Choosing a surgeon for robotic prostatectomy is one of the most important decisions a man with prostate cancer will make. Surgeon volume, technique, nerve-sparing approach, and the support team all affect outcomes. These 10 questions help you gather the information you need to make a confident, informed decision.
1. How many robotic prostatectomies have you personally performed?
Volume matters. Outcomes improve significantly with surgeon experience. Ask for the surgeon's personal caseload — not the hospital's volume or the department's total. Surgeons performing fewer than 30–50 cases per year are generally considered lower volume. The best outcomes data comes from high-volume surgeons who perform this operation regularly. This is publicly available information for UK surgeons: the BAUS audit publishes individual caseload data at baus.org.uk.
2. What technique do you use — standard or Retzius-sparing?
The Retzius-sparing (posterior) approach preserves the anatomical structures associated with early urinary continence. Most patients treated with this technique achieve pad-free or minimal-pad continence significantly faster than with the standard approach. Ask specifically whether your surgeon is trained in and routinely performs this technique — it requires additional training beyond standard robotic prostatectomy, and not all surgeons offer it.
3. What are your personal continence and potency outcomes?
Ask for the surgeon's own data — not published trial results. A good surgeon will be able to tell you: what percentage of their patients are pad-free at 3, 6 and 12 months; and what percentage recover erectile function usable for intercourse (with or without PDE5 inhibitors such as sildenafil). These numbers should be yours to compare against published benchmarks. Any hesitation to provide personal data should itself be informative.
The BAUS (British Association of Urological Surgeons) publishes surgeon-level caseload data in its audit. You can look up any UK urologist's operative volume at baus.org.uk. This is publicly available information and is worth reviewing before your consultation.
4. Will you perform nerve-sparing, and how do you decide?
Nerve-sparing preserves the neurovascular bundles responsible for erectile function. Whether it is possible depends on cancer location, grade, PSA and MRI findings. Ask your surgeon: how do they decide whether nerve-sparing is safe? Do they use intraoperative frozen section analysis? Do they err on the side of wider margins or functional preservation — and why? There is no universally correct answer, but the reasoning should be transparent and personalised to your case.
5. What is your positive surgical margin rate?
A positive surgical margin (cancer cells reaching the edge of the removed specimen) is associated with a higher risk of cancer recurrence. Ask for your surgeon's personal positive surgical margin rate, ideally stratified by tumour stage (pT2 versus pT3). Published benchmarks suggest positive margin rates of 10–15% for pT2 disease should be achievable in experienced hands. Higher rates may warrant further discussion.
6. Who is in the operating team with you?
Robotic prostatectomy is a team procedure. Ask whether a trained assistant surgeon will be present throughout the operation. Some surgeons operate alone or with trainees at the bedside. Others operate alongside a second experienced robotic surgeon. Understand who will be there and what role each person plays. The quality of bedside assistance directly affects key procedural steps including haemostasis and specimen extraction.
7. What happens if there are complications?
Ask about the surgeon's major complication rate and re-operation rate. Ask where you would be treated if a complication occurred — is there a 24-hour urology team at the hospital? Who do you call in the middle of the night? Good surgeons will answer these questions without hesitation. If there is evasiveness on this point, treat it as a red flag.
8. Will I need radiotherapy or hormone therapy after surgery?
If your cancer is intermediate or high risk, adjuvant or salvage radiotherapy may be required even after successful surgery. Ask your surgeon: based on my MRI, biopsy grade and PSA, what is the likelihood I will need further treatment? If the answer is high, consider whether surgery is the right primary treatment for your case — or whether primary radiotherapy with hormone therapy might achieve better overall outcomes. This is a conversation that should happen before you commit to an operation.
9. What does the prehabilitation programme look like?
Evidence supports starting pelvic floor exercises before surgery — not after. Ask whether you will be referred to a specialist pelvic floor physiotherapist before your operation. Ask about the catheter removal protocol (10–14 days is standard for the Retzius-sparing approach). Ask what support is available for urinary rehabilitation post-operatively. A structured prehabilitation programme significantly improves continence recovery speed.
10. What are the costs, and what does my insurance cover?
For private patients, ask for a full written cost estimate covering: surgeon fees, anaesthetist fees, hospital facility fees, pathology, post-operative appointments, and any catheter removal appointments. Ask your insurer whether pre-authorisation is required and whether there are any potential shortfalls. A good private secretary will walk you through all of this before you commit. Surprises on a bill after a cancer operation are deeply unwelcome — insist on clarity upfront.
Frequently asked questions
Yes, particularly for intermediate or high-risk disease. A second opinion from a different specialist may suggest the same treatment, confirm your confidence, or present an alternative approach you had not considered. Mr Ameen regularly sees patients for second opinions and welcomes this — there is no obligation to proceed with treatment after a consultation.
The operation typically takes 2–3 hours from first incision to closure. Anaesthetic and preparation time means you will be in theatre for 3–4 hours total. You will be on the ward and awake within an hour or two of the procedure ending. Most patients stay 1–2 nights and go home with a urinary catheter, which is removed at approximately 10–14 days.
Both are minimally invasive, but robotic surgery uses a da Vinci console that gives the surgeon enhanced 3D vision, wristed instruments (7 degrees of freedom versus 4 for laparoscopic), and tremor filtration. Most high-volume centres have moved to robotic prostatectomy as the standard approach, and the majority of training programmes now focus on robotic technique.
Surgery is most appropriate for localised prostate cancer confined to or just outside the prostate. Very high-risk localised disease or locally advanced disease may be better managed with primary radiotherapy and hormone therapy. This should be discussed in a multidisciplinary team context. The right treatment depends on cancer characteristics, patient fitness and individual priorities.
Mr Ameen performs robotic radical prostatectomy at the Wellington Hospital, St John’s Wood — a leading London private hospital with a full-time da Vinci robotic surgery programme and a dedicated urology team.
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Mr Torath Ameen offers expert consultations for prostate cancer and robotic surgery. He welcomes patients seeking a second opinion and will take the time to answer every question clearly.
This article is intended for general patient education only. It does not constitute medical advice and may not apply to every individual's circumstances. Clinical decisions should always be made in consultation with a qualified healthcare professional. If you are concerned about your health, please seek prompt medical assessment.