Choosing a robotic prostate surgeon involves more than finding someone who uses a particular surgical system. You should consider your surgeon’s specialist prostate cancer experience, recent radical prostatectomy workload, outcomes, communication and ability to explain whether surgery is appropriate for you.
The robotic system does not perform your operation independently. Your surgeon controls the instruments, but your care also depends on the bedside assistant, anaesthetists, nurses, pathologists and recovery services supporting you before and after surgery.
Confirm That Surgery Is Appropriate for You
Before choosing your surgeon, you should confirm that radical prostatectomy is an appropriate treatment for your cancer. Your Grade Group, PSA, clinical stage, imaging, general health, life expectancy and treatment priorities should all contribute to this decision.
You should receive a balanced explanation of the suitable options available to you. Depending on your cancer, these may include active surveillance, radical prostatectomy, external beam radiotherapy, brachytherapy or another appropriate approach.
Look for a Prostate Cancer Specialist
You should look for a consultant urological surgeon whose regular clinical practice includes prostate cancer and radical prostatectomy. Experience with robotic operations involving other organs does not automatically demonstrate specialist expertise in prostate cancer surgery.
You can use the GMC medical register to confirm whether your surgeon is licensed to practise and whether they are listed on the Specialist Register in an appropriate surgical specialty. However, registration alone does not tell you how frequently they perform prostatectomy or what outcomes you may expect.
Ask Who Will Perform Your Operation
You should ask who will perform the principal stages of your prostatectomy and who will sit at the robotic console. A trainee, fellow or second consultant may participate as part of a supervised surgical team.
Your surgeon should explain who will be involved, how responsibility is divided and what supervision will be provided. You should also know who will review you if your named surgeon is unavailable after the operation.
Ask About Prostatectomy Case Volume
You should ask how many robot-assisted radical prostatectomies your surgeon has performed recently and how many they currently perform each year. The number should relate specifically to radical prostatectomy rather than all robotic procedures.
Higher surgeon and hospital volumes have been associated with better outcomes in many studies, including lower rates of complications and positive surgical margins. NICE advises commissioners to base robotic systems in centres expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies each year to support cost-effectiveness. This is a centre-level planning threshold rather than a minimum annual number for an individual surgeon or a guarantee of quality. You should therefore consider recent outcomes, case complexity, data completeness and team experience alongside case volume.
Consider the Hospital’s Experience
Your surgeon is supported by a wider team involved in your care, including anaesthetists, theatre staff, radiologists, pathologists and specialist nurses. Choosing a hospital with experience in robotic prostatectomy may give you access to more established surgical, monitoring and rehabilitation pathways, although you should still ask how your individual care will be coordinated.
Key Factors About Hospital Experience
| Factor | What It Involves | Why It Matters | What To Consider |
| Multidisciplinary team | Includes surgeons, anaesthetists, nurses, radiologists and pathologists | Supports coordinated care throughout treatment | Look for a team with prostate cancer experience |
| Robotic prostatectomy experience | Hospital regularly performs prostate removal procedures | Builds expertise in managing different patient needs | Ask about the centre’s experience |
| Complication management | Ability to identify and treat possible problems after surgery | Supports safer recovery | Check what support is available after surgery |
| Specialist support services | Access to specialist nurses and follow-up care | Helps with recovery and rehabilitation | Consider the full care pathway |
| Hospital infrastructure | Established surgical and diagnostic services | Allows smoother communication between teams | Experienced centres may offer more coordinated care |
| Quality of care | Experienced teams and structured services support outcomes | Helps improve consistency and patient support | Discuss the hospital’s approach with your surgeon |
Review Your Surgeon’s Recent Outcome Data
You should ask whether your surgeon and hospital collect recent, audited outcomes from radical prostatectomy. The information you review may include your risk of complications, readmission or transfusion, your expected hospital stay, surgical-margin results, postoperative PSA findings, urinary continence and erectile function.
You should ask how recently the data were collected, how many people provided follow-up information and how each outcome was defined. You should also check how long cancer-control results were followed and whether your surgeon’s case complexity was considered, because raw percentages may not allow you to compare different surgeons fairly.
Ask About Cancer-Control Outcomes
You should ask about your surgeon’s positive surgical margin rates according to pathological stage rather than relying on one overall percentage. You can also ask about postoperative PSA results, biochemical recurrence and how often patients require additional treatment.
A positive margin does not mean that your cancer will definitely return or that you automatically need immediate radiotherapy. Your risk depends on your complete pathology, postoperative PSA and other cancer characteristics.
Discuss Continence Results
You should ask how your surgeon defines urinary continence and when your outcome would be measured. Results based on no pads may differ substantially from results that include your use of one precautionary pad.
You should ask for results at clearly defined points such as three, six and twelve months. You should also ask whether the figures include everyone treated, how many patients supplied follow-up information and what support you would receive if your leakage persisted.
Discuss Erectile Function Honestly
You should ask how your surgeon measures erectile recovery and whether the figures refer to unassisted erections or erections achieved with tablets, injections or a vacuum device. Your age, erections before surgery, health and nerve-sparing status should be considered when interpreting the results.
You should be cautious if you are given one erectile-function percentage that does not account for these factors. No surgeon can guarantee that your erections will return to their previous quality after prostatectomy.
Ask About Nerve-Sparing Experience
You should ask whether preservation of one or both nerve bundles appears appropriate for your cancer. Your surgeon should explain how your MRI, biopsy findings and tumour position influence the proposed nerve-sparing plan.
Your cancer control must remain the priority, and your surgeon may need to change the plan if the findings during your operation differ from what was expected. Even successful nerve preservation cannot guarantee that your erections will recover.
Ask How Your MRI Affects the Operation
You should ask how your MRI findings have been considered alongside your biopsy, PSA, clinical examination and other staging information. Your MRI may help your surgeon assess the tumour’s position and its relationship to your prostate capsule, sphincter and nerve bundles.
Your MRI cannot show every microscopic area of cancer and should not determine the entire operation by itself. Your surgeon should explain which findings affect your planned dissection, nerve preservation and other surgical decisions.
Consider Experience With Your Type of Cancer
Routine localised prostate cancer and more complex high-risk disease may require different levels of expertise. You should ask whether your surgeon regularly treats patients with your Grade Group, cancer stage, prostate size or previous treatment history.
- Cancer complexity: Different cancer stages and risk groups may require different levels of surgical experience and planning
- Grade Group experience: Ask whether your surgeon regularly treats patients with a similar prostate cancer grade to yours
- Prostate size: Larger prostates may present additional technical challenges that require specific surgical expertise
- Previous treatments: Prior radiotherapy or focal therapy can make surgery more complex and require specialist experience
- Salvage surgery: Procedures after previous treatment should be managed by teams experienced in handling higher-risk surgical situations
Choosing a surgeon with experience in your specific type of prostate cancer can help ensure your treatment is planned appropriately. Discussing their experience with similar cases can give you greater confidence when making decisions about your care.
Ask About Lymph-Node Surgery
You should ask whether pelvic lymph-node dissection is recommended for you and which risk calculation supports that decision. Your MRI alone cannot reliably exclude microscopic cancer in your lymph nodes.
Lymph-node removal can provide important staging information, but its direct treatment benefit remains uncertain. Your surgeon should explain the planned extent of surgery and your risks of lymphocele, leg or genital swelling, bleeding, infection and blood clots.
Be Cautious About Guarantees
You should not be promised complete cancer removal, immediate urinary control, preservation of erections or freedom from further treatment. Your outcome can vary even when your surgery is technically successful.
You should look for explanations that are specific to your cancer and openly discuss uncertainty. Claims of perfect results or suggestions that one robotic platform eliminates the recognised risks of prostatectomy should concern you.
Review the Recovery and Support Pathway
You should ask what support you will receive after your operation, including help with your catheter, wound care, pathology results, PSA monitoring, pelvic floor rehabilitation and erectile-function treatment. You should also know whom you can contact if your catheter stops draining or you develop fever, worsening pain, bleeding or another concern.
Your follow-up plan should explain when your pathology will be discussed, when your first PSA will be checked and how your urinary or sexual side effects will be reviewed. You should ask what specialist continence, pelvic-health and sexual-rehabilitation services will be available if your recovery takes longer than expected.
Consider a Second Opinion
You may find a second opinion helpful if you are uncertain about surgery, have higher-risk cancer, need salvage treatment or have received substantially different recommendations.
You can also ask to discuss your options with a clinical oncologist so that you understand radiotherapy as well as surgery. Obtaining another opinion does not require you to change your treatment team.
Myth vs Fact
| Myth | What You Should Know |
| You should choose the surgeon who uses the newest robot. | You should prioritise your surgeon’s prostate cancer experience, outcomes and team rather than the platform’s age. |
| You can identify the best surgeon using case numbers alone. | You should consider volume alongside outcomes, case complexity and the quality of your wider care. |
| Your GMC Specialist Register entry proves robotic expertise. | You can use it to confirm specialist status, but you still need to ask about current prostatectomy experience. |
| You can directly compare every surgeon’s margin rate. | You should check your surgeon’s case mix, cancer stages, definitions and data completeness first. |
| Your MRI can guarantee that nerves will be preserved. | You should understand that microscopic cancer may not be visible and your plan may change. |
| You need lymph-node removal whenever you have surgery. | You should ask whether your calculated risk makes it appropriate for you. |
| You will definitely regain continence and erections with an experienced surgeon. | You should expect your individual health, baseline function and cancer to influence recovery. |
| You do not need another specialist opinion once you meet a surgeon. | You may benefit from discussing radiotherapy or surveillance with an appropriate specialist before deciding. |
Key Takeaways
- You should confirm that surgery is an appropriate treatment for your cancer before choosing a surgeon.
- You should look for a consultant whose regular practice includes prostate cancer and radical prostatectomy.
- You can check your surgeon’s registration and specialist status through the GMC register.
- You should ask about recent robot-assisted radical prostatectomy numbers rather than all robotic operations.
- You should consider your surgeon’s outcomes alongside the experience of the whole hospital team.
- You should ask how continence, erectile function and cancer-control outcomes are defined and measured.
- You should ask who will perform the main stages of your operation.
- You should understand how your MRI, biopsy, PSA and clinical stage affect your surgical plan.
- You should be cautious about guarantees or unusually perfect results.
- You may benefit from a second opinion or an appointment with a clinical oncologist before making your decision.
Frequently Asked Questions
1. How do you choose a robotic prostate surgeon?
You should consider your surgeon’s specialist experience in prostate cancer, recent robot-assisted radical prostatectomy workload, clearly defined outcomes and communication style. You should also review the support available to you before and after your operation.
2. Does the robotic system matter more than your surgeon?
No. Your surgeon controls the instruments and makes every clinical decision during your operation. You should prioritise your surgeon’s experience, outcomes and wider surgical team rather than choosing solely according to the model of robotic system.
3. How many robotic prostatectomies should your surgeon perform?
You should ask how many robot-assisted radical prostatectomies your surgeon performs each year and how recently they have treated patients with cancer similar to yours. There is no single minimum number that guarantees quality, so you should also consider outcomes, case complexity and hospital experience.
4. Should you choose a prostate cancer specialist?
You should choose a consultant urological surgeon whose regular practice includes prostate cancer and radical prostatectomy. Experience using robotic technology for other operations does not necessarily provide the specialist knowledge required for your prostate cancer surgery.
5. What questions should you ask your surgeon?
You should ask who will perform the main stages of your operation, how many similar procedures they perform and how their outcomes are measured. You should also ask how your cancer affects nerve preservation, lymph-node surgery, urinary recovery and erectile function.
6. How should you interpret your surgeon’s outcome data?
You should check whether the results are recent, complete and based on clearly defined measurements. You should also ask whether differences in cancer stage, baseline health and patient complexity have been considered, as raw percentages may not allow you to compare surgeons fairly.
7. What should you ask about nerve-sparing surgery?
You should ask whether preserving one or both nerve bundles is considered appropriate for your cancer and why. Your surgeon should explain that nerve preservation may improve your chance of recovering erections but cannot guarantee that your previous erectile function will return.
8. Should your surgeon review your MRI before surgery?
Yes. Your surgeon should consider your MRI alongside your biopsy, PSA, clinical stage and other relevant information. Your MRI may help guide surgical planning, but it cannot identify every microscopic area of cancer or determine every part of your operation independently.
9. Should you get a second opinion?
You may benefit from a second opinion if you are uncertain about surgery, have higher-risk cancer, need salvage treatment or have received different recommendations. You may also wish to speak with a clinical oncologist so that you can compare surgery with radiotherapy and other suitable options.
10. What support should you expect after choosing your surgeon?
You should receive a clear plan covering your catheter, pathology results, PSA monitoring, pelvic floor rehabilitation and erectile-function treatment. You should also know who to contact if you develop a catheter problem, infection, worsening pain or another concern during your recovery.
Final Thoughts: Choosing the Right Robotic Prostate Surgeon
You should choose your robotic prostate surgeon by considering their current prostate-cancer practice, recent radical-prostatectomy workload, clearly defined outcomes, communication and the experience of the hospital team supporting you. You should also make sure that surgery has been compared fairly with the other treatments suitable for your diagnosis.
The robotic platform does not determine your result by itself. Your outcome also depends on your cancer characteristics, baseline urinary and sexual function, general health, surgical plan and access to appropriate recovery support.
If you are considering robotic prostate surgery in London, you can contact us at Prostate Clinic London to discuss your diagnosis, treatment options and arrange your consultation.
References
- British Association of Urological Surgeons (2024) Robotic-assisted radical prostatectomy (RARP). Published March 2024. Available at: https://www.baus.org.uk/_userfiles/pages/files/patients/leaflets/Rad%20prost%20robot.pdf
- British Association of Urological Surgeons (no date) About the radical prostatectomy audit. Available at: https://www.baus.org.uk/patients/surgical_outcomes/radical_prostatectomy/about.aspx
- 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
- Day, E., Tzelves, L., Dickinson, L., Shaw, G. and Tandogdu, Z. (2025) ‘A systematic review and meta-analysis of the impact of preoperative surgical planning in robotic-assisted radical prostatectomy on trifecta outcomes’, Minerva Urology and Nephrology, 77(1), pp. 25–32. Available at: https://pubmed.ncbi.nlm.nih.gov/40183180/
- 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
- General Medical Council (no date) The Specialist Register. Available at: https://www.gmc-uk.org/registration-and-licensing/our-registers/a-guide-to-our-registers/specialist-registration
- Guo, H., Zhang, L., Shao, Y., An, K., Hu, C., Liang, X. and Wang, D. (2024) ‘The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis’, PLOS ONE, 19(7), article e0301653. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11239040/
- 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/
- Marra, G., Marquis, A., Yanagisawa, T., Shariat, S.F., Touijer, K. and Gontero, P. (2023) ‘Salvage radical prostatectomy for recurrent prostate cancer after primary nonsurgical treatment: an updated systematic review’, European Urology Focus, 9(2), pp. 251–257. Available at: https://pubmed.ncbi.nlm.nih.gov/36822924/
- 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
- 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/
- 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/