If you are considering surgery for prostate cancer, you may spend time comparing robotic surgery with other approaches and researching different hospitals. You should also consider your surgeon’s experience, as radical prostatectomy is technically demanding and can affect your recovery and cancer-related outcomes.
Research suggests that greater surgical experience and higher procedure volume may be associated with outcomes such as fewer peri-operative complications, lower positive surgical-margin rates and better urinary continence recovery. However, experience is only one part of the picture, as your age, general health, cancer stage, prostate anatomy and pre-treatment erectile function can also influence your results.
Why Does Your Prostate Surgeon’s Experience Matter?
Radical prostatectomy involves removing your prostate and usually the seminal vesicles while carefully protecting nearby structures involved in urinary and sexual function. Your surgeon needs to balance removing the cancer thoroughly with preserving healthy tissue wherever it is safe to do so.
Experience can help your surgeon recognise anatomical differences and manage technically challenging situations during the operation. Research has also identified learning curves in prostate surgery, suggesting that some outcomes can improve as surgeons gain experience, although experience alone cannot guarantee a particular result for you.
What Does “Surgeon Experience” Actually Mean?
An experienced prostate surgeon is not defined only by years in practice. Relevant measures include how many radical prostatectomies they have performed overall and how regularly they perform the operation now.
Current procedure volume can show how focused their present practice is on prostate surgery. You should also consider experience with cases similar to yours and whether the surgeon’s outcomes are routinely monitored.
What Is a High-Volume Prostate Surgeon?
A high-volume prostate surgeon performs radical prostatectomy regularly, but there is no universally accepted annual threshold. Definitions vary between studies and healthcare systems.
Higher surgical volume has been associated with some better outcomes, but volume is not a guarantee of cancer control, continence or erectile-function recovery.
Evidence Note
A 2021 systematic review of 60 retrospective studies found that higher surgeon and hospital caseloads were associated with lower positive surgical-margin rates, fewer peri-operative complications and less need for adjuvant or salvage treatment. However, study methods varied and many findings were affected by bias or confounding.
A separate review of 13 studies involving 47,316 patients found that most studies reported better continence recovery with higher annual surgeon volumes. Definitions varied, so these findings should guide questions about a surgeon’s practice rather than predict your individual recovery.
Is There a Learning Curve for Radical Prostatectomy?
Radical prostatectomy has a learning curve, with technical skill developing through specialist training and repeated experience.
Older open and laparoscopic studies found that some oncological outcomes improved across many procedures. Contemporary robot-assisted surgery may show different or less pronounced learning-curve patterns.
Can Surgeon Experience Affect Cancer Control?
Some studies of open and laparoscopic radical prostatectomy have linked greater surgeon experience with lower biochemical-recurrence risk. Evidence from contemporary robot-assisted surgery is less consistent.
Cancer control also depends strongly on tumour grade, stage and biology. Surgical experience may support careful planning and dissection, but it cannot override the underlying behaviour of the cancer.
What Are Surgical Margins and Why Do They Matter?
After your prostate is removed, a pathologist examines it to check whether cancer cells are present at the edge of the tissue. This is known as a positive surgical margin. It does not automatically mean your cancer will return, but it may increase your recurrence risk and influence your follow-up care.
Your cancer’s size and location can affect whether clear margins are achieved, as can the surgical technique used. Research has also linked greater surgical experience with lower positive-margin rates in some settings, making your surgeon’s experience another factor worth considering.
Can Experience Affect Urinary Continence After Surgery?
Some urinary leakage is common after radical prostatectomy because the surgery takes place close to the structures that control urination. Your recovery can depend on factors such as your age, urinary function before surgery, pelvic floor strength, anatomy and surgical technique.
Research suggests that patients treated by higher-volume surgeons may have better continence recovery at certain stages after surgery. However, experience cannot guarantee that you will avoid leakage. The association may reflect differences in surgical technique, familiarity with the procedure, patient selection and other surgeon or centre-level factors.
Can Your Surgeon’s Experience Affect Erectile Function?
Erectile dysfunction can occur after radical prostatectomy because the nerves involved in erections run close to your prostate. Nerve-sparing surgery aims to preserve these nerves when it is safe to do so, but your surgeon must always prioritise effective cancer removal.
Surgical experience may be relevant to decisions about nerve-sparing, but the relationship between surgeon volume and erectile-function recovery is less clearly established than some other outcomes. Your age, erectile function before surgery, cancer location, general health and whether nerve-sparing is oncologically appropriate remain particularly important.
Why Is Nerve-Sparing Surgery So Technically Demanding?
The nerves involved in erections run very close to your prostate and can vary in their exact position from person to person. Your surgeon needs to consider your scans, biopsy results and individual anatomy when deciding how closely to operate around these delicate structures.
The aim is to preserve the nerves where it is safe to do so without compromising cancer removal. Surgical experience can help your surgeon make these decisions carefully, but the best approach is not always to preserve the most nerves; it is to achieve the right balance between cancer control and functional recovery for you.
Does Robotic Surgery Remove the Importance of Surgeon Skill?
Robotic surgery can provide your surgeon with a magnified three-dimensional view and articulated instrument control, but the technology does not make surgical decisions independently. Your surgeon still controls the robot and decides where to cut, what tissue to preserve and how to respond to your individual anatomy.
This means the surgeon’s skill and experience remain important, even when robotic technology is used. When you compare treatment options, you should consider your surgeon’s experience with the specific robotic procedure as well as the technology, hospital and wider clinical team.
Does the Experience of the Hospital Matter Too?
Your surgeon works within a wider team that may include anaesthetists, nurses, radiologists, pathologists and physiotherapists. Higher hospital and surgeon volumes have been associated with fewer complications and lower positive surgical-margin rates.
Centres that regularly treat prostate cancer may also have established pathways for catheter care, continence recovery and erectile-function rehabilitation.
Can an Experienced Surgeon Reduce the Risk of Complications?
Radical prostatectomy cannot be made risk-free. Complications such as bleeding, infection, blood clots or urinary problems can still occur, although higher surgeon and hospital volumes have been associated with fewer peri-operative complications.
Your individual risk also depends on your health, previous procedures, medications and cancer complexity.
Does Experience Affect How Quickly You Recover?
Surgeon and centre experience may influence complication rates, length of stay and readmission. However, your recovery also depends on age, fitness, general health, surgical complexity and any complications.
Urinary control may improve over several months, while erectile recovery can take longer. Your surgeon should explain what is realistic for you and provide appropriate follow-up.
Why Should You Look at Outcomes as Well as Operation Numbers?
Operation numbers are useful, but you should also ask about outcomes such as surgical margins, complications, PSA results, continence and erectile-function recovery.
Ask how these outcomes are defined, measured and audited, as methods can vary between surgeons and centres.
UK Guidance Note
In the UK, surgical volume is recognised as one useful indicator of service experience, but it should not be considered in isolation. BAUS advises patients that higher procedure volume is associated with better outcomes overall while also cautioning that a lower-volume surgeon does not automatically have poor results and that outcome figures need careful interpretation.
NICE also recommends that robotic systems used for localised prostate-cancer surgery are based in centres expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies per year for cost-effectiveness reasons. This is a centre-level recommendation, not an official minimum number of procedures that an individual surgeon must perform.
English NHS data analysed through the GIRFT programme also found lower 90-day emergency readmission rates for robot-assisted prostatectomy at higher-volume hospital trusts and among higher-volume surgeons, supporting the value of considering both the individual surgeon and the wider centre.
What Questions Should You Ask Your Prostate Surgeon?
You should feel comfortable asking your surgeon about their experience before deciding on radical prostatectomy. You could ask how often they perform the procedure, how many they have completed and how much of their current practice focuses on prostate cancer.
It is also useful to ask about their results for surgical margins, complications, urinary continence and erectile-function recovery where relevant to you. Ask how these outcomes are measured and whether they reflect the types of patients they treat. This can help you develop realistic expectations rather than relying on impressive-looking numbers alone.
Questions to Ask When Comparing Prostate Surgeons
| What to ask | Why it can help |
| How many radical prostatectomies do you perform each year? | Shows how regularly the surgeon currently performs the operation |
| How many have you performed in total? | Provides context about cumulative procedure experience |
| How often do you treat cases similar to mine? | Experience with comparable cancer and surgical complexity may be relevant |
| What is your positive surgical-margin rate? | Helps you discuss oncological outcomes, but results should be interpreted according to cancer stage and case mix |
| How do you define continence? | Definitions vary between surgeons, centres and studies |
| How do you report erectile-function recovery? | Outcomes depend strongly on function before surgery and nerve-sparing eligibility |
| What are your complication and readmission rates? | Provides information about peri-operative outcomes |
| Are your outcomes audited or independently reviewed? | Helps you understand how the figures are collected and how confidently they can be interpreted |
Should You Choose a Surgeon Based on the Highest Volume?
Surgical volume can be useful when choosing your surgeon, but the highest annual case number does not automatically identify the best surgeon for every patient. Experience with cases similar to yours also matters.
Good communication, audited outcomes and the quality of the wider treatment team should be considered alongside volume.
Should You Get a Second Opinion Before Prostate Surgery?
A second opinion can be helpful when you have several prostate-cancer treatment options. Another specialist may confirm the recommendation or discuss alternatives such as radiotherapy or active surveillance.
It can also help you understand whether surgery and nerve-sparing are appropriate and how different treatments may affect urinary, sexual or bowel function.
What Factors Besides Surgeon Experience Affect Your Results?
Several personal and clinical factors can influence outcomes after prostate surgery in addition to surgeon experience.
- Cancer stage and grade: More advanced or aggressive cancer may require more extensive surgery.
- Age and general health: These can influence recovery and complication risk.
- Urinary and sexual function: Pre-treatment function affects recovery.
- Individual anatomy: Cancer location and nearby nerves can influence the surgical approach.
These factors should be considered when discussing your likely results and recovery.
How Can You Make a More Informed Choice About Your Surgeon?
When choosing your prostate surgeon, you should look at the complete picture rather than focusing on one statistic. Consider their experience with prostate cancer surgery, surgical volume, outcomes and how clearly they communicate with you about your treatment and expectations.
You should understand what your surgeon believes is realistically achievable in your case, including the likelihood of nerve sparing and the potential risks to urinary and sexual function. Be cautious of guarantees, as no surgeon can promise complete cancer control, perfect continence or preserved erectile function for every patient.
Myth vs Fact
| Myth | Fact |
| The surgeon who performs the most operations will always give you the best result. | Higher volume is associated with better outcomes overall, but it cannot guarantee an individual result. |
| Years as a consultant tell you everything about surgical experience. | Relevant experience also includes current volume, cumulative experience and similar cases. |
| A robotic system makes surgeon experience less important. | No. The surgeon controls the robot and makes the operative decisions. |
| A positive surgical margin means the operation has failed. | No. It increases recurrence risk but does not mean cancer will definitely return. |
| A high-volume surgeon can guarantee continence or erections after surgery. | No. Age, pre-treatment function, anatomy and nerve-sparing suitability also matter. |
Key Takeaways
- Radical prostatectomy is technically demanding, and surgeon experience can influence some cancer-related, complication and functional outcomes.
- Higher surgeon and hospital volumes are associated particularly with lower positive surgical-margin and perioperative complication rates.
- Research also suggests that greater surgeon experience may be associated with better urinary continence recovery after surgery.
- There is no single universally accepted number that automatically defines a “high-volume” prostate surgeon.
- Surgical volume should be considered alongside audited outcomes, experience with cases similar to yours, communication and the expertise of the wider hospital team.
- No surgeon can guarantee complete cancer control, continence or erectile-function recovery after radical prostatectomy.
Frequently Asked Questions
1. Does your prostate surgeon’s experience affect your results?
Yes, your surgeon’s experience can influence outcomes after radical prostatectomy. Greater surgical experience may be linked with fewer complications and better recovery of urinary continence. However, your cancer and overall health also play an important role.
2. What does an experienced prostate surgeon mean?
Experience means more than simply the number of years a surgeon has worked. You should consider how regularly they perform radical prostatectomy and how much experience they have with prostate cancer. Experience with cases similar to yours can also be valuable.
3. Is a high-volume prostate surgeon better?
Higher surgical volume has been associated with fewer complications and lower positive surgical-margin rates in some studies. However, there is no single number that defines a high-volume surgeon. You should also consider their outcomes, expertise and wider clinical team.
4. Can surgeon experience affect cancer control?
Some research, particularly involving open and laparoscopic radical prostatectomy, has linked greater surgical experience with a lower risk of biochemical recurrence. Evidence from modern robot-assisted surgery is less consistent, and your cancer stage, grade and biological characteristics remain major determinants of recurrence risk.
5. Can surgeon experience affect urinary continence?
It may, as higher-volume surgeons have been associated with better continence recovery in some research. However, your age, urinary function, anatomy and pelvic floor strength also affect recovery. Your surgeon cannot guarantee that you will avoid urinary leakage.
6. Can surgeon experience affect erectile function?
Experience can help your surgeon make careful decisions about nerve-sparing surgery when it is safe. Your age, existing erectile function and general health also influence recovery. Even with successful nerve sparing, erections can take time to recover.
7. Does robotic surgery make surgeon experience less important?
No. Robotic technology provides enhanced vision and instrument control, but your surgeon still makes the key surgical decisions. Their experience with robotic prostate surgery therefore remains important when you are choosing your treatment.
8. Should you look at your surgeon’s outcomes?
Yes, operation numbers are useful, but you should also ask about actual outcomes. These may include surgical margins, complications, continence, PSA results and erectile-function recovery. You should also ask how these results are measured.
9. Should you get a second opinion before prostate surgery?
A second opinion can help you understand whether surgery is the right option for you. Another specialist may discuss alternatives such as radiotherapy or active surveillance, depending on your cancer. It can also help you compare expected benefits and risks.
10. How can you choose the right prostate surgeon?
Look at your surgeon’s experience, surgical volume, outcomes and experience with cases similar to yours. You should also consider how clearly they explain your treatment and expected recovery. Choosing based on the complete picture is better than relying on one statistic.
Final Thoughts: Choosing the Right Prostate Surgeon for You
Your prostate surgeon’s experience can be an important part of your treatment decision, particularly when you are considering radical prostatectomy. Greater experience may be associated with better outcomes in areas such as complications, surgical margins and urinary continence, but your individual cancer, anatomy, general health and pre-treatment function also have a significant influence on your recovery.
If you’re considering prostate surgery and would like to discuss how surgeon experience, treatment options and your individual priorities may affect your decision, our team at Prostate Clinic London would be happy to talk this through with you. If it feels helpful, we can also arrange a consultation.
References:
- Kempisty, J. et al. (2025) ‘Assessment of Surgical Quality in Radical Prostatectomy: Review of Objective Intraoperative and Functional Evaluation Scales’, Journal of Clinical Medicine, 14(21), 7458. Available at: https://www.mdpi.com/2077-0383/14/21/7458
- Zambudio-Munuera, A. et al. (2026) ‘Robot-Assisted Radical Prostatectomy Beyond the Learning Curve: Does Prior Laparoscopic Experience Influence Surgical Outcomes?’, Cancers, 18(4), 548. Available at: https://www.mdpi.com/2072-6694/18/4/548
- Vickers, A.J. et al. (2010) ‘The learning curve for surgical margins after open radical prostatectomy: implications for margin status as an oncological end point’, The Journal of Urology, 183(4), pp. 1360–1365. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2861336/
- Bravi, C.A. et al. (2019) ‘The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning-Curve Study’, The Journal of Urology, 202(1), pp. 108–113. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7521607/
- Trieu, D. et al. (2021) ‘Surgeon case volume and continence recovery following radical prostatectomy: a systematic review’, ANZ Journal of Surgery, 91(4), pp. 521–529. Available at: https://pubmed.ncbi.nlm.nih.gov/33319438/
- Van den Broeck, T. et al. (2021) ‘A systematic review of the impact of surgeon and hospital caseload volume on oncological and nononcological outcomes after radical prostatectomy for nonmetastatic prostate cancer’, European Urology, 80(5), pp. 531–545. Available at: https://pubmed.ncbi.nlm.nih.gov/33962808/
- British Association of Urological Surgeons (no date) Understanding the Radical Prostatectomy Graphs. Available at: https://www.baus.org.uk/patients/surgical_outcomes/radical_prostatectomy/understanding_the_radical_prostatectomy_graphs.aspx
- National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management. NICE guideline NG131. Last reviewed August 2025. Available at: https://www.nice.org.uk/guidance/ng131
- Gray, W.K., Day, J., Briggs, T.W.R. and Harrison, S. (2022) ‘An observational study of volume–outcome effects for robot-assisted radical prostatectomy in England’, BJU International, 129(1), pp. 93–103. Available at: https://pubmed.ncbi.nlm.nih.gov/34133832/
- Vickers, A.J. et al. (2007) ‘The surgical learning curve for prostate cancer control after radical prostatectomy’, Journal of the National Cancer Institute, 99(15), pp. 1171–1177. Available at: https://pubmed.ncbi.nlm.nih.gov/17652279/
- Vickers, A.J. et al. (2009) ‘The surgical learning curve for laparoscopic radical prostatectomy: a retrospective cohort study’, The Lancet Oncology, 10(5), pp. 475–480. Available at: https://pubmed.ncbi.nlm.nih.gov/19342300/