In this article, prostate surgery refers to radical prostatectomy, an operation to remove the prostate gland and seminal vesicles to treat prostate cancer. If you are considering prostate surgery, you may wonder how likely it is that you will feel satisfied with your decision afterwards. Treatment decision regret describes doubt or distress about a healthcare choice when you later feel that another option might have produced a more acceptable outcome.
It is not exactly the same as being dissatisfied with one aspect of recovery. You may experience a difficult side effect while still believing that surgery was the most appropriate treatment for your cancer.
Regret is not only linked to the operation itself but also to how well you understood your options beforehand. The quality of information you received, your expectations and your recovery experience can all influence how you feel about your decision later.
Understanding this in advance can help you make a more informed choice. Taking time to discuss benefits, risks and alternatives with your clinical team may reduce uncertainty and help you feel better prepared for your decision.
Why Some Men Experience Regret After Surgery
Radical prostatectomy is one treatment option for selected men with localised or locally advanced prostate cancer. It aims to remove the prostate and cancer, but it can also cause urinary, sexual and reproductive side effects that affect quality of life.
Sexual changes are not limited to difficulty getting an erection. Radical prostatectomy causes permanent loss of ejaculation because the prostate and seminal vesicles are removed. You may still be able to experience orgasm after surgery, but it will be dry because you will no longer ejaculate, and the sensation may feel different. Natural conception through sexual intercourse is therefore no longer possible after surgery. Some men may also experience changes in orgasm, penile shortening or urine leakage during sexual activity.
Studies have associated treatment regret with unmet expectations, unexpected side effects and feeling insufficiently involved in treatment decisions. When expectations do not match the reality of recovery, it can lead to disappointment or uncertainty.
How Common Is Regret After Prostate Surgery?
Research suggests that most men do not report significant decision regret after treatment for localised prostate cancer. Feeling well informed about your options and likely outcomes may reduce uncertainty about your decision.
A smaller group of men do report some level of regret. This can depend on your personal experience, including side effects and how your recovery compares with what you expected.
Reported rates vary between studies because regret is measured in different ways and at different times after treatment. Even so, the overall finding is that most men do not report significant decision regret.
Evidence Note
A 2023 systematic review estimated that 18% of men who underwent prostatectomy experienced decision regret. A separate prospective study found that 16% of men who had surgery reported treatment-related regret five years after diagnosis. Although these figures are similar, they should not be treated as directly interchangeable because the studies used different questionnaires, definitions, patient groups and follow-up periods.
The same systematic review estimated significant decision regret in 13% of men managed with active surveillance and 19% of men treated with radiotherapy, compared with 18% of men who underwent prostatectomy. These pooled figures should not be used to conclude that one treatment causes more regret than another because the included studies differed in their patient groups, questionnaires and follow-up periods.
How Is Treatment Regret Measured?
Researchers often use questionnaires such as the Decision Regret Scale to understand how people feel about an earlier healthcare decision. The Decision Regret Scale is a validated five-item questionnaire used to measure regret about a healthcare decision.
These questionnaires explore whether a person remains comfortable with the choice, would make the same decision again and feels that the decision was consistent with their priorities.
Studies do not always use the same questionnaire or the same score to define significant regret. People may also be surveyed at different points during recovery. Someone questioned soon after surgery may feel differently from someone questioned several years later.
For this reason, figures such as 16% or 18% should be treated as estimates from particular groups rather than as predictions of how you will personally feel.
Factors That Influence Treatment Regret
Several factors can affect whether you experience regret after prostate surgery. These include the extent and impact of side effects, your expectations before treatment, how involved you felt in decision-making and how satisfied you were with the information provided.
Feeling involved in choosing your treatment may help reduce uncertainty and make it easier to understand why a particular option was selected. Understanding why surgery is recommended and what your recovery may involve can help you feel more prepared and in control.
Clear communication with your clinical team is important in shaping your experience. Realistic expectations and clear information may make the treatment process more manageable and may be associated with less regret.
The Importance of Shared Decision-Making
Shared decision-making means you and your healthcare team work together to choose the most suitable treatment for your situation. This involves discussing your cancer risk, available options, potential benefits and possible side effects so you can make an informed choice.
If your cancer is suitable for active surveillance, you will have regular monitoring so that treatment can be offered if there are signs that the cancer is progressing or if you later decide that treatment is right for you.
Depending on your cancer risk group, general health and life expectancy, suitable options may include active surveillance, radical prostatectomy or radiotherapy. These options are not equally appropriate for every person, and some men may need other treatments or combinations of treatments.
Ask your specialist to explain possible benefits and risks using absolute numbers over a stated period. For example, ask how many men out of 100 experience a particular outcome within one, five or ten years and how closely those figures apply to your age, general health, cancer risk and urinary and sexual function before treatment.
When more than one treatment is clinically suitable, consider asking whether you can discuss your options with both a urological surgeon and a clinical oncologist. Hearing how different specialists explain the benefits and disadvantages of each treatment may help you make a more balanced decision.
The Role of Cancer Characteristics in Decision-Making
Your PSA level, clinical stage and Grade Group are used to assign a Cambridge Prognostic Group, which helps your specialist assess your cancer risk and identify suitable treatment options. For some localised cancers, surgery is one of several possible approaches. For others, active surveillance, radiotherapy or a combination of treatments may be more appropriate.
Your specialist should explain the expected cancer-control benefits and quality-of-life effects of every clinically suitable option rather than assuming that one approach is right for everyone.
How Expectations Affect Satisfaction After Surgery
Your expectations before prostate surgery can influence how you feel afterwards. If you expect a quick recovery or minimal side effects, the reality of a gradual healing process may feel more difficult than anticipated.
Having open and honest conversations with your specialist before treatment can help you understand what is realistic. This includes discussing recovery timelines, possible side effects and how these may affect your daily life.
When you know what to expect, the recovery process can feel more manageable. Realistic expectations may reduce the difference between what you anticipate and what you experience during recovery.
What Regret Statistics Cannot Predict
A regret rate describes what happened across a group of patients. It cannot tell you whether you personally will regret treatment.
Your experience may depend on your cancer risk, health before surgery, urinary and sexual function, personal priorities, surgical outcome and how the result compares with what you expected. Feelings about a decision may also change over time.
When reviewing statistics, consider which questionnaire was used, when patients were surveyed and what the researchers counted as significant regret.
The Impact of Urinary Side Effects
Urinary leakage is common after the catheter is removed following prostate surgery. It often improves over the following months, but recovery varies, and some men continue to experience leakage for more than a year or require further treatment. Understanding the likely course of recovery and the available support can help you feel better prepared.
Key Considerations About Urinary Side Effects
| Aspect | What It Involves | Potential Impact | What You Can Do |
| Urinary leakage | Loss of bladder control, especially early after surgery | Can affect daily activities and confidence | Use pads if needed and follow medical advice |
| Recovery timeline | Leakage commonly improves during the first few months, but recovery varies, and some men continue to need pads or further treatment after a year. Reported continence rates also vary according to whether continence is defined as using no pads or allowing one precautionary pad. | Some men may experience longer-term issues | Discuss expected recovery with your specialist |
| Emotional impact | Unexpected symptoms may affect how you feel about treatment | May contribute to concern or regret | Being informed beforehand can help manage expectations |
| Pelvic floor exercises | Exercises to strengthen bladder control muscles | Pelvic floor muscle exercises are commonly recommended before and after prostate surgery. They may help some men regain bladder control, although research findings vary and using the correct technique is important. | Start exercises as advised by your care team |
| Persistent urinary symptoms | Assessment may include pelvic health physiotherapy, continence services and, for some men, specialist treatments | Persistent symptoms may continue to affect daily activities, confidence and quality of life | Review options if symptoms continue |
| Preparation before surgery | Understanding possible side effects in advance | May help you feel more prepared for recovery | Ask questions and plan support early |
The Impact of Erectile Function Changes
Erectile dysfunction is another important factor that can affect how you feel after prostate surgery. The likelihood of recovery depends on factors such as your age, erectile function before surgery, whether nerve-sparing techniques are used and your overall health.
Understanding these possibilities before treatment can help you prepare emotionally and consider rehabilitation options. This may include medicines, devices or specialist support as part of erectile rehabilitation.
Erectile function may improve gradually, particularly if erections were good before surgery and nerve-sparing surgery was possible, but recovery is not guaranteed. Improvement may continue for up to two years or longer in some men. Some men will continue to need tablets, vacuum devices, injections or other specialist treatments, while others may not regain erections firm enough for penetrative sex even with treatment.
Nerve-sparing surgery is only appropriate when the surgeon considers that it can be performed without compromising cancer control. Whether one or both nerve bundles can be preserved depends on the location and extent of the tumour.
Before surgery, ask when erectile rehabilitation is expected to begin, who will supervise it and which alternatives may be offered if tablets are not effective. Options may include vacuum devices, penile injections or referral to a specialist sexual-function service.
Permanent Sexual and Reproductive Changes
Radical prostatectomy causes permanent loss of ejaculation because the prostate and seminal vesicles are removed. You may still experience orgasm, but it will be dry and may feel different. Natural conception through sexual intercourse is no longer possible. If having biological children in the future may be important to you, ask for fertility advice early because sperm collection and storage must be arranged before surgery.
How Surgical Outcomes Affect Feelings About Treatment
How you feel about surgery may be influenced by both cancer outcomes and quality-of-life effects. Some men remain comfortable with their decision despite significant side effects, while others experience regret even when the cancer outcome is favourable.
If side effects are more significant than expected or recovery takes longer than anticipated, you may feel disappointed or uncertain about your decision. These experiences can shape how you view the outcome of your treatment.
Understanding the range of possible outcomes before surgery is important. Being well informed may help you set realistic expectations and feel better prepared for different outcomes.
Cancer Control and the Possibility of Further Treatment
Radical prostatectomy aims to remove the cancer, but the operation cannot guarantee that no further treatment will be needed. The removed prostate tissue is examined after surgery, and your PSA level is monitored for signs that cancer may remain or return.
Depending on the pathology findings and subsequent PSA results, your team may recommend continued observation or discuss treatments such as radiotherapy or hormone therapy. Understanding this possibility before surgery may help you avoid assuming that the operation will always mark the end of cancer treatment.
Your specialist can explain what your current risk assessment suggests about positive surgical margins, PSA recurrence and the possibility of additional treatment. The answer will depend on your individual cancer characteristics rather than the surgical approach alone.
Does Robotic Prostate Surgery Reduce Regret?
Robot-assisted radical prostatectomy allows the surgeon to operate through small keyhole incisions using instruments that provide magnified vision and precise movement. The robot does not perform the operation independently. Every movement is controlled by the surgeon.
Compared with open surgery, the robotic approach may offer advantages such as less blood loss, smaller wounds and a shorter hospital stay for some patients. However, research has not consistently shown that robotic surgery produces better long-term urinary or sexual function. One randomised study found that urinary and sexual function outcomes were similar two years after robot-assisted and open radical prostatectomy.
Evidence directly comparing treatment regret after robot-assisted and open prostatectomy is limited and inconsistent. Robot-assisted surgery should therefore not be presented as a way to prevent treatment regret. Cancer outcomes, urinary and sexual recovery, expectations and involvement in treatment decisions may have a greater influence on how a person feels after treatment.
Myth vs Fact
| Myth | Fact |
| Most men regret having prostate surgery. | Most men do not report treatment-related or significant decision regret after radical prostatectomy. The studies discussed reported rates of approximately 16% to 18%, although they used different definitions, patient groups and follow-up periods. |
| Regret means the operation was unsuccessful. | Treatment regret is not the same as cancer treatment failure. A man may have good cancer control but still experience regret because of urinary leakage, erectile dysfunction, changes in orgasm or other effects on quality of life. |
| Robotic surgery prevents treatment regret. | Evidence comparing regret after robot-assisted and open surgery is limited and inconsistent. Robot-assisted surgery cannot guarantee better long-term urinary or sexual outcomes or remove the possibility of treatment regret. |
| Choosing surgery quickly is always the safest option. | Some prostate cancers need treatment, while others may be suitable for active surveillance or another approach. Your specialist should explain your cancer risk, treatment options and how much time you can safely take to decide. |
| Urinary and sexual side effects always disappear. | Many men improve over time, but recovery varies. Some continue to experience urinary leakage or erectile difficulties and may need rehabilitation or specialist treatment. |
| Treatment regret can be completely prevented. | Clear information, realistic expectations and meaningful involvement in treatment decisions have been associated with lower levels of regret, but they cannot guarantee how you will feel after treatment. |
How Surgeon Experience Can Influence Satisfaction
Surgical experience and the systems available within the treating hospital may influence outcomes. Research has associated higher surgeon and hospital procedure volumes with lower rates of some complications, positive surgical margins and additional treatment. However, procedure volume alone cannot guarantee an individual result.
You may wish to ask how frequently the surgeon performs radical prostatectomy, how the team records continence and erectile outcomes, whether the results are independently audited and which definition of continence is used.
Good communication before and after your procedure plays an important role in satisfaction. Trust and clear communication with your clinical team may help you feel more reassured throughout treatment and recovery.
The Emotional Side of Prostate Cancer Treatment Decisions
Choosing prostate cancer treatment can be emotionally challenging, and you may feel pressure to make the “right” decision. Concerns about cancer control, possible side effects and your future quality of life can all contribute to uncertainty.
It is normal to have questions or worries before surgery. Taking time to understand your options and how they may affect you can help reduce anxiety and improve confidence in your decision.
Speaking openly with your specialist, partner or support network can be helpful. Sharing your concerns allows you to process information more clearly and choose a path that feels right for you.
If worry, low mood or uncertainty begins to affect your sleep, relationships or daily activities, speak to your clinical nurse specialist, GP or another member of your care team. Psychological support or counselling may help you process the diagnosis, treatment decision and changes that can follow surgery.
How Follow-Up Support Can Help Recovery
Support after surgery is an important part of your recovery. Regular follow-up appointments allow your healthcare team to monitor your progress, address concerns and offer treatments and rehabilitation that may help manage side effects.
Knowing that support is available can make the recovery process feel less overwhelming. It can also give you confidence that any issues you experience will be taken seriously and managed appropriately.
Ongoing care may help you adapt over time and support your quality of life after treatment. Continued support can help you manage side effects and adjust to the physical and emotional changes that may follow treatment.
When to Seek Medical Help After Surgery
Follow the discharge instructions and contact details provided by your surgical team. If you cannot contact your surgical team and the problem is urgent but not immediately life-threatening, contact NHS 111 for advice.
Contact your surgical team or urology ward urgently if your catheter stops draining, falls out or appears blocked. You should also seek prompt advice if you develop a fever, increasing wound redness, worsening pain, persistent vomiting or difficulty passing urine after the catheter has been removed. Do not attempt to replace the catheter yourself.
Call 999 if you develop chest pain, severe difficulty breathing, collapse or uncontrolled heavy bleeding. Contact your surgical team urgently or use NHS 111 if you develop sudden breathlessness, cough up blood or notice new pain, redness or swelling in one calf. If your symptoms become severe or rapidly worsen, call 999.
The Role of Personal Priorities in Treatment Decisions
Every man has different priorities when choosing prostate cancer treatment. You may place the greatest value on cancer control, while urinary function, sexual function and recovery may also be important considerations.
- Treatment goals: Your main aim may be to remove or control the cancer as effectively as possible
- Quality of life: You may prioritise maintaining urinary control and sexual function after treatment
- Risk tolerance: Your comfort with potential side effects or complications can influence your decision
- Lifestyle impact: How treatment may affect your daily routine, work and relationships can be an important consideration
- Long-term outlook: Your preferences about recovery, follow-up care and future health planning may shape your choice
Your personal values should play a central role in your decision-making. Discussing your priorities openly with your specialist can help guide the most suitable approach and support a treatment plan that aligns with your expectations.
Steps You Can Take Before Choosing Surgery
Before deciding on prostate surgery, it is important to take time to fully understand your diagnosis. Speaking with a specialist and asking detailed questions about outcomes and side effects can help you feel more prepared.
You should also consider how your personal circumstances, such as age, overall health and lifestyle, may affect recovery. Taking these factors into account can help you choose an option that aligns with your priorities and expectations.
Making an informed decision can increase your confidence and comfort with your choice. Ultimately, the aim is not only to treat the cancer effectively but also to protect your quality of life as far as possible.
Key Takeaways
- Around 16% to 18% of surgical patients reported treatment-related or significant decision regret in the studies discussed, although the studies used different definitions and follow-up periods.
- Not reporting significant regret is not necessarily the same as being completely satisfied with every aspect of recovery.
- Urinary, sexual and reproductive changes can affect how you feel about treatment.
- Realistic expectations and meaningful involvement in the decision may reduce uncertainty.
- Treatment should be selected according to your cancer risk, health, priorities and the options that are clinically suitable for you.
Frequently Asked Questions
1. What does treatment regret mean after prostate surgery?
Treatment regret means you may feel uncertain or dissatisfied with your decision after surgery. Regret may arise when recovery, side effects or treatment outcomes differ from what you expected.
2. How common is treatment regret after radical prostatectomy?
Studies have reported treatment-related or significant decision regret in approximately 16% to 18% of men after radical prostatectomy. These figures are not directly interchangeable because the studies used different definitions, patient groups and follow-up periods.
3. Which factors are associated with treatment regret?
Regret has been associated with unexpected side effects, poorer urinary or sexual function, unmet expectations and feeling less involved in the treatment decision. These are associations and do not mean that every person who experiences a side effect will regret surgery.
4. How can you reduce the risk of regret before surgery?
You cannot guarantee that treatment regret will be avoided. However, understanding all clinically suitable options, their possible outcomes and their potential side effects can help you make a decision that reflects your priorities and expectations.
5. Do side effects influence how you feel after surgery?
Urinary incontinence, erectile dysfunction and other unexpected side effects may influence how you feel about your decision. Being prepared for these possibilities can help you manage expectations.
6. Can shared decision-making lower the likelihood of regret?
Greater participation in treatment decisions has been associated with less regret. However, research has not proved that shared decision-making prevents regret in every patient.
7. Can your expectations affect your satisfaction after surgery?
Your expectations can influence how you feel afterwards. Realistic expectations may reduce the difference between what you expect and what you experience during recovery.
8. Does the type of surgery affect your chances of regret?
The surgical technique can influence outcomes, but it does not guarantee whether you will feel regret. Your overall health, cancer characteristics and understanding of the procedure are also important.
9. How can follow-up care help after prostate surgery?
Follow-up care allows your healthcare team to monitor your PSA, assess your recovery and address urinary, sexual or emotional difficulties. It can also provide access to rehabilitation or specialist support, although it cannot guarantee how you will feel about the original treatment decision.
10. What can you do to feel more confident about your decision?
You can take time to understand your diagnosis, discuss all options and consider your personal priorities. Making a well-informed choice can help you feel better prepared and more comfortable with the reasons behind your treatment decision.
Final Thoughts: Making an Informed Decision with Confidence
Treatment regret after prostate surgery is not inevitable. Most men in available studies do not report significant treatment regret. Studies have associated lower regret with clearer expectations, better information and greater involvement in treatment decisions.
Regret has been associated with unexpected side effects, unmet expectations and feeling insufficiently involved in the treatment decision. Taking time to explore all available options, ask questions and discuss your priorities with a specialist can help you make a decision that feels right for you.
Every case is different, and the most suitable approach is one that balances effective cancer control with your quality of life. Choosing a clinically suitable treatment that reflects your values and priorities may help you feel more confident about the decision.
To discuss prostate cancer treatment options, possible side effects and whether surgery may be suitable for you, contact Prostate Clinic London to arrange a specialist consultation.
References
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