and personal priorities.
2. Which diagnosis details should you know before surgery?
You should know your PSA, biopsy Gleason score or Grade Group and clinical TNM stage when these have been established. If your cancer is localised or locally advanced, you should also ask which Cambridge Prognostic Group applies to you and what it means for your treatment options.
3. Is surgery always the best treatment for your prostate cancer?
No. You should compare surgery with every other suitable option, which may include active surveillance, radiotherapy or brachytherapy. Your cancer, health, life expectancy and preferences should guide your decision.
4. How important is your surgeon’s experience?
You should ask about your surgeon’s recent robot-assisted radical prostatectomy workload and experience with cancers similar to yours. You should consider those numbers alongside their outcomes and the quality of your wider hospital team.
5. Which outcomes should you ask your surgeon about?
You should ask about complications, surgical margins, postoperative PSA, urinary continence and erectile function. You should also ask how each result is defined, measured and adjusted for differences between patients.
6. Can you always have nerve-sparing surgery?
No. Your suitability depends on your cancer’s location and extent. Your surgeon should prioritise cancer control and explain whether preserving one or both nerve bundles appears safe for you.
7. What are your main risks from prostate surgery?
Your risks can include bleeding, infection, blood clots, urinary leakage, erectile dysfunction and injury to nearby structures. You should ask how frequently these occur in your surgeon’s practice.
8. What should you expect during your recovery?
You should expect a period with a catheter, gradual return to normal activities and ongoing improvement in urinary control. You should receive guidance about pelvic floor exercises, erectile-function treatment and urgent warning signs.
9. How may your surgery affect your sex life?
Your surgery may affect your erections, orgasm, sexual confidence and relationships. You will no longer ejaculate semen or be able to conceive naturally, although you may still experience an orgasm. If having biological children may be important to you, you should discuss sperm storage before your surgery.
10. Should you consider a second opinion?
You may benefit from another opinion if you are uncertain, have higher-risk cancer or have received different recommendations. You should also have an opportunity to discuss radiotherapy with a specialist clinical oncologist.
Final Thoughts: Asking the Right Questions Before Prostate Surgery
Preparing your questions can help you understand your diagnosis, compare your suitable treatments and decide whether surgery reflects your priorities. You should receive clear information about your surgeon’s experience, your possible cancer-control outcomes, your urinary and sexual risks and the support available during your recovery.
You should not be promised complete cancer removal, immediate continence or full recovery of your erections. You should have enough information and time to make a decision that reflects your cancer, health and personal priorities. To discuss your diagnosis and treatment options, contact us at Prostate Clinic London to arrange a specialist consultation.
References
- British Association of Urological Surgeons (2024) Robotic-assisted laparoscopic (keyhole) radical prostatectomy. Published March 2024, leaflet O24/103. Available at: https://www.baus.org.uk/_userfiles/pages/files/patients/leaflets/Rad%20prost%20robot.pdf
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer
- General Medical Council (2020, updated 2024) Decision making and consent. Available at: https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent
- Liss, M.A. et al. (2010) ‘Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient-reported validated questionnaires’, The Journal of Urology, 183(4), pp. 1464–1468. Available at: https://pubmed.ncbi.nlm.nih.gov/20171689/
- National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management. NICE guideline NG131. Last updated 15 December 2021 and last reviewed 13 August 2025. Available at: https://www.nice.org.uk/guidance/ng131
- National Institute for Health and Care Excellence (2021) Shared decision making. NICE guideline NG197. Available at: https://www.nice.org.uk/guidance/ng197
- Prostate Cancer UK (2023) Choosing a treatment. Updated September 2023. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/choosing-a-treatment
- Prostate Cancer UK (2024) Surgery: radical prostatectomy. Updated July 2024. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/surgery
- Royal College of Surgeons of England (no date) Who’s who in the surgical team. Available at: https://www.rcseng.ac.uk/patient-care/surgical-staff-and-regulation/whos-who-in-the-surgical-team/
- Royal College of Surgeons of England (2025) Robotic-assisted surgery: a pathway to the future. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/robotic-assisted-surgery/
- Sari Motlagh, R. et al. (2021) ‘Penile rehabilitation strategy after nerve-sparing radical prostatectomy: a systematic review and network meta-analysis of randomised trials’, The Journal of Urology, 205(4), pp. 1018–1030. Available at: https://pubmed.ncbi.nlm.nih.gov/33443457/
- Van den Broeck, T. et al. (2021) ‘A systematic review of the impact of surgeon and hospital caseload volume on oncological and non-oncological outcomes after radical prostatectomy for non-metastatic prostate cancer’, European Urology, 80(5), pp. 531–545. Available at: https://pubmed.ncbi.nlm.nih.gov/33962808/