What Robotic Prostatectomy Is
A radical prostatectomy removes the whole prostate and the seminal vesicles, and the nearby lymph nodes when the risk of spread justifies it. In the robotic method, five or six small cuts are made in the lower abdomen. The surgeon sits at a console and moves the instruments, while a camera gives a magnified three-dimensional view of the deep pelvis, where the prostate lies close to the bladder, rectum and the nerves that control erections.
The robot does not act on its own. The surgeon makes every movement, so the surgeon's training and experience in this operation matter more than the machine.
Dr. Singh performs robotic surgery at Chandan Hospital, Lucknow. Consultations to plan an operation are held at the hospital OPD, at the Gomti Nagar clinic or by teleconsultation.
Who Surgery Suits, and Who It May Not
Surgery is usually suggested when the cancer is still inside the prostate or has only just grown beyond it, and the man is fit for an operation and likely to live for many years. The decision rests on the biopsy grade (Gleason score and Grade Group), PSA, MRI findings and your own priorities.
Often suggested
Intermediate and high-risk cancer that has not spread, and younger men who prefer to have the cancer removed.
Other options may suit better
Low-risk cancer that can be watched safely, men with other illnesses that make a major operation risky, or cancer that has already spread.
If you have had a raised PSA but no biopsy yet, read what to do after a raised PSA first. To understand a biopsy report, see the Gleason score explained.
The Operation in Brief
- Before surgery. A prostate MRI and the biopsy report help plan the operation, including whether the nerves can be spared. Pelvic floor exercises are started two to four weeks earlier.
- During surgery. Under general anaesthesia, the prostate is freed, the nerve bundles are protected when it is safe to do so, the gland is removed in a bag, and the bladder is joined to the urethra with fine stitches.
- Time and stay. The operation usually takes about two to four hours. Most men go home within two to three days with a catheter.
- Pathology. About one to two weeks later the report gives the final grade, stage, margins and lymph node findings, which guide any further treatment.
A step-by-step description, including what nerve-sparing means, is in Robotic radical prostatectomy (RARP): the operation explained.
How It Compares with Other Options
For cancer that has not spread, surgery, radiotherapy and, for low-risk disease, active surveillance can each be reasonable. In studies of localised Prostate Cancer, survival from the cancer has been similar with surgery and radiotherapy, so the choice often comes down to the side effects you prefer to accept and your overall health.
| Option | What it involves | Main points to weigh |
|---|---|---|
| Robotic prostatectomy | Small incisions, prostate removed, catheter for about a week | Usually less blood loss and a shorter stay than open surgery. Urine leakage and erection problems are the main side effects, and both improve over time in most men. |
| Open prostatectomy | One lower abdominal incision | Cancer control is similar in experienced hands. Recovery is often slower, with more blood loss. |
| Radiotherapy | Daily treatments over several weeks, sometimes with hormone therapy | No operation. Bowel and bladder irritation can occur, and erection problems may appear later. It cannot be repeated easily in the same area. |
| Active surveillance | Regular PSA, MRI and repeat biopsies | For low-risk cancer only. It avoids treatment side effects but needs close follow-up. See Active surveillance. |
The best choice is individual. A fuller discussion is in why Prostate Cancer treatment should be individualised, and a comparison of surgical methods is in robotic, open and laparoscopic surgery.
Recovery
- Walking starts on the day of surgery or the next day. Most men leave hospital in two to three days.
- The catheter is usually removed after about a week or two.
- Light activity resumes within a few weeks, and heavy lifting is avoided for about six weeks.
- Urine control improves over weeks to a few months, and pelvic floor exercises help.
- Erections take longer, often many months, and depend on the cancer and on whether the nerves could be spared.
- The first PSA is checked about six to eight weeks after surgery, and then regularly.
A fuller timeline is in Recovery after robotic prostatectomy.
Risks and Side Effects
Like any major operation, prostatectomy has risks: bleeding, infection, blood clots and problems with anaesthesia. Those specific to this operation are:
- Urine leakage. Common at first and improves with time. A small number of men have lasting leakage.
- Erectile dysfunction. Common, even when the nerves are spared. Recovery can take six to 24 months and is not guaranteed.
- No semen. Orgasm is still possible, but dry. Discuss sperm storage first if you hope to have children.
- Cancer at the edge of the specimen or in lymph nodes. This may mean further treatment, such as radiotherapy.
It is reasonable to ask any surgeon how many prostatectomies they perform each year and how they follow their patients' urine control and PSA results.
Frequently Asked Questions
Is robotic prostatectomy better than open surgery?
Cancer control is generally similar in experienced hands. Robotic surgery usually means smaller wounds, less blood loss and a shorter hospital stay. The surgeon's experience matters more than the platform.
How long does it take to recover?
Most men leave hospital in two to three days and return to light activity in a few weeks. Urine control and erections take longer to recover, from several weeks to many months.
Will I be able to have erections afterwards?
Many men do, especially when the nerves can be spared and erections were good before surgery. Recovery can take six to 24 months and treatment may help.
Is surgery or radiotherapy better for Prostate Cancer?
For cancer that has not spread, survival has been similar with both in studies, so the choice depends on the side effects you prefer to accept, your health and your cancer. Both should be discussed.
Do I need surgery straight away?
Not always. Low-risk cancer can often be watched safely with regular PSA tests, MRI and biopsies. Your reports will show which approach suits you.
What should I bring to the consultation?
Bring the biopsy report, the prostate MRI and any PSMA scan, recent PSA results, and a list of your medicines. Reports can be shared in advance for teleconsultations.