A prostate biopsy is the definitive test used to determine whether abnormal prostate cells are cancerous. Modern biopsy techniques have changed significantly. Rather than routinely passing biopsy needles through the rectum, prostate tissue can now be sampled through the skin of the perineum, the small area between the scrotum and anus.

The TP Pivot Pro™ is a specialised needle-guidance system designed to facilitate a freehand transperineal prostate biopsy. It allows the biopsy needle to be accurately directed into different areas of the prostate using real-time ultrasound guidance, while requiring only a small number of skin puncture sites.

The transperineal approach has become increasingly attractive because it provides excellent access to the prostate while substantially reducing the risk of infection associated with passing biopsy needles through the rectum.

Why Might I Need a Prostate Biopsy?

A raised PSA does not automatically mean prostate cancer. PSA may also rise because of benign prostate enlargement, inflammation, infection, recent instrumentation or other factors.

A biopsy is generally recommended when the overall clinical picture suggests a meaningful risk of prostate cancer.

This may include:

• A persistently or progressively elevated PSA
• An abnormal prostate examination
• A suspicious lesion identified on multiparametric MRI
• An increased PSA density, which relates the PSA level to prostate volume
• A strong family history or other recognised prostate cancer risk factors
• Persistent suspicion of prostate cancer despite a previous negative biopsy
• The need to reassess a known prostate cancer as part of an active surveillance programme

Modern guidelines recommend performing prostate MRI before biopsy in most men suspected of having localised prostate cancer. MRI findings, PSA density and other individual risk factors can then be combined to determine whether biopsy is appropriate. In selected men with a negative MRI and low clinical risk, biopsy may safely be avoided in favour of PSA surveillance.

What Is a TP Pivot Pro™ Transperineal Biopsy?

TP Pivot Pro™ is a single-use needle guidance device that attaches to the transrectal ultrasound probe used to visualise the prostate.

Importantly, although the ultrasound probe sits within the rectum to provide the image, the biopsy needle does not pass through the rectum.

Instead, the biopsy needle passes through the cleaned skin of the perineum.

The device incorporates an adjustable, pivoting needle guide. This allows the surgeon to change the angle and height of the biopsy needle and reach different parts of the prostate while maintaining ultrasound visualisation.

Why Use a Transperineal Approach?

Historically, many prostate biopsies were performed transrectally. During a transrectal biopsy, the needle passes from the rectum directly into the prostate.

The bowel naturally contains large numbers of bacteria. Passing multiple biopsy needles through the rectal wall therefore introduces a small but important risk of urinary infection, prostatitis and occasionally serious bloodstream infection or sepsis.

With a transperineal biopsy, the needle passes through disinfected skin instead.

A major randomised clinical trial comparing contemporary transperineal and transrectal biopsies reported no significant infections among 372 men undergoing transperineal biopsy, compared with an infection rate of 1.6% after transrectal biopsy. Cancer detection was similar between the two approaches.

The transperineal route also provides very good access to areas of the prostate that may sometimes be more difficult to sample transrectally, particularly the anterior and apical regions.

How Is the Biopsy Performed?

1. MRI and Biopsy Planning

Whenever appropriate, a multiparametric MRI of the prostate is performed before biopsy.

The MRI identifies areas that look suspicious for clinically significant prostate cancer. These are usually reported using the PI-RADS system, ranging from PI-RADS 1 to PI-RADS 5.

MRI information can then be used to guide targeted biopsy samples. Current European guidelines recommend combining targeted biopsy with appropriate regional or perilesional sampling when suspicious MRI abnormalities are present.

2. Anaesthesia

Transperineal biopsy can be performed using:

Local anaesthetic, sedation or general anaesthesia, depending on the clinical circumstances, patient preference and the technique used.

The TP Pivot Pro™ system is specifically designed to facilitate a minimally invasive freehand approach and can be used under local or general anaesthesia.

3. Ultrasound Examination

An ultrasound probe is gently inserted into the rectum.

The probe produces real-time images of the prostate, allowing the surgeon to see:

• The prostate gland
• Its boundaries
• The urethra
• The prostate apex and base
• The planned path of the biopsy needle

The ultrasound probe is used for imaging only. The biopsy needle itself enters through the perineal skin.

4. The TP Pivot Pro™ Guide Is Positioned

The TP Pivot Pro™ biopsy guide is securely attached to the ultrasound probe.

Its pivoting mechanism allows the surgeon to alter the trajectory of the introducer needle while watching its position on the ultrasound image.

This makes it possible to reach different regions of the prostate through a very small number of skin access points.

5. Biopsy Samples Are Taken

A biopsy needle is passed through the introducer and into the prostate under direct ultrasound guidance.

Each activation of the biopsy device removes a very thin cylinder of prostate tissue known as a core.

Two complementary types of biopsy may be performed.

Targeted biopsies sample abnormalities seen on MRI.

Regional or systematic biopsies sample predetermined regions of the prostate to reduce the chance of missing important cancer elsewhere in the gland.

Modern 2026 European prostate cancer guidelines favour MRI-informed targeted and regional sampling rather than simply performing the same systematic biopsy pattern in every patient.

How Long Does the Procedure Take?

The exact time varies depending on prostate size, MRI findings and the number of biopsies required.

The procedure itself is generally relatively short, although additional time is required for preparation, anaesthesia and observation afterwards.

Most patients undergoing an uncomplicated biopsy can return home the same day.

What Happens to the Biopsy Samples?

Each biopsy core is sent to a specialist anatomical pathologist.

The pathologist determines:

• Whether cancer is present
• How much cancer is present in each core
• The type of cancer
• The aggressiveness or Grade Group of the cancer
• The percentage or length of each biopsy involved
• Whether other important microscopic features are present

Prostate cancer is commonly reported using ISUP Grade Groups 1 to 5.

Broadly speaking, Grade Group 1 represents the least aggressive pattern, while Grade Group 5 represents the most aggressive.

The biopsy result is then interpreted alongside the PSA, MRI findings, prostate examination, prostate volume and the patient’s overall health.

What Are the Advantages of TP Pivot Pro™?

Potential advantages of this minimally invasive transperineal technique include:

• Very low risk of serious infection
• Avoidance of passing biopsy needles through the rectum
• Excellent access to the anterior, posterior and apical prostate
• Accurate targeting under real-time ultrasound guidance
• Ability to combine MRI-targeted and regional biopsies
• A small number of perineal skin punctures
• Ability to perform the procedure under local anaesthetic in appropriate patients
• A freehand technique that allows the needle trajectory to be adjusted during the procedure

The Pivot Pro™ does not itself diagnose cancer. It is a guidance system that assists the surgeon in accurately performing a transperineal biopsy.

Possible Complications

Transperineal prostate biopsy is generally well tolerated, but no biopsy is completely risk-free.

Blood in the Urine

A small amount of blood in the urine is common after biopsy and usually settles without treatment.

Drinking adequate fluids can help unless you have been advised to restrict your fluid intake for another medical reason.

Blood in the Semen

Blood in the semen is also common after prostate biopsy.

The semen may appear pink, red, brown or rust-coloured. This can persist intermittently for several weeks and is usually harmless.

Bruising or Minor Bleeding

Some bruising or tenderness can occur around the perineal puncture sites.

Significant bleeding is uncommon.

Difficulty Passing Urine

Temporary swelling of the prostate after biopsy can occasionally make urination difficult.

Rarely, acute urinary retention occurs and a temporary urinary catheter is required.

The risk may be greater in men with a particularly large prostate, significant pre-existing urinary symptoms or when a large number of biopsy cores are required.

In the PREVENT randomised trial, urinary retention requiring intervention occurred in approximately 0.3% of men undergoing transperineal biopsy, although rates vary between different biopsy techniques and patient populations.

Infection

Infection remains possible, but it is one of the major areas in which transperineal biopsy offers an advantage.

Because the biopsy needle does not pass through the bacteria-rich rectum, the risk of infection and sepsis is substantially lower than with the traditional transrectal route.

In the PREVENT trial, there were zero grade 2 or greater infections in the transperineal biopsy group, compared with 1.6% following transrectal biopsy.

Your surgeon will advise whether antibiotics are required according to the procedure being performed and local protocols.

When Should I Seek Medical Attention After My Biopsy?

Contact your surgeon or seek urgent medical assessment if you develop:

• Fever, chills or shaking
• Increasing difficulty passing urine
• Complete inability to urinate
• Heavy or persistent bleeding
• Large blood clots in the urine
• Increasing pain or swelling
• Feeling significantly unwell

Although serious infection is uncommon after transperineal biopsy, a fever or systemic illness following any prostate biopsy should be assessed promptly.

What Happens After the Prostate Biopsy?

The next step depends entirely on the pathology result.

No Cancer Is Found

A negative biopsy is reassuring, but it does not reduce the future risk of prostate cancer to zero.

Your urologist will consider:

PSA levels and PSA trend, MRI findings, PSA density, prostate size, family history, the adequacy of the biopsy and your overall prostate cancer risk.

Depending on these findings, management may involve routine PSA surveillance, repeat MRI or, less commonly, another biopsy if clinical suspicion remains high.

Low-Risk Prostate Cancer Is Found

Not every prostate cancer needs immediate treatment.

Men with low-risk prostate cancer, and selected men with favourable intermediate-risk disease, may be suitable for active surveillance.

Active surveillance typically involves repeated PSA testing, clinical review, MRI and repeat biopsy when appropriate.

The aim is to monitor the cancer carefully and offer treatment only if there is evidence that it is becoming more significant. Current guidelines continue to recommend active surveillance as the preferred approach for many men with low-risk prostate cancer.

Clinically Significant Prostate Cancer Is Found

If the biopsy demonstrates clinically significant cancer, the next step is to determine:

• The Grade Group
• The amount of cancer present
• Whether the cancer appears confined to the prostate
• Whether additional staging investigations are required
• Your PSA level
• Your age and general health
• Your personal treatment priorities

Some men will undergo further imaging such as PSMA PET/CT before deciding on treatment, particularly when higher-risk disease is identified.

Treatment options may include:

Active surveillance, robotic-assisted radical prostatectomy, radiotherapy, sometimes combined with hormonal therapy, or other treatments depending on the individual situation.

There is rarely a single treatment that is correct for every man. Management should be tailored to the biological behaviour of the cancer and the patient’s individual priorities.

From PSA to Diagnosis: The Modern Prostate Cancer Pathway

Abnormal PSA or clinical concern
↓
Repeat PSA and individual risk assessment
↓
Multiparametric MRI
↓
MRI and PSA-density assessment
↓
Biopsy recommended if clinically appropriate
↓
TP Pivot Pro™ transperineal targeted ± regional biopsy
↓
Pathology result
↓
No cancer → surveillance / reassessment
Low-risk cancer → consider active surveillance
Clinically significant cancer → staging and treatment discussion

Frequently Asked Questions

Is a transperineal prostate biopsy painful?

Local anaesthetic significantly reduces discomfort. Patients commonly notice pressure, vibration or the clicking of the biopsy device rather than sharp pain. Sedation or general anaesthesia can be used in appropriate circumstances.

Does the needle go through the rectum?

No. The ultrasound probe sits in the rectum to create the images, but the biopsy needle enters through the skin of the perineum.

Can the biopsy find cancers at the front of the prostate?

Yes. One of the advantages of the transperineal approach is excellent access to anterior and apical regions of the prostate.

Does everyone with a high PSA need a biopsy?

No. PSA is only one part of the assessment. Repeat PSA measurement, prostate examination, MRI, PSA density, family history and other risk factors may all influence whether biopsy is necessary.

Can an MRI replace a prostate biopsy?

MRI is extremely useful but cannot currently provide the same definitive information as examination of prostate tissue under a microscope. In selected low-risk men with a reassuring MRI, biopsy can sometimes be avoided or deferred. When clinically significant prostate cancer remains suspected, tissue biopsy remains the standard method of confirming the diagnosis.

How long will it take to receive my results?

Timing varies between pathology laboratories. Your urologist will normally arrange a follow-up appointment to discuss the pathology rather than relying on the written report alone.

A More Precise Way to Investigate Prostate Cancer

The goal of modern prostate biopsy is not simply to take more samples. It is to obtain the right samples from the right areas of the prostate while minimising unnecessary risk.

Combining high-quality prostate MRI with a minimally invasive transperineal technique such as TP Pivot Pro™ allows suspicious lesions and relevant regions of the prostate to be sampled accurately without repeatedly passing biopsy needles through the bowel.

For appropriate patients, this represents an important evolution in the diagnosis of prostate cancer: MRI-informed, targeted, transperineal and focused on reducing complications while preserving diagnostic accuracy.

This information is intended for general education and does not replace individual medical advice. The need for prostate biopsy, choice of anaesthesia, biopsy technique and subsequent treatment should be discussed with your urologist.

Come review with your friendly Brisbane Based Urologist Dr Jo Schoeman (Uro-Jo) to discuss this minimal invasive option.

Understanding Robotic Prostate Cancer Surgery

A diagnosis of prostate cancer brings with it several important decisions. For men with cancer that is confined to the prostate, or selected cancers that have extended just beyond it, radical prostatectomy remains an established curative treatment option.

Robotic-assisted radical prostatectomy (RARP) is a minimally invasive approach in which the prostate and seminal vesicles are removed using a robotic surgical system. Depending on the characteristics of the cancer, lymph nodes in the pelvis may also be removed.

The robotic system does not perform the operation independently. Every movement is controlled by the surgeon. The technology provides magnified three-dimensional vision and highly manoeuvrable instruments, allowing precise dissection within the confined space of the male pelvis.

Compared with traditional open surgery, robotic-assisted surgery generally offers smaller incisions, less blood loss, a shorter hospital stay and faster early recovery. Importantly, however, the experience and skill of the surgeon remain more important than the particular surgical platform used.

Who May Benefit from Radical Prostatectomy?

Radical prostatectomy is most commonly considered for men with localised prostate cancer who have a sufficiently long-life expectancy to benefit from definitive treatment.

It may also form part of treatment for selected men with locally advanced or higher-risk prostate cancer, sometimes combined with additional treatments such as radiotherapy or androgen deprivation therapy.

The decision is individual and takes into account:

• PSA level and PSA history
• Prostate biopsy results and Grade Group/Gleason score
• Clinical stage of the cancer
• MRI findings
• PSMA PET/CT or other staging investigations when indicated
• Age and general health
• Other medical conditions
• Baseline urinary function
• Baseline erectile and sexual function
• Expected life expectancy
• Patient preferences regarding cancer control and treatment side effects

For some men with low-risk prostate cancer, active surveillance may be preferable to immediate surgery. Radiotherapy is also an important alternative to surgery for many patients.

The objective is therefore not simply to determine whether an operation can be performed, but whether surgery represents the most appropriate treatment for that individual patient.

When May Surgery Not Be Appropriate?

There are relatively few absolute contraindications to robotic prostatectomy, but surgery may not be the preferred treatment when the potential risks outweigh the expected benefits.

Examples include:

• Significant medical illness making general anaesthesia or major surgery unsafe
• Limited life expectancy from other health conditions
• Some cases of metastatic prostate cancer where systemic therapy is the principal treatment
• Situations where another treatment offers a better balance between cancer control and quality of life
• Large BMI, requiring a weight loss program prior to surgery

Previous abdominal or pelvic surgery, obesity, a very large prostate or previous prostate procedures may make robotic surgery technically more challenging, but they are not necessarily absolute contraindications.

Previous pelvic radiotherapy can make surgery substantially more complex and may increase the risk of complications. Such cases require careful individual assessment.

What Happens During Robotic Radical Prostatectomy?

Several small incisions are made in the abdomen through which robotic instruments and a camera are introduced.

The prostate and seminal vesicles are carefully separated from surrounding structures and removed. The bladder is then reconnected to the urethra, creating a new join called the vesicourethral anastomosis.

A urinary catheter is left across this join while it heals.

For men with intermediate- or high-risk prostate cancer, a pelvic lymph node dissection may also be recommended depending on the estimated likelihood of lymph node involvement.

One of the most important decisions made before and during surgery concerns the nerves responsible for erections.

Nerve-Sparing Versus Non-Nerve-Sparing Surgery

Running immediately alongside the prostate are delicate neurovascular structures that contribute to erectile function.

Whenever oncologically safe, the surgeon may attempt to preserve these nerves.

Bilateral nerve sparing

Both neurovascular bundles are preserved where the cancer characteristics and anatomy allow.

This offers the greatest opportunity for recovery of natural erections, particularly in younger men who had good erectile function before surgery.

Unilateral nerve sparing

Sometimes cancer is close to the nerves on one side of the prostate but appears safely separated on the other.

In this situation, the surgeon may preserve the neurovascular bundle on one side while performing a wider excision on the cancer-bearing side.

Non-nerve-sparing surgery

When cancer appears to extend close to or beyond the prostate adjacent to the neurovascular bundles, preserving these structures may compromise the completeness of cancer removal.

One or both bundles may therefore need to be removed.

Cancer control takes priority over preservation of erectile function.

Nerve-sparing is most appropriate when there is a reasonable expectation that the cancer can be completely removed while leaving the neurovascular tissue intact. Cancer Council Australia similarly notes that nerve-sparing surgery is most suitable when cancer is not close to these nerves and that erectile difficulties can still occur despite successful nerve preservation.

Modern MRI and biopsy information can help the surgeon plan whether nerve sparing is appropriate on each side of the prostate.

Preparing for Robotic Prostatectomy

Successful recovery begins before the operation.

Preparation may include a pre-operative medical and anaesthetic assessment, blood tests and review of medications. Blood-thinning medications may need to be stopped or modified under medical supervision.

Patients should maintain regular physical activity where possible and optimise conditions such as diabetes, hypertension and cardiovascular disease. Smoking cessation is strongly encouraged.

Patients should also understand what to expect regarding the urinary catheter, hospital stay, postoperative activity restrictions and recovery at home.

Pelvic Floor Physiotherapy Before Surgery

Pelvic floor rehabilitation should ideally begin before surgery rather than after the catheter is removed.

A consultation with a physiotherapist experienced in men’s pelvic health can help identify the correct muscles and teach an individualised exercise program.

The Prostate Cancer Foundation of Australia recommends at least one pre-operative assessment with a specialist men’s health pelvic floor physiotherapist to optimise urinary continence recovery.

The goal is not simply to perform hundreds of pelvic floor contractions. Correct technique, coordination, endurance and appropriate relaxation of the muscles are important.

What Happens After Surgery?

Hospitalisation following uncomplicated robotic prostatectomy is generally relatively short.

Patients are encouraged to mobilise soon after surgery to reduce the risk of blood clots and assist recovery.

A urinary catheter remains in place while the connection between the bladder and urethra heals. Catheter removal is commonly performed approximately one to two weeks after surgery, depending on the surgeon and individual circumstances.

Patients can gradually increase their activity after discharge but should avoid heavy lifting and strenuous exercise during the early healing period. Many patients return towards their usual activities over approximately six weeks.

The removed prostate is examined by a specialist pathologist. The final pathology provides important information including:

• Cancer Grade Group
• Pathological tumour stage
• Whether cancer extends outside the prostate
• Seminal vesicle involvement
• Surgical margin status
• Lymph node involvement, when lymph nodes have been removed

A PSA blood test is subsequently performed. Following successful radical prostatectomy, PSA should fall to a very low or undetectable level.

Ongoing PSA monitoring is essential.

Pelvic Floor Rehabilitation and Urinary Continence

Temporary urinary leakage is common after radical prostatectomy.

Leakage is usually most noticeable when coughing, sneezing, standing from a chair, exercising or lifting. Continence generally improves progressively over the following weeks and months and may continue improving for up to a year.

Once the catheter has been removed and the surgeon has given approval, pelvic floor exercises are recommenced.

A structured program may involve:

• Correct pelvic floor muscle activation
• Strength and endurance training
• Functional contractions before coughing, lifting or standing
• Bladder training where appropriate
• Gradual return to exercise
• Monitoring of pad usage and urinary leakage

Patients with troublesome persistent incontinence should undergo further assessment rather than simply being advised to continue exercises indefinitely.

For persistent stress urinary incontinence, surgical treatments including a male sling or artificial urinary sphincter may eventually be considered. Cancer Council notes that surgical treatment may be appropriate when significant incontinence fails to improve over approximately 6–12 months.

Erectile Function and Penile Rehabilitation

Erectile dysfunction is one of the most important potential consequences of radical prostatectomy.

Even when both neurovascular bundles are preserved perfectly, erections usually do not return immediately.

The nerves may temporarily lose function following surgery because of manipulation, inflammation and changes in their blood supply. Recovery can take months and sometimes several years. Cancer Council Australia notes that erectile function can continue improving for up to three years after prostate cancer treatment.

Recovery depends on several factors including:

• Age
• Erectile function before surgery
• Cardiovascular health
• Diabetes and other medical conditions
• Smoking
• Whether one or both nerves could be preserved
• Extent of the cancer
• Surgical factors

What Is Penile Rehabilitation?

Penile rehabilitation aims to maintain penile tissue health while the nerves recover and to assist patients in returning to satisfactory sexual function.

Treatment is individualized and may include:

PDE5 inhibitor tablets

Medications such as sildenafil or tadalafil increase blood flow to the penis and may be introduced following surgery when clinically appropriate.

They are more likely to produce erections when functional nerve pathways remain.

Vacuum erection device

A vacuum erection device draws blood into the penis mechanically. Regular use may help maintain penile tissue health and can also provide erections for sexual activity.

Penile injection therapy

Intracavernosal injections can produce erections independently of normal nerve signalling and can be particularly useful when tablets are ineffective during the early recovery period.

Penile prosthesis

For men with persistent erectile dysfunction who have not achieved satisfactory results with less invasive therapies, implantation of a penile prosthesis can provide a reliable long-term solution.

Cancer Council Australia recommends discussing penile rehabilitation before and after treatment and describes tablets, vacuum devices, injections and penile implants among the available treatment options.

Sexual rehabilitation should ideally be discussed before surgery, so that the patient and partner understand what changes to expect and what treatment options are available afterwards.

Changes to Orgasm, Ejaculation and Fertility

Radical prostatectomy permanently changes ejaculation.

Because the prostate and seminal vesicles are removed and the vas deferens are divided, semen is no longer produced during orgasm.

Men can usually still experience orgasm, but it is a dry orgasm.

Some men describe altered orgasmic sensation, and a small proportion experience discomfort or urinary leakage during orgasm.

Natural fertility is lost following radical prostatectomy. Men who may wish to father children in the future should therefore discuss sperm banking before treatment.

Possible Complications of Robotic Radical Prostatectomy

Most patients recover without major complications, but radical prostatectomy remains major pelvic surgery.

Potential complications include:

Bleeding

Blood loss is generally lower with robotic surgery than traditional open surgery, although significant bleeding or transfusion is still possible.

Infection

Urinary, wound or other infections can occur and may require antibiotics.

Blood clots

Deep vein thrombosis and pulmonary embolism are uncommon but potentially serious complications. Early mobilisation and, where indicated, compression devices or anticoagulant medication help reduce this risk.

Urinary leakage

Stress urinary incontinence is common initially and usually improves progressively.

Persistent significant leakage should be assessed by a urologist and may eventually require a male sling or artificial urinary sphincter.

Erectile dysfunction

This is managed through a structured sexual and penile rehabilitation program using medication, vacuum therapy, injection therapy or, where appropriate, penile prosthesis surgery.

Urine leak from the bladder-urethral join

Occasionally the new connection between the bladder and urethra takes longer to heal. The urinary catheter may simply need to remain in place for longer.

Bladder neck contracture or urethral narrowing

Scar tissue can occasionally narrow the urinary passage and cause a weak urinary stream or difficulty emptying the bladder. Further investigation and endoscopic treatment may be required.

Lymphocele

Following pelvic lymph node dissection, lymphatic fluid can occasionally collect within the pelvis. Small collections may resolve without treatment, while larger or symptomatic collections may require drainage.

Injury to adjacent structures

Damage to structures such as the rectum, ureters, blood vessels or bowel is uncommon but recognised and may require immediate repair or further treatment.

What If Cancer Is Found at the Surgical Margin?

The pathology report determines whether cancer cells extend to the edge of the removed specimen. This is called a positive surgical margin.

A positive margin does not automatically mean that prostate cancer will return.

Management depends on the final pathology, PSA results and other risk factors. Some patients can be safely monitored, while others may benefit from additional treatment.

If PSA remains detectable after surgery or subsequently begins to rise, investigations and salvage radiotherapy, sometimes combined with hormone therapy, may be considered.

Regular PSA surveillance therefore remains an essential part of prostate cancer care after surgery.

Balancing Cancer Control and Quality of Life

Robotic radical prostatectomy is not simply an operation to remove the prostate. Successful treatment involves three overlapping goals:

Cancer control
Complete removal of the cancer remains the primary objective.

Urinary recovery
Early pelvic floor assessment and structured rehabilitation can assist recovery of continence.

Sexual recovery
Appropriate nerve preservation, where oncologically safe, combined with early penile rehabilitation can maximise the opportunity for recovery of sexual function.

These priorities sometimes compete with one another. In particular, aggressive nerve preservation should never compromise cancer clearance.

For this reason, treatment should be tailored to the individual patient, the individual cancer and even the individual side of the prostate.

Questions to Ask Your Urologist

Before deciding on robotic radical prostatectomy, useful questions include:

• Is surgery the best treatment for my particular prostate cancer?
• What alternatives should I consider?
• Is my cancer suitable for nerve-sparing surgery?
• Can both nerves be preserved, or only one?
• Will I require pelvic lymph node dissection?
• What is my individual risk of urinary incontinence?
• What is my likelihood of recovering erections?
• When should I start pelvic floor physiotherapy?
• What penile rehabilitation program do you recommend?
• How long will the catheter remain in place?
• When can I return to driving, exercise and work?
• How will my PSA be monitored after surgery?
• What happens if my PSA does not become undetectable or rises later?

The Importance of Individualized Treatment

No two prostate cancers, and no two patients, are exactly alike.

Robotic-assisted radical prostatectomy can provide excellent cancer control for appropriately selected men while offering the advantages of minimally invasive surgery. The best outcomes, however, depend on careful patient selection, appropriate surgical planning, experienced surgery and structured rehabilitation following treatment.

A comprehensive approach should therefore begin before the operation and continue well beyond discharge from hospital, incorporating cancer surveillance, urinary continence rehabilitation, sexual rehabilitation and attention to overall physical and psychological wellbeing.

This information is intended for general education and does not replace individual medical advice. Treatment recommendations should be discussed with your urologist, radiation oncologist and multidisciplinary prostate cancer team.

Come and have a chat to your local Brisbane Based Urologist, Dr Jo Schoeman, to discuss options for your prostate cancer.