Prostate health in the Charleston area

Dr. Farah, a urologist in North Charleston, Summerville and Nexton, SC, cares for men from the first elevated PSA through diagnosis, robotic prostatectomy and recovery, and treats an enlarged prostate (BPH) with medicines, Rezum, TURP, Aquablation or single-port robotic simple prostatectomy. For prostate cancer he performs robotic-assisted radical prostatectomy (RARP), and if erections or bladder control need help afterward, he treats them himself.

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Medically reviewed by Guillaume Farah, MD · Last reviewed October 2026

Elevated PSA

What should I do about an elevated PSA?

A raised PSA is common and often not cancer. Infection, an enlarged prostate or recent activity can all raise it. Dr. Farah handles the complete work-up, so the surgeon who reviews your first test is the same one who would treat you.

  1. 01

    Repeat PSA

    Confirms whether the rise is real, sometimes with an extra blood or urine test.

  2. 02

    Prostate MRI

    Shows whether any area looks suspicious. Many men need nothing more after a normal MRI.

  3. 03

    MRI-fusion biopsy

    Targets the exact area the MRI found, only if one is found.

  4. 04

    Results, in person

    Dr. Farah reviews the results with you in the office and explains every option.

Prostate cancer

How is robotic prostatectomy done?

The prostate and seminal vesicles are removed with a surgical robot through a few small incisions, with pelvic lymph node dissection when the cancer's risk calls for it. Dr. Farah plans each operation around life after it, protecting the nerves and muscles that control erections and bladder control wherever the cancer allows.

  • Multi-port robot. Robotic prostatectomy for prostate cancer is done with the multi-port robot; the single-port robot is used for simple prostatectomy for an enlarged prostate.
  • Nerve-sparing, graded to the cancer, to protect erectile function.
  • Hood-sparing and urethral-sparing technique to help bladder control return sooner.
  • Extraperitoneal approach where suitable, staying outside the abdominal cavity.
  • Penile rehabilitation starting as soon as the catheter is out.

What to expect

  1. Surgery day. Walking the same evening.
  2. Next day. Most men go home.
  3. About 7 days. Catheter out; pelvic floor exercises and erection rehab begin.
  4. Months 1 to 3. Bladder control improves week by week; erections return more slowly.
  5. 6-month checkpoint. A clear next step, whatever the answer.
See every step on the pathway

Is surgery my only option?

No. Many low-risk cancers are safest watched closely with PSA tests and MRI (active surveillance). Others are treated with surgery or radiation. Dr. Farah explains what each option means for bladder control and erections, and works with radiation and cancer specialists when that's the better fit. Second opinions are welcome.

What if erections or bladder control don't come back?

There are lasting fixes, and Dr. Farah performs them himself: a penile implant for erections, and a male sling or artificial urinary sphincter for leakage. This includes men treated by other surgeons or with radiation.

Penile implants, slings and sphincters

Enlarged prostate (BPH)

What are my options for an enlarged prostate?

Weak stream or up at night? Treatment for an enlarged prostate is matched to your prostate's size and shape, and your priorities, such as protecting ejaculation.

  • Habits and medicine. Drinking less in the evening and a daily pill help many men.
  • Rezum (water vapor therapy). A quick steam treatment shrinks the prostate and can be done in the office.
  • Aquablation. A robot-guided water jet removes the blocking tissue precisely, usually with one night in hospital.
  • TURP. The traditional operation trims the tissue away from the inside.
  • Single-port robotic simple prostatectomy. Removes the enlarged part of the prostate with the single-port robot, through one small incision, working through the bladder (a transvesical approach). For men with a large prostate and severe symptoms; one night in the hospital, and the catheter comes out in 5 days.
See every step for an enlarged prostate

Prostate questions

How long is the hospital stay after robotic prostatectomy?

Most men go home the day after surgery, and walk the evening of the operation.

Do you offer single-port robotic surgery?

Yes, for an enlarged prostate. Dr. Farah performs robotic simple prostatectomy for BPH with the single-port robot, through one small incision. Robotic prostatectomy for prostate cancer is done with the multi-port robot.

What happens at the first consultation?

Dr. Farah reviews your PSA history, MRI, biopsy pathology and any prior operative notes, examines you, and walks through every option, including those that don't involve surgery. You leave with a written plan and, if surgery is right for you, a date. Bring your records, medication list and someone you trust.

Does an elevated PSA mean I have prostate cancer?

Not necessarily. Infection, an enlarged prostate or recent activity can all raise PSA. The work-up usually starts with a repeat PSA and, if it stays raised, a prostate MRI and possibly a targeted biopsy.

How quickly can I be seen?

New patients are seen within 24 to 48 hours at offices in North Charleston, Summerville and Nexton.

The evidence

Landmark studies behind these recommendations, for readers who want the clinical detail.

  • 2024 JAMA Oncology · Hu et al. RCT PREVENT: transperineal vs transrectal MRI-targeted prostate biopsy 875 men. Infection 0% with transperineal biopsy and no antibiotic prophylaxis vs 1.6% transrectal; grade group 2 or higher detection 55% vs 52%. Read in JAMA Oncology
  • 2018 NEJM · Kasivisvanathan et al. RCT PRECISION: MRI-targeted or standard biopsy for prostate cancer diagnosis 500 men. MRI pathway found more clinically significant cancer (38% vs 26%) and less insignificant cancer (9% vs 22%); 28% avoided biopsy after a non-suspicious MRI. Find it on PubMed
  • 2023 NEJM · Hamdy et al. RCT ProtecT: 15-year outcomes after monitoring, surgery or radiotherapy for localized prostate cancer 1,643 men. Prostate cancer mortality about 3% in every arm; metastasis 9.4% with active monitoring vs 4.7% after prostatectomy and 5.0% after radiotherapy. Find it on PubMed
  • 2022 Canadian Journal of Urology · Gilling et al. RCT WATER: five-year outcomes of Aquablation vs TURP 181 men. Similar symptom relief, with a larger benefit for Aquablation in prostates over 50 mL; ejaculatory dysfunction 7% vs 25%; retreatment about 1% per year. Find it on PubMed
  • 2021 Journal of Urology · McVary et al. RCT Rezum water vapor thermal therapy: final 5-year results of the sham-controlled trial 197 men. IPSS improved by 11.3 points (about 48%) at 5 years; surgical retreatment 4.4%; no sustained new erectile dysfunction. Find it on PubMed

Talk to Dr. Farah about your options.

New patients are seen within 24 to 48 hours in North Charleston, Summerville and Nexton. Second opinions are welcome.

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