Prostate cancer is a condition that can cause considerable anxiety, with treatment choices that have the potential to significantly affect quality of life.

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Prostate cancer affects one in eight New Zealand men, but the aggressiveness of the cancer is variable. In some cases, the right management is to monitor the cancer rather than radically treat it with surgery or radiation, but accurate use of diagnostic tools is the key to confidently making the right decision for your prostate cancer. Choose a Urologist who has appropriate training, experience, and volume of work in prostate cancer.

Men who have an elevated PSA level or abnormal digital rectal examination (finger check) should see a Urologist. The established best practice for prostate cancer diagnosis is a multi-parametric MRI scan of the prostate, follow by a targeted trans-perineal prostate biopsy. Sometimes further imaging such as PSMA-PET scanning is also useful.

Again, not all men with prostate cancer need radical treatment as prostate cancers can be so slow-growing that men die “with them not of them”. Usually, low-grade prostate cancer can be closely observed, and even higher-grade cancers can be managed non-invasively in older men or those with other significant medical problems. It is essential that your Urologist takes the time to understand your health in its entirety; we are treating men, not prostate cancer.

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Prostate cancer surgery involves removal of the entire prostate, the ejaculatory ducts, seminal vesicals, and in some cases pelvic lymph nodes. The three goals of prostate cancer surgery are complete removal of the cancer, a rapid return to urinary continence (no leaking of urine), and where appropriate, return of erectile function. Preserving erectile function requires a “nerve-sparing” procedure, which may not be appropriate with some cancer parameters, or if pre-existing erectile function is poor.
The risk of on-going incontinence requiring further treatment after surgery is low but depends on your surgeon’s experience and surgical volume (number of operations per year). An experienced robotic surgeon can have an incontinence rate below 2%.

The risk of erectile function is more variable, depending on whether both or at least one erectile nerve can be safely preserved, and the man’s age and pre-existing erectile function. Again, surgeon experience and volume are essential.

To see a prostate anatomy animation, click here:


Surgery is a single treatment that is usually performed with the intention of avoiding the need for any further interventions such as radiation therapy, chemotherapy, or hormone therapy. Less commonly, men with high-risk prostate cancer have surgery as part of “multi-modal therapy”, where surgery is just one component of the treatment. Prostate cancer surgery usually improves urinary symptoms, as most men with prostate cancer already have some symptoms of BPH which is treated definitively with removal of the prostate. Having surgery as primary treatment leaves radiation therapy in reserve as a “back stop” measure should the cancer ever return in the future. With a nerve-sparing procedure, erectile function can continue to improve for up to three years following surgery. Properly trained and experienced robotics surgeons can have overall rates of incontinence below 2%. Removal of the prostate means that a full laboratory assessment can be carried out to definitively “grade and stage” the cancer, giving a very clear indication of the risk of the cancer returning.

Robotic-Assisted Radical Prostatectomy (RARP) is the standard of care in the USA, Australia, and Western Europe. RARP has a number of advantages for men over traditional open prostate cancer surgery, including enhanced recovery, fewer complications including less bladder neck contracture, earlier return to continence, and in experienced hands a trend towards better erectile function outcomes. The da Vinci robotic platform is just a tool, and optimal outcomes are only achieved when the surgeon is appropriately trained and experienced. An experienced open surgeon will achieve better outcomes than a poorly trained robotic surgeon. Your Urologist will talk to you about the surgical method they are most experienced in, and whether a nerve-sparing procedure is appropriate.

To see a short video on robotic prostate cancer surgery, follow this link: