Hearing the word surgery after a prostate cancer diagnosis is often the moment things start to feel real.
Up until that point, patients are usually juggling information — PSA levels, biopsy results, MRI scans, Gleason scores. It can feel abstract. Manageable. Something you’re still “watching.”
But when surgery enters the conversation, the stakes feel higher.
At Dr. David Samadi’s practice, many men arrive with the same question:
“How do I know when surgery is actually necessary — and not just one option among many?”
The answer isn’t based on fear or urgency. It’s based on timing, cancer behavior, and long-term outcomes.
Not All Prostate Cancer Needs Surgery — And That Matters
One of the first things Dr. David Samadi explains to patients is this:
Prostate cancer is not one disease.
Some prostate cancers grow so slowly that immediate treatment isn’t required. Others behave more aggressively and demand decisive action.
Surgery becomes necessary not because cancer exists, but because of how that cancer behaves.
This distinction is critical — and it’s where experience guides decisions.
When Active Surveillance Is No Longer Enough
Many men start with active surveillance. That’s appropriate for carefully selected, low-risk cancers.
But surveillance has limits.
Surgery is often recommended when:
- PSA levels rise consistently
- Biopsy results show higher-grade cancer
- MRI imaging reveals growth or extension
- Cancer begins threatening nearby structures
At this point, waiting longer can reduce the chance of cure.
Dr. Samadi is careful here. He doesn’t rush patients into surgery — but he also doesn’t delay when cancer biology signals it’s time to act.
The Role of Cancer Grade and Stage
Two numbers matter most when deciding on surgery:
- Grade (how aggressive the cancer cells look)
- Stage (how far the cancer has spread)
Surgery is commonly recommended when:
- Cancer is localized to the prostate
- There is a reasonable chance for complete removal
- Long-term cancer control outweighs observation
This is where surgical planning becomes strategic, not automatic.
Why Surgery Can Offer Clarity
One reason many patients ultimately choose surgery is certainty.
With surgery:
- The prostate is removed
- Cancer is fully analyzed
- Margins are evaluated directly
- Future PSA should drop to undetectable levels
For many men, this clarity brings peace of mind — especially when cancer risk is no longer theoretical.
Dr. Samadi often sees patients choose surgery not out of fear, but because they want resolution, not prolonged uncertainty.
When Surgery Is Preferable to Radiation
Both surgery and radiation are valid treatments. But they’re not interchangeable.
Surgery is often favored when:
- The patient is younger or healthier
- Long-term control is a priority
- Accurate staging is important
- Salvage options may be needed later
Dr. Samadi helps patients understand that choosing surgery keeps future treatment pathways open if cancer ever returns.
That flexibility matters.
Why Surgeon Experience Changes the Equation
This is something patients don’t always realize at first.
Prostate cancer surgery is not just about removing an organ. It’s about navigating:
- Nerves that control erections
- Muscles that control continence
- Blood supply and pelvic anatomy
Dr. Samadi has performed thousands of prostate cancer surgeries over decades, refining technique with one goal in mind:
Cancer control without sacrificing quality of life when it’s safe to preserve it.
That balance only comes from volume, judgment, and experience.
The SMART™ Technique and Surgical Precision
Robotic prostatectomy itself is not new. The foundations were established decades ago.
What differentiates outcomes today is how surgery is performed.
Dr. Samadi developed the SMART Surgery (Samadi Modified Advanced Robotic Technique) to improve precision, nerve preservation, and reconstruction — without compromising cancer removal.
This technique reflects years of observation, adjustment, and refinement — not experimentation.
When Waiting Becomes Riskier Than Acting
Surgery becomes necessary when:
- Cancer shows signs of progression
- Delays increase the chance of spread
- Functional preservation is best achieved sooner rather than later
In these cases, postponing surgery doesn’t protect quality of life — it threatens it.
This is where honest conversations matter most.
Frequently Asked Questions
Does needing surgery mean my cancer is advanced?
Not necessarily. Many localized cancers are treated surgically to achieve cure.
Is surgery always better than radiation?
No. The best treatment depends on age, health, cancer features, and patient priorities.
Can surgery still preserve erectile function?
In many cases, yes — but outcomes depend on nerve involvement, baseline function, and surgical technique.
How long does recovery take?
Initial recovery takes weeks. Functional recovery can take months and varies by individual.
Should I get a second opinion before surgery?
Many patients do. Understanding your options is part of informed decision-making.
The Bottom Line
Prostate cancer requires surgery when timing matters, cancer biology demands action, and long-term outcomes depend on removing the disease completely.
The decision is not about fear.
It’s about precision.
And it’s about choosing the right surgeon at the right moment.
Contact Dr. David Samadi
If you’ve been told surgery may be necessary — or you’re unsure whether it’s time — a consultation can help clarify your next step.
Dr. Samadi is:
- World-renowned prostate cancer surgeon
- A Key Opinion Leader featured on Fox News and Newsmax
Known for combining cancer control with functional preservation
Website: https://roboticoncology.com
Address: 485 Madison Avenue, 21st Floor, New York, NY 10022
Phone: 212-365-5000
Your consultation includes:
- Review of imaging and biopsy results
- Honest discussion of all treatment paths
- Clear explanation of risks and expectations
- A plan built around long-term health, not pressure
212-365-5000