Prostate Cancer Surgery · London

Prostate Cancer Specialist
London

Expert diagnosis, robotic surgery, and survivorship care for prostate cancer — delivered by a high-volume consultant urological surgeon at four London hospitals.

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QualificationMA Cantab · MB BChir · FRCS Urol

Robotic procedures900+ as consultant · 225+ a year

Patient rating4.99 / 5 on Doctify

Referrals & insuranceSelf-referral · All major insurers

Important: Prostate cancer is the most common cancer in men in the UK — around one in eight men will be diagnosed in their lifetime. When detected early, it is highly treatable and often curable. A new diagnosis can feel overwhelming, but understanding your options clearly makes an enormous difference. I am here to guide you through every step.

Already been told your PSA is raised?

If you have a raised PSA result and have not yet had an MRI or biopsy, please visit my Raised PSA page first. It explains the full diagnostic pathway — including multiparametric MRI and targeted transperineal biopsy — and how to get an accurate diagnosis as quickly as possible.

Raised PSA — assessment and diagnosis → What is a transperineal biopsy? →

This page focuses on what happens once a diagnosis of prostate cancer has been made — covering the treatment options, the benefits of robotic surgery, and what recovery and follow-up look like. For an overview of the whole journey, read Prostate Cancer — From Raised PSA to Robotic Surgery.

Understanding your diagnosis

Not all prostate cancers behave the same way. Once a diagnosis is confirmed, the key factors that guide treatment are the grade of the cancer (how aggressive it is) and its stage (how far, if at all, it has spread). These are assessed using the Gleason/Grade Group system and imaging.

Low risk

Gleason 6
Grade Group 1

Slow-growing, confined to the prostate. Active surveillance or treatment are both appropriate depending on individual circumstances.

Intermediate risk

Gleason 7
Grade Groups 2–3

Clinically significant cancer. Definitive treatment — surgery, radiotherapy, or in selected cases focal therapy — is typically recommended.

High risk

Gleason 8–10
Grade Groups 4–5

More aggressive cancer. Prompt treatment is important. Surgery and multimodal therapy are discussed in detail.

Treatment options

Treatment is always tailored to the individual — taking into account the grade and stage of your cancer, your age, overall health, and personal priorities. All options are discussed openly so that you can make an informed decision.

Active surveillance

For carefully selected men with low-risk, slow-growing prostate cancer, active surveillance — closely monitoring the cancer without immediate treatment — is a well-established and safe approach. It avoids the side effects of treatment unless and until they become necessary. Regular PSA tests, MRI scans, and occasional repeat biopsies form part of the monitoring programme.

Robotic-assisted radical prostatectomy

Mr Sri's primary surgical specialism

Surgical removal of the prostate using the da Vinci robotic surgical system. Robotic surgery offers precision that significantly exceeds conventional open or laparoscopic approaches, particularly in preserving the bladder neck, urethral sphincter, endopelvic fascia and delicate nerve bundles responsible for continence and sexual function. This is the most common treatment for localised and locally advanced prostate cancer. It can also be used in select cases where cancer has remained or returned following either radiotherapy or focal therapy.

Mr Sri performs both Retzius-sparing and standard nerve-sparing robotic prostatectomy, choosing the technique that best suits your cancer and anatomy (see below). As Principal Investigator for the ELIPSE trial, he also treats men with high-risk and locally advanced (T3) disease, including extended lymph node dissection where needed.

Radiotherapy

External beam radiotherapy (EBRT) or brachytherapy (internal radiotherapy) are effective alternatives to surgery, particularly in men who prefer to avoid an operation or who have medical conditions that increase surgical risk. Radiotherapy is also used after surgery if there are signs that cancer has returned. Mr Sri works closely with clinical oncology colleagues for patients where radiotherapy is the preferred or most appropriate pathway.

Weighing up your options? Read Robotic Prostatectomy vs Radiotherapy — How Do I Choose?

Focal therapy

Selected patients only

Focal therapy treats only the area of the prostate containing cancer, rather than the whole gland — using high-intensity focused ultrasound (HIFU, including the robotic Focal One system), irreversible electroporation (NanoKnife) or cryotherapy. For carefully selected men with small, intermediate-risk cancers confined to one area, it can reduce the risk of urinary and erectile side effects compared with whole-gland treatment.

It is not suitable for everyone, and it requires a firm commitment to ongoing MRI and PSA monitoring, as some men will need further treatment later. Mr Sri is Principal Investigator at St George's for the national PART trial, which compares focal therapy with standard radical treatment.

Learn more: Focal therapy explained · Focal One HIFU · How NanoKnife works

Retzius-sparing or standard nerve-sparing — chosen for you

Most surgeons use one technique for every patient. Mr Sri performs both of the leading approaches to robotic prostatectomy, and recommends the one that best fits your cancer, your anatomy and your priorities.

From behind the bladder

Retzius-sparing robotic prostatectomy

The prostate is removed from behind, leaving the supporting structures at the front of the bladder untouched. There is consistent evidence that urinary control returns earlier than with the standard approach.

About Retzius-sparing surgery · Read the Notebook article

The established approach

Standard nerve-sparing robotic prostatectomy

The well-proven technique, with excellent access for larger prostates, higher-risk cancers and cases needing lymph node removal. The nerves controlling erections are preserved wherever it is safe to do so.

About robotic prostatectomy

Why robotic surgery — and what to expect

For most men with localised prostate cancer choosing surgery, robotic-assisted prostatectomy using the da Vinci system is the gold standard. The precision of robotic technique — particularly in identifying and preserving the neurovascular bundles — translates directly into better functional outcomes for patients.

>90%

of men dry or leaking minimally after nerve-sparing robotic prostatectomy

1 night

median hospital stay — most men go home the following morning

225+

robotic upper tract and pelvic procedures performed by Mr Sri each year

Mr Sri's audited robotic series, 2026. Individual outcomes vary and will be discussed with you.

Nerve-sparing technique — preserving one or both neurovascular bundles — is used wherever it is oncologically safe to do so, and significantly improves the recovery of erectile function after surgery. Potency recovery is a gradual process and varies by age and baseline function, but in appropriate candidates it is meaningfully better with robotic nerve-sparing compared to non-nerve-sparing or open surgery.

Most patients are discharged after one night in hospital, go home with a catheter for around one week, and return to light activity within days. The majority are back to their normal routine within two to four weeks. For a detailed guide, read Robotic Prostatectomy Recovery — Week by Week.

Watch: nerve-sparing prostatectomy explained

What nerve-sparing surgery involves — and what recovery looks like

Mr Sri explains the neurovascular bundles, how the da Vinci robot makes nerve preservation possible, and what continence and erectile function recovery involves after robotic prostatectomy.

Continence >90%

Annual robotic procedures 225+

Median stay 1 night

Trial PI ELIPSE & PART

Survivorship — life after prostate cancer treatment

Treatment is only the beginning. What happens afterwards — monitoring, recovery, and quality of life — matters just as much. My survivorship programme is built around three priorities.

Cancer monitoring

Regular PSA surveillance to detect any sign of recurrence early, with a clear plan agreed at the outset. If PSA rises after surgery, further assessment and treatment options are discussed promptly.

Continence recovery

Specialist physiotherapy support for pelvic floor rehabilitation begins before surgery and continues afterwards. The great majority of patients achieve excellent continence, particularly following nerve-sparing robotic technique.

Recovery week by week

Erectile function recovery

Andrology support — including penile rehabilitation — is a priority for all appropriate patients after nerve-sparing prostatectomy. Early intervention significantly improves long-term potency outcomes, and I work with specialist colleagues to deliver this as part of structured follow-up.

Erectile recovery after surgery

Frequently asked questions

I have just been diagnosed — what happens next?

The first step is a clear and supportive consultation to go through your diagnosis, what it means, and what all your options are. There is rarely a need to make an immediate treatment decision — taking a little time to understand your situation and ask questions is always appropriate. I will guide you through every stage.

Will I be incontinent after surgery?

Temporary leakage is common in the first weeks after prostatectomy, but the great majority of men achieve excellent continence with time and pelvic floor physiotherapy. Over 90% of my patients treated with nerve-sparing robotic technique are dry or leaking only minimally at one year. The experience and technique of the surgeon — alongside the robotic approach — are key factors in this outcome. I expect patients to be dry at night and use a single pad for safety at six weeks post-operatively. Achieving this typically places you ahead of the curve in terms of continence recovery.

Will I have Retzius-sparing or standard surgery?

I perform both, and the choice depends on your cancer, prostate size and anatomy. Retzius-sparing surgery can speed up the return of urinary control, while the standard approach gives better access in some higher-risk cancers or larger prostates. I will explain which I recommend for you, and why, at your consultation.

Will surgery affect my sexual function?

Erectile function recovery after prostatectomy depends on several factors — including age, baseline function, and whether nerve-sparing was possible. Recovery takes time, typically months to a year or more. With nerve-sparing robotic technique and structured penile rehabilitation support beginning early after surgery, the outcomes are meaningfully better than with non-nerve-sparing or open surgery. This is always discussed honestly and in detail before any decision is made.

How do I know whether surgery or radiotherapy is right for me?

Both surgery and radiotherapy are effective treatments for localised prostate cancer, with comparable cancer control rates in most risk groups. The right choice depends on your cancer characteristics, your priorities regarding side effects, your general health, and personal preference. I discuss both options openly, and where appropriate refer to oncology colleagues, so that you can make a fully informed decision. For most patients there is no right or wrong answer — it comes down to personal preference in terms of treatment journey and outlook. The key is to take your time and not rush into any treatment decision.

Am I suitable for focal therapy?

Focal therapy may suit men with a small, intermediate-risk cancer that is clearly visible on MRI and confined to one area of the prostate. It is not suitable for high-risk or widespread cancer, and it requires long-term MRI and PSA monitoring. I can assess your scans and biopsy results and advise honestly whether focal therapy, surgery, radiotherapy or surveillance is the best fit.

How soon can I get back to normal life?

Most patients are discharged after one night in hospital and return home with a urinary catheter for approximately one week. The majority are back to light daily activities within days and to their normal routine within two to four weeks. More strenuous exercise and heavy lifting are typically resumed at six weeks.

Do I need a GP referral?

No — you can self-refer directly, whether you have a confirmed diagnosis or are still in the investigative stage. Many patients come having already received a diagnosis and wish to discuss their options with a specialist before deciding on treatment.

Mr Denosshan Sri

MA Cantab | MB BChir | FRCS Urol | Consultant Urological Surgeon

Mr Sri is a consultant urological surgeon at St George's University Hospital and Kingston Hospital, with subspecialist expertise in prostate and kidney cancer. He has performed over 900 robotic operations as a consultant and averages more than 225 a year, including Retzius-sparing and nerve-sparing robotic prostatectomy. He is Urology Cancer Lead at St George's, leads its RCS-accredited robotic fellowship, and is Principal Investigator for the ELIPSE and PART prostate cancer trials. He sees private patients at Nuffield Health Parkside (Wimbledon), New Victoria Hospital (Kingston), HCA Princess Grace Hospital (Marylebone) and Welbeck (Harley Street). Full profile