Things to Know About Robotic Prostate Cancer Surgery

At USC Verdugo Hills Hospital, robotic prostate cancer surgery improves patient outcomes.

Prostate cancer affects 1 in 8 men in the United States, and surgery can be a life-saving option. Thanks to innovations in robotic surgery, many patients can recover fully with vital nerves intact.

Rene Sotelo, MD, a urologic surgeon at USC Verdugo Hills Hospital, part of Keck Medicine of USC, is an internationally recognized expert in robotic procedures.

Here, he answers frequently asked questions.

What do men usually worry about most before prostate cancer surgery, and what do you wish they knew?

Most men worry about two things: urinary leakage and sexual function. Those are very real concerns, as some degree of urinary or sexual side effects can occur after surgery. However, many patients improve over time, and we have effective treatments to help with recovery.

What I wish patients knew is that the surgeon’s experience and technique play an important role in minimizing potential side effects. We plan the operation with these issues in mind, using meticulous techniques and nerve-sparing strategies when they are oncologically safe.

How do you determine if surgery is a good option for a patient with prostate cancer?

Some prostate cancer tumors grow slowly and can be safely monitored, while others require active treatment. When we think about surgery for prostate cancer, we focus on three main factors: how aggressive the cancer is, the patient’s overall health and the individual’s priorities.

For men with localized cancer and a longer life expectancy, surgery can offer excellent cancer control. At the same time, we are honest about the trade-offs. It’s important for patients to understand that any prostate cancer treatment — whether surgery, radiation or focal therapies — can affect urinary control and sexual function.

For that reason, the decision is never automatic. We balance cancer control with quality of life and choose the option that best fits the patient’s goals.

What kinds of prostate cancer treatments are available at USC-VHH?

We offer modern prostate cancer care focused on minimally invasive techniques and personalized treatments.

One of the main surgical options is robotic-assisted prostate surgery. This approach is often associated with less blood loss and faster recovery compared to traditional open surgery. The risks, including urinary incontinence and erectile dysfunction, vary depending on the patient and the extent of the disease.

For patients with localized prostate cancer, we also offer noninvasive or minimally invasive options. These include high-intensity focused ultrasound (HIFU) or external beam radiation therapy, which aim to treat cancer while minimizing damage to surrounding areas.

When patients hear ‘robotic surgery,’ what do they usually think it means — and what is the reality?

Many patients imagine a robot making decisions or operating independently, and that is not true. Robotic surgery is completely surgeon-directed.

The robot is simply a highly advanced tool that translates the surgeon’s hand movements into precise actions inside the body.

What are the steps involved with robotic surgery for prostate cancer?

We first complete a preoperative evaluation, including cardiology clearance when appropriate.

The procedure is performed under general anesthesia. We make a few small incisions and insert specialized instruments connected to a robotic system. The surgeon controls everything from a console, using a magnified three-dimensional view that allows for very precise movements.

The prostate is carefully separated from the surrounding tissues and removed. The bladder is then reconnected to the urethra and a temporary catheter is placed to allow healing.

Do robotics help better protect the patient’s nerves?

Robotic technology has significantly improved how we see and perform prostate cancer surgery. About 90% of prostate cancer surgeries in the United States include robotic assistance.

The enhanced magnification and precision allow surgeons to better identify and work around the nerves involved in urinary control and erections — structures that may be more difficult to visualize with other surgical approaches.

That said, the data show that long-term cancer control and functional outcomes still depend heavily on patient factors and surgical expertise.

Robotics improve consistency and recovery, but they do not eliminate risks. Ultimately, they give experienced surgeons better tools to perform a very delicate operation.

What can patients expect during the recovery process?

Patients are not alone in the recovery process. We actively support them before and after prostate surgery, and we track PSA levels closely to watch for signs of cancer.

Most patients are walking quickly and go home after a short hospital stay, often just one day. Urinary control may be imperfect early on, but this often improves over weeks to months with time and pelvic floor exercises.

Sexual function may take longer to recover and depends on factors such as age, baseline function, whether nerve-sparing was possible, and the surgeon’s experience and technique.

What do you tell patients who may be feeling overwhelmed and unsure about how to proceed?

Fear is natural with any surgery, and part of our job is to help patients work through those fears. I encourage patients to ask questions and focus on truly understanding their options rather than rushing into a decision. Feeling overwhelmed is normal, but our team is prepared to help turn that uncertainty into a clear, informed plan.

What are some features of the prostate cancer care at USC-VHH and Keck Medicine – Glendale?

Our team-based, multidisciplinary approach allows us to personalize treatment, use minimally invasive techniques when appropriate and focus on both cancer control and long-term quality of life. We guide patients with clear information and support them through every step of the process.

Patients also benefit from being part of the Keck Medicine health system, which provides access to highly specialized expertise.

For local patients, it’s an added advantage that this expertise is available so close to home. But we do also see patients from outside Los Angeles who choose us for our high level of care.

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