Background: Prostate Cancer and Treatment Options
Prostate cancer is the most common cancer in men. It usually develops slowly and causes no symptoms for a long time. Depending on the stage of the tumor and the aggressiveness of the cancer cells, various treatments are available. In addition to surgery (radical prostatectomy), these include radiation therapy, hormone therapy, drug-based treatments, and active surveillance (watchful waiting) for low-risk cases. The choice of treatment depends on many factors, including the patient’s PSA level, age, and overall health.
Who is a good candidate for prostate cancer surgery?
Prostate cancer surgery is particularly suitable for men whose tumor is still confined to the prostate. Doctors refer to this as locally confined prostate cancer. In this case, there is a high chance of a cure, as the tumor can be eliminated by completely removing the prostate (prostatectomy).
The tumor stage and the aggressiveness of the tumor also play a role. If metastases are already present, surgery is usually no longer recommended as the sole treatment. In such cases, combinations with radiation therapy or drug treatments may be considered.
The Role of PSA Levels and the Gleason Score
The PSA level (prostate-specific antigen) is an important laboratory marker for the diagnosis and monitoring of prostate cancer. It is measured in the blood and indicates how actively the prostate tissue is functioning. After prostate surgery, the level should be virtually undetectable. If it rises again later, this indicates a recurrence or metastases.
In addition, the Gleason score is determined. It indicates how much the cancer cells differ from healthy tissue and allows conclusions to be drawn about the aggressiveness of the tumor. Together, the PSA level and Gleason score help plan the optimal course of treatment.
Surgical Procedure (Radical Prostatectomy)
Radical prostatectomy is the standard procedure for locally confined prostate cancer. During the procedure, the entire prostate, including the prostatic capsule, is removed. Often, the seminal vesicles and vas deferens are also removed, and if spread is suspected, the lymph nodes are removed as well.
Since the urethra runs through the prostate, it must be cut during the procedure and then reconnected to the bladder. To allow urine to drain, patients are fitted with a urinary catheter for a few days.
The surgery is performed under general anesthesia and lasts several hours. Depending on the surgical method and the individual’s recovery, a hospital stay of about 7–14 days is typical.
Overview of Surgical Methods
| Method | Access | Advantages | Disadvantages |
|---|---|---|---|
| Retropubic Radical Prostatectomy | Abdominal incision | Direct view of the prostate and lymph nodes | Larger scar, longer healing time |
| Perineal radical prostatectomy | Perineal incision | Less blood loss | More difficult access to lymph nodes |
| Laparoscopic prostatectomy (minimally invasive) | Small incisions in the abdomen (“keyhole surgery”) | Less blood loss, faster recovery | Technically challenging, longer surgery duration |
| Robot-assisted prostatectomy (Da Vinci surgery) | Minimally invasive with a robotic arm | Very precise, often better preservation of continence and sexual function | High cost, not available everywhere |
All procedures share the same goal: the complete removal of the tumor. The choice of method depends on the patient’s individual factors as well as the experience of the operating surgeon.
Possible Risks and Complications
As with any major surgery, complications can occur during prostate cancer surgery. These include:
- Blood loss during surgery
- Injury to the bladder, urethra, or blood vessels
- Infections or wound healing problems
- Urinary incontinence due to damage to the sphincter muscle
- Erectile dysfunction due to damage to the nerve pathways
Many of these side effects can be reduced through modern surgical techniques and targeted postoperative care, but they do not always disappear completely.
Aftercare & Rehabilitation: Life After Prostate Surgery
After surgery, structured rehabilitation is crucial for restoring quality of life. This includes:
- Pelvic floor exercises to improve continence
- Medication or aids for erectile dysfunction
- Regular PSA tests to monitor for a possible recurrence
- Rest and a gradual return to daily life
During the first six weeks after surgery, patients must take it easy physically. With the support of doctors, physical therapists, and, if necessary, psychologists, the transition back to an active life is usually successful.
Prognosis: Chances of Recovery and Quality of Life
The prognosis after prostate cancer surgery is very good, especially in the early stages. If the tumor is completely removed, the chances of recovery are high.
However, quality of life depends heavily on how well continence and sexual function are preserved. Results vary depending on the surgical method and individual factors. Early rehabilitation measures can help reduce limitations.
Surgery or Radiation Therapy? A Comparison
| Criterion | Surgery (Prostatectomy) | Radiation Therapy |
|---|---|---|
| Goal | Removal of the entire prostate | Destruction of cancer cells through radiation |
| Chances of cure | High for locally confined prostate cancer | Similarly high in the early stages |
| Side effects | Incontinence, erectile dysfunction, blood loss | Bowel problems, bladder irritation, erectile dysfunction |
| Follow-up care | PSA tests, rehabilitation | PSA tests, possibly combined with hormone therapy |
| Suitable for | Patients in good general health | Patients who do not wish to undergo surgery or are not candidates for surgery |
Both approaches have advantages and disadvantages. The decision should always be made in consultation with a urologist or a specialized urology clinic.
FAQ: Prostate Cancer Surgery
When is prostate cancer surgery recommended?
Surgery for prostate cancer is primarily recommended for men whose prostate cancer is confined to the prostate and has not yet spread to other organs. In these cases, a radical prostatectomy is often curative. Alternatively, active surveillance (also known as watchful waiting) may be an option in the early stages. In this approach, doctors regularly monitor the PSA level and the tumor stage without immediately removing the prostate.
What side effects can prostate cancer surgery cause?
Various side effects may occur after surgery. Common ones include urinary incontinence due to damage to the sphincter muscle or erectile dysfunction if small blood vessels and nerves near the prostate are affected. Blood loss or damage to blood vessels are also possible complications. In some cases, the side effects result in limitations, which can, however, be improved through targeted rehabilitation.
What is the recovery process like after surgery?
A urinary catheter is usually still needed one to two days after surgery. Patients typically have to stay in the hospital for several days to two weeks, depending on the procedure. With a minimally invasive or robot-assisted approach, recovery is often faster than after open surgery. Overall, it takes several weeks for most men with prostate cancer to resume their daily routines.
What methods are available: open or robot-assisted?
Radical prostatectomy can be performed in various ways: as a traditional open surgery with direct access to the prostate, as a minimally invasive keyhole surgery, or as a robot-assisted prostatectomy. The robot-assisted approach is considered particularly precise and can reduce the risk of incontinence or erectile dysfunction. Which method is used depends on the tumor stage, the location of the prostate, and the surgeon’s experience.
How does surgery differ from radiation therapy?
Both surgery for prostate cancer and external beam radiation therapy aim to eliminate the tumor. While surgery involves removing the prostate along with the tumor, radiation therapy destroys the cancer cells using targeted radiation. According to international guidelines on “prostate cancer,” both procedures are considered equally effective for locally confined prostate cancer. The main differences lie in the side effects: Surgery can affect continence and sexual function, while radiation therapy more frequently causes bowel or bladder irritation.
Sources
- aerzteblatt.de/
- S3-Leitlinie „Prostatakarzinom“ (AWMF-Register-Nr. 043-022OL), Stand 02.07.2025: register.awmf.org/de/leitlinien/detail/043-022OL
- Krebsinformationsdienst des DKFZ: Radikale Prostatektomie: www.krebsinformationsdienst.de/prostatakrebs/operation
- prostata-hilfe-deutschland.de/
