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Which doctor should I choose?

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User
Posted 26 Mar 2025 at 20:19

A radiologist reviewed the PSMA PET and MRI images. He said that there was no spread and the tumor was not close to the nerve. Therefore, the very experienced doctor (over 3000 robotic surgeries) said that there was no need for frozen section. The less experienced doctor (1000 robotic surgeries) will use the neurosafe method in the surgery. Also, this very experienced doctor said that he will perform nerve-sparing surgery and that I will not have any incontinence or erection problems. His own results in young patients were like this. The less experienced doctor said that I will have incontinence for 3 months and that it can last up to 1 year, I will have erection problems for the first 3 months and then it will gradually improve. Frankly, the experienced doctor is very confident in himself and the results. Which doctor should I choose now? It is a very difficult decision for me. These two surgeons are respected surgeons in my country. I do not live in the UK. Thank you.

User
Posted 26 Mar 2025 at 20:19

A radiologist reviewed the PSMA PET and MRI images. He said that there was no spread and the tumor was not close to the nerve. Therefore, the very experienced doctor (over 3000 robotic surgeries) said that there was no need for frozen section. The less experienced doctor (1000 robotic surgeries) will use the neurosafe method in the surgery. Also, this very experienced doctor said that he will perform nerve-sparing surgery and that I will not have any incontinence or erection problems. His own results in young patients were like this. The less experienced doctor said that I will have incontinence for 3 months and that it can last up to 1 year, I will have erection problems for the first 3 months and then it will gradually improve. Frankly, the experienced doctor is very confident in himself and the results. Which doctor should I choose now? It is a very difficult decision for me. These two surgeons are respected surgeons in my country. I do not live in the UK. Thank you.

User
Posted 26 Mar 2025 at 22:16

Hello mate.

I think that you're in a very lucky position. Both surgeons are very experienced. If I were in your position, I'd pick the most experienced and who promised the quicker recovery. 

Best of luck. 👍

User
Posted 26 Mar 2025 at 22:59

I had a similar Issue and nothing beats the data. If someone makes claims they should be able to back it up with data. And the data should portray not just the volumes but the success statistics of the procedure they have undertaken. That’s certainly something I asked of my professor who did my surgery and he could back it up with granular data. It’s a bit of a nightmare with all the emotions At play to have to mess around with these variables, but unfortunately it’s fairly common.

User
Posted 28 Mar 2025 at 22:43

I’d do the research on the numbers. Volume is one thing but successful outcomes will be interesting to split out. Does the surgeon  make the surgical outcome data public? 

For me cancer control was primary. Continence a nice to have and generally a function of surgeon skill/approach. ED can be still very hit and miss although I was fortunate. 

Edited by member 28 Mar 2025 at 22:45  | Reason: Not specified

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User
Posted 26 Mar 2025 at 22:16

Hello mate.

I think that you're in a very lucky position. Both surgeons are very experienced. If I were in your position, I'd pick the most experienced and who promised the quicker recovery. 

Best of luck. 👍

User
Posted 26 Mar 2025 at 22:59

I had a similar Issue and nothing beats the data. If someone makes claims they should be able to back it up with data. And the data should portray not just the volumes but the success statistics of the procedure they have undertaken. That’s certainly something I asked of my professor who did my surgery and he could back it up with granular data. It’s a bit of a nightmare with all the emotions At play to have to mess around with these variables, but unfortunately it’s fairly common.

User
Posted 28 Mar 2025 at 16:50

Originally Posted by: Online Community Member

I had a similar Issue and nothing beats the data. If someone makes claims they should be able to back it up with data. And the data should portray not just the volumes but the success statistics of the procedure they have undertaken. That’s certainly something I asked of my professor who did my surgery and he could back it up with granular data. It’s a bit of a nightmare with all the emotions At play to have to mess around with these variables, but unfortunately it’s fairly common.

 

What the very experienced doctor said is that the statistics of no side effects are 100%. He stated that after performing 2000 robotic surgeries, his patients who had nerve-sparing surgery had no urinary incontinence or erectile dysfunction. This is not scientific data, it is just a verbal statement. It feels like a commercial and I have a hard time trusting him. Also, since he will not perform any frozen surgery, I am not sure if he will be able to completely remove the cancer. However, he almost guaranteed that there will be no problems with erectile dysfunction or urinary incontinence. This also contradicts scientific data.

User
Posted 28 Mar 2025 at 22:43

I’d do the research on the numbers. Volume is one thing but successful outcomes will be interesting to split out. Does the surgeon  make the surgical outcome data public? 

For me cancer control was primary. Continence a nice to have and generally a function of surgeon skill/approach. ED can be still very hit and miss although I was fortunate. 

Edited by member 28 Mar 2025 at 22:45  | Reason: Not specified

User
Posted 30 Mar 2025 at 21:52
Ozdes, it seems to me the second doctor is being more honest. Judging by all the people on this site who have reported their experience it is very rare to have rapid recovery of erectile function, even if those nerves are successfully preserved they take a serious battering during the operation and for the vast majority of patients it takes months for them to recover. Also I personally would grab the opportunity to have a surgeon who has the team to do the Neurosafe checks during the operation, pre-op scans and biopsies are not perfect guides and you don't want cancerous cells left behind to cause recurrence.

Success rates for continence are getting better, and it depends on the definition of continence, some studies define it as no more than one pad a day which doesn't match what most people think of as being continent. In the end all humans are different, and for some the inner sphincter (there are two) which can't be identified from scans or during the operation turns out to be in a position where it is damaged during removal of the prostate.

User
Posted 31 Mar 2025 at 08:13

Ozdes

did you see this that was posted yesterday

https://community.prostatecanceruk.org/posts/t31531-Neurosafe-PROOF-trail-results

User
Posted 31 Mar 2025 at 20:03

Originally Posted by: Online Community Member
Ozdes, it seems to me the second doctor is being more honest. Judging by all the people on this site who have reported their experience it is very rare to have rapid recovery of erectile function, even if those nerves are successfully preserved they take a serious battering during the operation and for the vast majority of patients it takes months for them to recover. Also I personally would grab the opportunity to have a surgeon who has the team to do the Neurosafe checks during the operation, pre-op scans and biopsies are not perfect guides and you don't want cancerous cells left behind to cause recurrence.

Success rates for continence are getting better, and it depends on the definition of continence, some studies define it as no more than one pad a day which doesn't match what most people think of as being continent. In the end all humans are different, and for some the inner sphincter (there are two) which can't be identified from scans or during the operation turns out to be in a position where it is damaged during removal of the prostate.

I agree with you. I also feel closer to the second doctor because of the neurosafe method and because I think he is more honest. However, the first doctor's promise that he will not have erection or urinary incontinence is also very tempting. Also, the first doctor's surgery fee is higher because he has the highest surgery volume in the country.

 

User
Posted 31 Mar 2025 at 20:05

Originally Posted by: Online Community Member

Ozdes

did you see this that was posted yesterday

https://community.prostatecanceruk.org/posts/t31531-Neurosafe-PROOF-trail-results

Yes, I saw that. If I am not mistaken, the recurrence (BCR) seems to be higher in the neurosafe group. However, the article I shared below concluded that the BCR may decrease in the neurosafe group.

 

https://www.nature.com/articles/s41391-024-00891-3

 

User
Posted 23 Dec 2025 at 00:06

Did one of the surgeons really claim you would have absolutely zero problems with continence and ED from day 1? If he says that in your case he would expect you to regain full continence and erectile function, that might be realistic, but there would probably be months of recovery first (esp for ED).

I had RALP 3.5 months ago with an extremely experienced surgeon with exceptionally high volume. I had zero problems with continence or ED prior to surgery and am 63 years old in excellent general health. He told me I was one of the patients least likely to have problems but he didn’t promise it would be like that from day 1.

I still have some incontinence but it’s always been manageable, initially with level 2 pads and now one level 1 pad per day. I’m confident it will be fully resolved in another 2-3 months.

ED is still there and my understanding is that only rare cases recover in less than 6 months and a year or more is more realistic. I’m still confident the ED will eventually resolve fully. It will just take time.

If there is any doubt about exactly what the higher volume surgeon said, I would go back and clarify. If he really said zero issues from day 1, I would be very sceptical.  

User
Posted 26 Dec 2025 at 12:28

If you’re trying to map out your next steps, I’ve found it really helpful to check anything that lays out how education ranges from 6 weeks to 1 year to finish. It gives you a feel for how fast you could jump in without turning your whole life upside down. I like that the info is in English and Spanish too, since it makes the whole process way easier to share with family.

Edited by moderator 26 Dec 2025 at 15:32  | Reason: Not specified

 
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