Santis rebuilds the case for an operation some men may hesitate to consider

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Prostate cancer overtook breast cancer in 2022 as the most commonly diagnosed cancer in the UK, with 64,425 men receiving the diagnosis compared with 61,640 breast cancer cases, according to Prostate Cancer UK’s analysis of NHS figures. That represents a 24% jump from the roughly 52,000 diagnoses recorded just a year earlier.

Santis, a private prostate cancer clinic in London, treats these numbers as an indication of a second, quieter problem sitting beneath the first. Detection has accelerated, but some men may still face uncertainty about the options and outcomes that contemporary treatment can offer once they are diagnosed.

Men newly-diagnosed with prostate cancer face a confusing choice of treatment options which range from surveillance to definitive treatment, with each having its own set of pros and cons. In reality, the choice that they must make boils down to which set of risks and benefits they are most prepared to accept.

Some men choose a non-surgical option such as focal therapy, which treats only a part of the prostate, in the belief that it offers a better trade-off between cancer treatment and the preservation of continence and sexual function.

However, follow-up in patients who have had prostate-preserving treatment can be more difficult because the prostate still makes PSA (the blood marker that is used to monitor patients after treatment, as well as to screen them) and salvage surgery for patients who have failed these treatments may be more challenging because of scarring, which can be associated with poorer functional outcomes.

Santis argues that in appropriately selected patients, a combination of high-volume surgery and technical refinements may help narrow the treatment outcome gap, potentially offering functional outcomes comparable to those reported with focal therapy while providing the clearer PSA monitoring associated with surgery and preserving potential salvage options.

A surgeon’s 26-year case against false choice

Professor Christopher Eden, who leads Santis’ prostate cancer practice from London Bridge Hospital, has spent 26 years watching men weigh that choice in his own consulting room. He performed the UK’s first laparoscopic radical prostatectomy in 2000 and has since carried out thousands of keyhole operations, and was later included on the Daily Mail’s list of Britain’s 10 leading prostate cancer surgeons.

Across that period, Professor Eden has argued that surgery’s technical results have improved at a faster rate than its reputation, leaving many wary of prostate surgery because of its historical association with substantial effects on quality of life. The data, however, tells a different story, with a published continence rate of 97.7% and a one-year potency rate of 78.1% among non-diabetic men under 70 with normal potency before surgery who underwent bilateral nerve preservation.

The technical modifications used by Professor Eden to help narrow the functional gap with focal therapy, while aiming to preserve the benefits of surgery, are three-fold: Retzius-sparing surgery; the use of intra-operative pathology (NeuroSAFE); and the use of a Single Port da Vinci robot, which may support faster recovery.

Professor Eden was the first surgeon in the UK to perform Retzius-sparing robotic prostatectomy, an approach that aims to preserve the anatomy in front of the prostate when the cancer’s location allows it, which includes the main anchor points of the continence mechanism. Conversely, conventional prostatectomy enters this space and may disrupt or alter some of these supporting structures. The technique can be more technically demanding and may involve a longer learning curve, which could help explain its slower adoption across the UK. It may also be unsuitable for some men depending on the location of their cancer.

Professor Eden’s own published results, along with independent studies, indicate favorable continence outcomes: 76.4% of men are pad-free at one month and 97.7% at one year. A larger multicentre analysis presented at the American Urological Association’s 2025 meeting found that Retzius-sparing patients had higher odds of regaining continence at three months compared with patients undergoing standard robotic prostatectomy.

Addressing uncertainty during surgery

The technique Professor Eden uses to help preserve bladder and sexual function while maintaining cancer control is NeuroSAFE, a real-time pathology check that examines prostate tissue while the patient is still on the operating table. Conversely, without NeuroSAFE, surgeons may have less information available during the procedure to help balance cancer control with functional outcomes, since the final pathology report is typically not available until after surgery.

NeuroSAFE instead gives Professor Eden a pathologist’s microscopic reading of the surgical margins before he closes, which may allow him to preserve tissue in patients where it might otherwise be removed as a precaution, while aiming to maintain cancer control.

“We have understood the practice, know where we stand, and what limitations we are dealing with,” Professor Eden says. “That is why we do not stop, but keep on studying how we can further improve.”

Supporting recovery

Professor Eden has also moved his practice into the da Vinci Single Port robotic system, which allows minimally invasive access through a single incision rather than the five or six required by a standard robotic prostatectomy; he helped introduce the platform to the UK alongside two HCA colleagues in 2024 and has since gained significant experience using the device.

Technology alone does not necessarily lead to better care, and Professor Eden has been explicit that the value lies in how it is used. Professor Eden has said that the future of robotics in prostate surgery “properly lies” in outcome-driven operations, “rather than in inexperienced surgeons using the hype of robots to attract patients”.

None of the three elements functions as a standalone fix. The Single Port robot gives Professor Eden magnified visualization and controlled movement through anatomy closely tied to post-operative function; the Retzius-sparing route may allow more normal anatomy to be preserved; and NeuroSAFE provides real-time information about whether nerve preservation could affect cancer control while there is still an opportunity to adjust the procedure.

Each method addresses a specific surgical concern. Together, they form a connected procedure performed through a single incision, with the aim of supporting three key priorities after prostate cancer treatment: cancer control, continence, and potency.

What a number means to one man

Professor Eden, together with his consultant anesthetist, Dr. Annie Haigh, who has anesthetized the majority of his cases for the past three decades together with a dedicated robotic surgical assistant, acknowledges that a single clinic in London cannot fix a national gap.

And the tens of thousands of new prostate cancer diagnoses recorded each year in the UK will not be reduced by the refinements of a single surgical team. What the team believes it can change is more immediate, namely the prospect of a man being told that preserving continence and sexual function requires him to accept a more limited treatment approach.

For a patient facing this dilemma for the first time in his life, choosing what appears to be the least invasive option is a rational response. However, Professor Eden argues that high-volume surgery, supported by an experienced operating team and years of technical refinements, can change the premise of that decision.

The purpose of the clinic’s results is not to suggest that every man should have surgery, nor to dismiss the appeal of focal therapy and radiotherapy, but to challenge the idea that prostatectomy inevitably destroys continence, intimacy, and independence. On the contrary, published evidence from Santis suggests that, in men who are suitable candidates for surgery, the possibility of earlier continence recovery and preserved sexual function, while still aiming to optimise cancer control, may meaningfully influence treatment decisions.

Patients who want to learn more about Santis and its approach to prostate cancer treatment can visit the clinic’s website

This article is for informational purposes only and does not substitute for professional medical advice. If you are seeking medical advice, diagnosis or treatment, please consult a medical professional or healthcare provider.