Diagnosed with prostate cancer and unsure what to do next?
A prostate cancer diagnosis can lead to several questions:
Do I need treatment immediately?
Is surgery necessary?
Am I suitable for robotic prostatectomy?
Should I choose surgery or radiation?
Can I have nerve-sparing surgery?
Do I need a PSMA PET/CT?
What does my MRI actually show?
Is my cancer localized, locally advanced or node-positive?
Do I need hormone treatment?
Should I take another opinion before deciding?
A second opinion can help you understand your diagnosis, stage, treatment options and the reasoning behind the recommended treatment.
At Shah’s Cancer & Robotic Surgery Centre, Ahmedabad, prostate cancer second opinions are focused on reviewing the available clinical information and determining whether surgery is appropriate, whether another treatment approach should be considered, or whether further evaluation is needed.
A useful prostate cancer second opinion should go beyond:
“Yes, surgery can be done.”
or
“Yes, robotic surgery is possible.”
The important questions are:
What exactly is the cancer?
How extensive is it?
What is the risk category?
Is it confined to the prostate?
Are lymph nodes involved?
Is there evidence of distant disease?
What treatment options are appropriate?
If surgery is considered, can it achieve appropriate cancer control?
Can the nerves be safely preserved?
Is pelvic lymph-node dissection indicated?
Could radiation or systemic treatment be more appropriate?
What happens after the first treatment?
The objective is to help the patient understand the complete treatment pathway before making a major decision.
A second opinion may be useful if you have:
The second-opinion assessment is based on the actual reports and imaging, not simply the diagnosis written on a referral letter.
I review:
The pattern over time can be as important as a single PSA value.
The biopsy provides important information about the cancer’s biology.
I review:
When necessary, pathology review may also be recommended.
MRI is particularly important for treatment planning.
I review the available MRI information for:
The MRI is not interpreted independently of the biopsy.
MRI + biopsy + PSA provide a much more useful picture than any one of them alone.
When PSMA PET/CT has been performed, I review it in relation to:
I assess for:
For high-risk and locally advanced disease, PSMA PET/CT can be particularly relevant to staging and treatment planning.
A negative scan, however, does not completely exclude microscopic disease.
If treatment has already been performed, I review the treatment history.
This may include:
Previous treatment can significantly influence the next treatment decision.
After reviewing the available information, the second opinion should answer five fundamental questions.
Localized?
Locally advanced?
Node-positive?
Metastatic?
The cancer is considered using:
Some patients may be candidates for active surveillance.
Others may benefit from definitive treatment.
The decision depends on the complete risk profile and patient factors.
Depending on the disease, this may include:
The purpose of a second opinion is not to automatically recommend surgery.
It is to determine which options are appropriate for that particular patient.
This is a separate question from:
“Can robotic surgery technically be performed?”
The assessment should consider:
For localized disease, the key question may be: Do I need treatment now, and if so, which treatment fits me best?
Possible approaches can include:
Active surveillance
For appropriately selected patients, active surveillance may avoid or delay treatment-related side effects while the cancer is closely monitored.
Radical prostatectomy
Surgical removal of the prostate may be considered for appropriately selected patients with sufficient life expectancy.
Radiation therapy
Radiation-based treatment is another established definitive treatment option.
The decision should consider cancer risk as well as urinary, sexual and bowel function, treatment burden and the patient’s priorities.
Detailed comparison is covered on:
Localized Prostate Cancer: Surgery vs Other Treatment Options →
High-risk prostate cancer requires more detailed assessment.
I review:
PSA + biopsy + Grade Group + MRI + PSMA PET/CT when indicated
The important question is whether the disease remains suitable for local treatment and what combination of treatments may provide the most appropriate cancer-control strategy.
Depending on the individual case, treatment may involve:
A high-risk diagnosis does not automatically mean that surgery is appropriate—or inappropriate.
When MRI or clinical staging suggests that the cancer has extended outside the prostate, treatment planning becomes more complex.
I specifically assess:
In selected patients, surgery may form part of a multimodal treatment strategy.
In others, radiation and systemic treatment may be more appropriate.
The objective is to determine where surgery fits in the complete treatment plan, rather than deciding on surgery in isolation.
If PSMA PET/CT or other investigations suggest pelvic lymph-node involvement, the treatment strategy needs to account for regional disease.
I review:
Treatment may involve a combination of:
Surgery + lymph-node dissection
and/or
Radiation + systemic treatment
and/or other multimodal approaches.
The appropriate strategy depends on the distribution and biology of the disease.
If you have already been advised to undergo robotic prostatectomy, a second opinion can help clarify:
Is surgery appropriate?
Is robotic surgery appropriate?
Is nerve-sparing feasible?
Is lymph-node dissection indicated?
What is the expected functional impact?
What is the likelihood that additional treatment may be needed?
What is the postoperative follow-up plan?
These questions are particularly important before an irreversible treatment.
A second opinion from a surgical uro-oncology specialist can also be useful if radiation has been recommended.
The purpose is not to automatically replace the radiation recommendation.
It is to understand:
Patients should then make the final treatment decision after understanding the alternatives.
A second opinion can also be useful when you have been advised:
“You do not need treatment now.”
The important questions are:
Active surveillance is a structured treatment strategy—not simply “waiting.”
A second opinion is not only for patients who have not yet undergone treatment.
It can also be useful after surgery.
For example:
Positive surgical margin
You may want to understand what it means for your recurrence risk and follow-up.
Rising PSA
You may need assessment of biochemical recurrence and whether additional imaging or salvage treatment should be considered.
Node-positive pathology
You may need discussion of whether additional treatment is appropriate.
High-risk pathology
A second opinion can help clarify the postoperative treatment strategy.
Functional problems
Persistent urinary or sexual dysfunction may require targeted assessment and rehabilitation.
Prostate cancer is not always a straightforward operation.
My prostate cancer practice includes patients with:
I have performed:
650- Total radical prostatectomies
627- Robotic radical prostatectomies
with robotic prostatectomy experience since 2013.
My training included a dedicated uro-oncology focus and extensive exposure to robotic pelvic oncology surgery.
This experience is relevant to second-opinion assessment because the question is often not simply:
“Can the prostate be removed?”
but:
“What is the safest and most appropriate oncological strategy for this particular tumour?”
You can provide the available:
The clinical information is reviewed together to understand:
Diagnosis → Grade → Stage → Risk → Treatment options
The consultation focuses on:
If surgery is appropriate and you decide to proceed, a detailed surgical plan can be developed.
If another treatment is more appropriate, the patient can be guided toward the relevant multidisciplinary specialist.
Yes.
A prostate cancer second opinion can often begin with review of medical records and imaging before the patient travels.
This can be particularly useful for patients from:
The purpose of reviewing reports beforehand is to help determine whether an in-person consultation or travel to Ahmedabad is likely to be useful.
For complex cases, however, an in-person examination may still be required.
Please keep the following ready:
The objective is not simply another prescription.
It should provide clarity about:
Diagnosis
What exactly is the cancer?
Stage
Where is the cancer?
Risk
How aggressive does it appear?
Treatment
What are the reasonable options?
Surgery
Is surgery appropriate?
Robotic surgery
Is robotic prostatectomy suitable?
Nerve-sparing
Can the nerves potentially be preserved safely?
Nodes
Is pelvic lymph-node dissection indicated?
Additional treatment
Could radiation or systemic treatment be required?
Follow-up
What happens after the first treatment?
No responsible second opinion should promise:
The purpose of a second opinion is to provide a clearer understanding of the disease and treatment choices, so that the patient can make an informed decision.
You can bring this checklist to your consultation:
Patients commonly seek another opinion because:
A second opinion can help transform:
“I have prostate cancer. What should I do?”
into: “I understand my stage, risk, treatment options and the reasons behind the recommended plan.”
Robotic Radical Prostatectomy
What the operation involves and who may be considered.
Nerve-Sparing Robotic Prostatectomy
How cancer location determines whether the neurovascular bundles can be preserved.
Pelvic Lymph-Node Dissection
Understanding nodal staging and the role of PLND.
Critical Steps in Robotic Prostatectomy
How surgical planning and technique influence cancer control and functional recovery.
Localized Prostate Cancer: Surgery vs Other Treatment Options
Active surveillance, surgery and radiation.
Locally Advanced & Node-Positive Prostate Cancer
Where surgery fits in T3, T4 and N1 disease.
Life After Robotic Prostatectomy
Cancer control, PSA, continence, sexual function, complications and our analysed results.
Our case library includes patients with different presentations and levels of complexity.
Cases may include:
View Prostate Cancer Case Summaries →
If you have recently been diagnosed with prostate cancer—or have already received a treatment recommendation—you can bring your reports for a structured review of your diagnosis and treatment options.
Dr Swati H. Shah
Pelvic (Uro & Gynec) Oncosurgeon
Robotic Uro & Gynec Cancer Surgeon
Apollo Hospital, Ahmedabad
Director — Shah’s Cancer & Robotic Surgery Centre
Founder & Director — Department of Pelvic Oncology, Apollo Hospital, Ahmedabad
18+ years in uro-gynaecologic cancer surgery
Robotic surgery since 2013
650 radical prostatectomies
627 robotic radical prostatectomies
The aim of a second opinion is simple: Understand the cancer. Understand the options. Then make an informed treatment decision.
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