The prostate cancer 
patient journey

A diagnosis of prostate cancer can feel like being dropped into the unknown without a map. Suddenly there are scans, biopsies, PSA results, Gleason scores, treatment options, risks, waiting times and opinions from every direction.

My role is to make the pathway clear.

I guide patients through diagnosis, decision-making, treatment and recovery with a focus on three things: cancer control, preservation of quality of life, and honest communication. Not every man needs surgery. Not every man needs immediate treatment. But every man needs a proper explanation of his risk, his options, and what each option may mean for his future.

Step 1: Understanding your diagnosis

The first step is to understand exactly what has been found.

This usually means reviewing your PSA history, MRI scan, biopsy results, prostate size, urinary symptoms, general health, family history and personal priorities. A prostate cancer diagnosis is not one single thing. Some cancers are low-risk and can be safely monitored. Others are more aggressive and need active treatment.

At your consultation, I will explain your results in plain English, including:

PSA level and PSA pattern over time
MRI findings and whether the cancer appears contained
Biopsy grade, including Gleason score / Grade Group
Cancer volume and location within the prostate
Whether there are signs of spread outside the prostate
How your age, health and priorities affect treatment choice

The aim is simple: you should leave the consultation knowing what you have, how serious it is, and what the realistic options are.

Step 2: Deciding whether treatment is needed

Many men assume that prostate cancer automatically means surgery or radiotherapy. That is not always true.

For some men, active surveillance is the safest and most sensible option. This means careful monitoring with PSA tests, MRI scans and repeat assessment when needed. For others, treatment is recommended because the cancer has features that make progression more likely.

Treatment decisions should be based on risk, not panic.

I will discuss the advantages and disadvantages of each suitable option, which may include:

Active surveillance
Robot-assisted radical prostatectomy
Radiotherapy
Hormone therapy
Focal therapy in selected cases
Referral for additional oncology opinion where appropriate

The right decision is not simply “the most aggressive” one. It is the one that gives the best balance between cancer control and your future quality of life.

Step 3: Planning surgery, where surgery is the right option

If surgery is recommended and you choose to proceed, the operation is planned carefully around your anatomy, cancer location and functional priorities.

Robot-assisted radical prostatectomy involves removing the prostate and seminal vesicles, then reconnecting the bladder to the urethra. The aim is complete cancer removal while protecting urinary control and, where safe, preserving the nerves involved in erections.

Key planning questions include:

Is nerve-sparing safe on one or both sides?

What is the membranous urethral length?

Can hood sparing be performed?
Is there suspicion of extracapsular extension?
Are pelvic lymph nodes likely to need removal?
Is a Retzius-sparing or modified Retzius-sparing approach suitable?
How likely are urinary symptoms that may affect recovery?
What are the realistic expectations for continence and sexual function?

This is where experience and judgement matter. A good operation is not just removing the prostate. It is knowing where to be bold, where to be delicate, and where cancer control must come first.

Step 4: Preparing for your operation

Preparation improves recovery. Before surgery, you will be given clear instructions about medication, fitness, pelvic floor exercises, blood thinning drugs, fasting, admission details and what to bring into hospital.

Where possible, I encourage men to start pelvic floor exercises before the operation. This gives you a better understanding of the muscles involved in urinary control and helps prepare you for catheter removal after surgery.

You will also have the opportunity to discuss sexual function recovery, penile rehabilitation, continence recovery, expected time off work, driving, exercise and return to normal activities.

No man should go into this operation not knowing what happens next.

Step 5: The hospital stay

Most patients stay in hospital for a short period after robotic prostate surgery. During this time, the team will monitor your pain control, mobility, wounds, catheter, drain if used, bowel function and general recovery.

You will go home with a catheter in place. This is normal. The catheter allows the join between bladder and urethra to heal. You will be given instructions about catheter care, warning signs, activity and follow-up.

Before discharge, you should know:

Who to contact if there is a problem
How to manage the catheter
What level of bleeding or leakage is expected
What pain relief to take
When the catheter is likely to be removed
When your histology results will be discussed

Step 6: Histology results and the first recovery phase

After the prostate is removed, it is examined carefully by the pathology team. This gives the most accurate assessment of the cancer.

The histology report usually confirms:

Final Grade Group / Gleason score
Tumour size and location
Whether the cancer was confined to the prostate
Whether the surgical margins are clear
Whether seminal vesicles or lymph nodes are involved
Whether any further treatment may be needed

This is a major checkpoint. If the cancer is fully removed and margins are clear, follow-up usually focuses on PSA monitoring and recovery. If there are higher-risk features, we discuss whether additional treatment or closer monitoring is needed.

Step 7: Catheter removal and continence recovery

Catheter removal is an important moment, but it is not the end of recovery. Leakage is common at first. For most men, urinary control improves over weeks and months.

Continence recovery depends on several factors, including age, baseline urinary function, prostate size, anatomy, surgical factors and pelvic floor strength.

You will be supported with pelvic floor advice and follow-up. The goal is steady progress, not instant perfection. Some men recover quickly. Others need more time. What matters is that you know what is normal, what is not, and when to ask for help.

Step 8: Sexual function recovery

Erectile function recovery after prostate surgery is variable. It depends on pre-operative function, age, other health conditions, cancer location, whether nerve-sparing was possible, and the body’s healing response.

Where appropriate, we will discuss penile rehabilitation. This may include tablets, vacuum devices, injections or specialist support. The aim is to preserve tissue health, support recovery and help you and your partner understand what is realistic.

This part of recovery deserves honest discussion. It should not be brushed aside, and it should not be dressed up with false promises.

Step 9: PSA follow-up

After prostate removal, PSA should fall to an undetectable or very low level. PSA monitoring is used to check for any sign of recurrence.

Follow-up is usually structured around regular PSA tests. The exact schedule depends on your pathology and risk profile.

A good follow-up plan gives you clarity: what result we expect, when tests are needed, and what we would do if the PSA does not behave as expected.

Step 10: Long-term recovery and getting back to life

The goal is not just to remove cancer. The goal is to get you back to living.

That means returning to work, exercise, relationships, travel, sex, confidence and normal routines. Recovery is physical, but it is also psychological. Many men feel the emotional impact only after the operation is over and everyone else assumes the problem has been solved.

Good prostate cancer care does not stop at the operating theatre door. It continues through recovery, surveillance and the practical business of rebuilding confidence.

What you can expect from me

You can expect direct communication, careful review of your results, and a clear explanation of your options. In complex or very high-risk cases, I will discuss the value of additional specialist input, including second opinions or multidisciplinary review where appropriate. If surgery is appropriate, I will explain the potential benefits, the risks and trade-offs honestly.

My approach is specialist, focused and data-driven but the centre of it is simple: you need to understand your disease, understand your choices, and feel properly supported through the pathway.

Book a consultation

If you have been diagnosed with prostate cancer, have been advised to consider surgery, or would like a second opinion, you can arrange a consultation through Spire Leicester or Spire Cambridge Lea.

Bring your PSA results, MRI report, biopsy report and any clinic letters if available. If you do not have everything, we can help identify what is needed.