Cared for by Dr Dimitri Gambachidze
Prostate cancer is the most frequent cancer in men, and in most cases it is diagnosed at a curable stage. The modern pathway begins with MRI before biopsy, so that unnecessary biopsies are avoided and significant tumours are sampled precisely. Not every prostate cancer needs immediate treatment: low-risk disease is often best managed by active surveillance. When treatment is required, the choice between surgery, radiotherapy and other options is made in a multidisciplinary tumour board and then discussed openly, weighing cancer control against continence and sexual function.
The prostate is removed through small incisions with the surgical robot, using magnified 3D vision. Nerve-sparing is tailored to the MRI and biopsy map to protect erectile function, and the bladder neck and urethral support are reconstructed to speed the return of continence.
For low-risk cancer, treatment is safely deferred and the disease monitored with PSA, MRI and repeat biopsy. Many men never need intervention, avoiding side effects altogether.
External beam radiotherapy or brachytherapy, with or without hormone therapy, is coordinated with the radiation oncology team when it suits the tumour and the patient better than surgery.
Salvage treatment, extended lymph node dissection and systemic therapy are planned jointly with medical oncology within the tumour board.
Most men regain full daytime continence within three to six months with pelvic floor rehabilitation; a minority need pads long term, and further treatment exists for them.
When nerve-sparing is oncologically safe, recovery is likely but gradual over twelve to twenty-four months, supported by early penile rehabilitation.
For localised disease, cancer control is comparable; the side-effect profile and your own priorities usually decide. Both options are presented after the tumour board discussion.