Surgery for high-risk prostate cancer · Dr Swati Shah · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Shah’s Gastro, Cancer & Robotic Surgery Centre — trained at national cancer centres, fully qualified in surgical oncology, and operating on urological cancers every week.
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Prostate Cancer Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
This page is for a man whose biopsy has come back as high-risk prostate cancer — a PSA above twenty, an ISUP grade group of four or five, or disease that has reached the edge of the gland — and for the family who will read the report with him. It explains the operation Dr Swati Shah performs for this risk group, what nerve-sparing can and cannot preserve, and what recovery looks like function by function.
High risk does not mean incurable, and it does not mean the cancer has spread. It is a label for disease that has enough aggression in it that a single treatment is often not enough, and that the treatment has to be planned with margins and lymph nodes in mind rather than comfort alone.
Prostate cancer is called high-risk when the PSA is above 20 ng/mL, or the ISUP grade group is 4 or 5, or the tumour is felt or seen to involve both sides of the gland. Any one of the three is enough. The label sets the treatment plan: radical prostatectomy with extended pelvic lymph node dissection, or radiotherapy with long-course hormone therapy — decided in a multidisciplinary discussion, never by one doctor alone.
Three pieces of information create the label, and they come from three different places. The PSA comes from the blood test. The grade group comes from the pathologist reading the biopsy cores. The stage comes from the examining finger and from the multiparametric MRI, which in Dr Swati Shah’s practice is always done before the biopsy, never after it.
Two further findings on the biopsy report carry weight out of proportion to their size, and they are under-reported in India: cribriform and intraductal patterns. Where the pathologist has named either, the disease behaves worse than its grade alone suggests, surveillance is not an option, and the plan is written accordingly. If your report does not mention them at all, it is worth asking whether they were looked for.
| Finding | Where it comes from | What it changes |
|---|---|---|
| PSA above 20 ng/mL | Blood test, repeated to confirm | Staging imaging before any treatment; nodes must be addressed |
| ISUP grade group 4 or 5 | Pathologist reading the biopsy cores | Surveillance is excluded; multimodal planning from the start |
| Disease on both sides of the gland | Examination and multiparametric MRI | Nerve-sparing on the affected side usually cannot be offered |
| Cribriform or intraductal pattern | Pathologist, if specifically reported | Treated as worse than the grade suggests; discussed in the MDT |
| Extracapsular extension on MRI | Multiparametric MRI before biopsy | Wider dissection on that side; radiotherapy afterwards is likely |
The operation is a radical prostatectomy — the whole prostate and both seminal vesicles are removed and the bladder is joined to the urethra — together with an extended pelvic lymph node dissection, which clears the external iliac, obturator and internal iliac nodes. In high-risk disease an extended dissection is the standard; a limited one under-stages the cancer and leaves disease behind.
Dr Swati Shah performs this operation robotically, laparoscopically or open depending on the man and the anatomy, and she says plainly what the evidence says: cancer control is equivalent across the three. The robotic approach gives less blood loss and a shorter stay. What matters more than the platform is how many of these operations the surgeon does and how the nodes are handled. Any centre that sells you the machine rather than the plan has the priorities backwards.
Three technical steps inside the operation are chosen for continence rather than for speed, and they are worth knowing the names of, because they are where early continence is won or lost: preserving the bladder neck, reconstructing the musculofascial layer behind the anastomosis, and preserving as much urethral length as the cancer allows. Where the apex of the gland is involved, a frozen section of the urethral margin is taken during the operation so the decision is made with the pathologist rather than guessed at.
The nerves that produce erections run along both sides of the prostate. They can be spared only where the cancer is not touching them: organ-confined disease on that side, no MRI evidence of extension through the capsule, and a low burden of cancer in the biopsy cores on that side. Dr Swati Shah does not nerve-spare into a positive margin. In high-risk disease that means sparing is sometimes possible on one side, sometimes on neither.
The cost of getting it wrong is not symmetrical. A man left with a positive margin because the surgeon hugged the gland to save his erections has been handed a higher chance of the cancer returning, and will very likely need radiotherapy afterwards — which brings its own effect on continence and on erections. He has paid twice. That is why Dr Swati Shah’s rule is stated before surgery rather than negotiated during it: where the two aims conflict, cancer clearance wins.
What follows honestly from that rule: in high-risk disease, bilateral nerve-sparing is the exception, not the expectation. Where the nerves cannot be spared, spontaneous erections do not return on their own — and that is not the end of sexual life, because tablets, injections, a vacuum device and, where they do not work, a penile implant are all available and all discussed. What must not happen is a man discovering after the operation that nobody told him beforehand.
Some consequences of a radical prostatectomy are certainties in every man, spared nerves or not: ejaculation stops permanently, orgasm becomes dry, and fertility ends. Others are risks that vary from man to man — leakage of urine, difficulty with erections, narrowing at the join, and the chance of a positive margin needing radiotherapy afterwards. The individual figures are given to you at the consent discussion, against your own age, gland and disease.
The certainties are stated first because they are the ones most often left until last. After this operation there is no semen at orgasm, ever again. Orgasm itself remains possible and remains a sensation; it is dry. Fertility ends with the operation, so if having a child still matters, sperm banking is arranged before surgery, not after. The prostate and seminal vesicles are gone permanently, and the penis may shorten a little.
The risks are a separate list, and they are real: bleeding needing transfusion, infection, clots in the legs or lungs, injury to the rectum or ureter, a urine leak from the join, a lymphocele or leg swelling after the node dissection, a narrowing at the join that needs a further procedure, and a positive surgical margin that makes radiotherapy likely. Every one of them is quoted to you as a number at the consent discussion, adjusted for your age, your gland size, your other illnesses and whether nerve-sparing is possible — which is why this page does not print a table of rates that would not be yours.
One thing on that list deserves its own sentence. Indian men are systematically under-counselled on the sexual and urinary consequences of this operation. Dr Swati Shah’s consent conversation is done personally and in full, with the partner present if the man agrees, and it is the part of the discussion that is never shortened for time.
Urinary control, sexual function and cancer surveillance recover on three different clocks. The catheter stays in for about seven to ten days. Pads are needed from the day it comes out, and for most men the need falls away over weeks to months. Erections, where nerves were spared, return slowly over twelve to twenty-four months and often incompletely. The first PSA is taken at six to eight weeks, not earlier.
The catheter and the first days. Most men are out of bed within hours and home on the first or second day after robotic surgery. The catheter comes home with you, and you and your family are taught how to look after it, what a blocked catheter looks like and whom to phone, before you are discharged. It is removed in the OPD about seven to ten days later.
Urinary control. Some leakage in the first weeks after the catheter is removed is close to certain. Pelvic floor exercises are the single highest-yield thing a man can do about it, and in Dr Swati Shah’s practice they start four weeks before the operation rather than after the catheter comes out — which is when most men are told to begin. They are then restarted supervised on the day the catheter is removed, not handed over as a leaflet. Most men improve steadily over the following months. Where heavy leakage is still present at a year, that is the decision point for a sling or an artificial urinary sphincter, and it is a decision, not a further wait.
Sexual function. Erections are not there when the catheter comes out, in any man. Where nerves were spared and the man was fully potent before, recovery is measured in one to two years and is often partial. Penile rehabilitation — a daily or on-demand tablet, and a vacuum device where it can be afforded — starts two to four weeks after nerve-sparing surgery, not at some later review. Where nerves could not be spared, the conversation moves earlier to injections or an implant.
Cancer surveillance. The first PSA is taken at six to eight weeks, because it takes that long to fall. It should become undetectable. It is then checked every three months for the first year, six-monthly to five years, then annually. Your pad count and an erectile function score are recorded at three, six, twelve and twenty-four months — written down as numbers, because these problems are managed only if they are measured, and Indian men will not raise them unasked.
For high-risk prostate cancer, external beam radiotherapy with two to three years of hormone therapy cures as effectively as surgery. The difference is the side effects and their timing: surgery gives urinary leakage immediately that then improves, while radiotherapy gives bowel and urinary irritation that appears over years and a slower decline in erections. A man who chooses radiotherapy has not chosen second best.
What usually tips the decision is not the cancer, since control is equivalent, but the man — his age and life expectancy, his urinary and bowel history, and whether two to three years of hormone therapy is acceptable to him. Surgery is offered where life expectancy is at least ten years, which is the criterion rather than the birthday.
★★★★★
“My relative was treated for prostate cancer by Dr. Swati Shah and we are extremely satisfied. Robotic Radical Prostatectomy was successful and recovery has been excellent. We highly recommend her to anyone searching for a prostate cancer specialist.”
Capt Rohit Priyadarshi · Google review, Apollo Hospital, Bhat
★★★★★
“My father was treated for prostate cancer by Dr. Swati Shah in Ahmedabad. The robotic prostate surgery was smooth, recovery was faster than expected, and we highly recommend her for prostate cancer treatment.”
Kishan Solanki · Google review, Apollo Hospital, Bhat
★★★★★
“Nice treatment of Prostate cancer. I am now fit.”
Patel Yagnesh Babubhai · Google review, Gota clinic
From the first consultation to full recovery, the pathway runs through five stages. Most men reach a fixed plan within two weeks of making contact, and the operation is scheduled after the multidisciplinary discussion, not before it.
Apollo Hospital, Bhat is empanelled with the major insurers and with Ayushman Bharat, and pre-authorisation is handled by the hospital’s own team before admission. What moves the estimate most is the surgical approach, the room category, how long you stay, the staging scans, and whether radiotherapy or hormone therapy is added after the histology.
Send your policy details with the reports and pre-authorisation is started alongside the medical planning rather than after it. For families funding treatment themselves, a written estimate is given once the plan is fixed. Staging scans are self-funded, and where one cannot be afforded a conventional bone scan with CT is used rather than delaying treatment. Bring all imaging, your medicine list, insurance papers and a family member who will stay, because catheter care is taught to both of you.
Sometimes on one side, occasionally on both, and honestly often on neither. It depends on where the cancer sits, what the MRI shows about the capsule and how much cancer the biopsy found on each side. Dr Swati Shah will not spare nerves at the cost of leaving cancer behind.
Sexual life continues, but it changes. Ejaculation stops permanently and orgasm becomes dry in every man. Where nerves were spared, erections may recover over one to two years and often incompletely; where they could not be, tablets, injections, a vacuum device or an implant are used. This is discussed in full before surgery.
Expect pads from the day the catheter comes out. Most men improve over weeks to months with pelvic floor work started before surgery and supervised after it. If heavy leakage is still present at a year, a sling or an artificial urinary sphincter is discussed then rather than waiting longer.
It is a genuine alternative with equivalent cancer control in this risk group, combined with two to three years of hormone therapy. It is presented by a radiation oncologist, not by the surgeon alone, and the choice usually turns on your age, your urinary and bowel history and which side-effect pattern you would rather live with.
It is likely if the margin is positive or the lymph nodes are involved, and that possibility is stated before surgery rather than after. The histology and the node report decide it, and the decision is taken in the multidisciplinary meeting.
It can be. The criterion is life expectancy of at least ten years and fitness for the operation, not the birthday. For some men in that position radiotherapy with hormone therapy is the better trade, and that is exactly what the joint discussion is for.
Dr Swati Shah I Robotic Uro Oncologist I Prostate, Kidney, Bladder Cancer specialist
Gota, Ahmedabad, Gujarat
Directions to the Gota clinic
Dr Swati Shah Uro Oncologist I Prostate, Bladder, Kidney Cancer I Robotic surgeon
Apollo Hospital, Bhat, Gandhinagar, Gujarat
Directions to Apollo Hospital, Bhat
Telephone and WhatsApp: +91 63590 11009
Dr Swati Shah consults at the Gota OPD in Ahmedabad and operates at Apollo Hospital, Bhat, Gandhinagar. Men travelling from Saurashtra, north Gujarat and Rajasthan can usually complete the consultation and the staging tests in a single visit if they call ahead.
High-risk prostate cancer is curable, and it is treated with cure as the aim — but the operation that cures it also changes urination and sex. This page is written to tell you both halves honestly: what the surgery removes, what can realistically be preserved, what preservation would cost you in cancer control, and how each function recovers, week by week and month by month. Call +91 63590 11009 WhatsApp Dr Swati Shah's team
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