Prostate cancer surgery can lead to a cure in the early stages of localized prostate cancer. In most cases, the prostate is removed (prostatectomy). The operation is often performed at a specialist urology clinic.
It is also possible to cure the cancer by radiating the prostate. However, there is a risk of damage to the nerves in the lower abdominal area as a result of the radiation. This can result in continence disorders or erectile dysfunction.
Surgery is possible if the carcinoma is limited to the prostate and has not yet spread (metastasis). Urology then speaks of localized prostate cancer.
Prostate cancer surgery is also known as a radical prostatectomy. The prostate is completely removed. The aim of the operation is to remove the tumor completely. If the tumor is suspected to have spread, the adjacent lymph nodes are often removed as well.
Post-op surgery is not always necessary immediately. The oncologist will discuss the treatment options with the patient before surgery. In some cases, surgery can be postponed or avoided altogether by using other methods. Other methods of prostate cancer treatment include
- Radiotherapy,
- medication or
- in very early stages of cancer, "active surveillance".
In active surveillance, the cancer findings are checked and recorded at regular intervals without any specific treatment being carried out.
As a rule, prostate cancer surgery is followed by radiotherapy or hormone withdrawal. Doctors hope that this will prevent a recurrence of the tumor.
Prostate cancer surgery can lead to a complete cure in the early stages of prostate cancer © o_a | AdobeStock
The prostate-specific antigen (PSA for short) is a marker of prostate tissue. The PSA value can be determined by means of a blood test.
In a man without a cancer diagnosis, the PSA level in the blood can be
be elevated.
On the other hand, an elevated PSA level without an underlying cause is always an alarm signal for prostate cancer.
With the help of a prostate punch biopsy, the suspicion can usually be refuted or confirmed. In this case, the PSA has a diagnostic value.
In a man with prostate cancer, the PSA value has a slightly different meaning: After prostate cancer surgery, the man should produce little or no PSA. If the PSA value rises again some time after the operation, it is clear that the person concerned is experiencing a recurrence. This means that the tumor has already metastasized and is now growing in other parts of the body. Prostate cancer often forms metastases in the skeletal bones and vertebrae.
In this case, the PSA has a prognostic value: a relapse due to metastasis worsens the prognosis and leads to further treatment.
A radical prostatectomy usually takes several hours. It is performed at a specialized hospital center under general anaesthetic.
During the prostate cancer operation, the patient lies on their back. If you suffer from back pain, point this out to your doctor during the consultation.
During prostate cancer surgery, the surgeon removes the prostate and its capsule as well as other surrounding tissue. These include, among other things
- the vas deferens,
- the seminal vesicles,
- the inner sphincter muscle of the bladder and the urethra.
If an advanced carcinoma is suspected, the regional lymph nodes are also removed.
Prostate surgery requires the urethra, which runs through the middle of the prostate, to be cut. It is reconnected after the prostate has been removed.
To allow the wounds to heal properly, men are given a bladder catheter at the end of the operation. This allows the urine to drain freely.
After the operation, the patient remains in the clinic for up to two weeks and continues to be monitored there. The duration of the stay is determined by the surgical technique and the patient's general physical condition.
Specialized urology clinics distinguish between four major surgical techniques. These include
- Retropubic radical prostatectomy: access is via an abdominal incision,
- perineal radical prostatectomy: access via a so-called perineal incision between the penis and anus,
- laparoscopic prostatectomy (keyhole surgery),
- robot-assisted laparoscopic prostatectomy: also performed laparoscopically, but with the help of a surgical robot. The robotic arm is controlled by an experienced surgeon.
Each of these procedures has its own advantages and disadvantages. Before the operation, the surgeon will discuss with you which procedure he considers to be the most promising for you.
Your general condition and the stage of the tumor are important. Your personal expectations and your life situation will also be taken into account when deciding which procedure to choose. Continence and erectile function, for example, can be better preserved in some procedures than in others.
The advantage of an early prostatectomy is that prostate cancer can be cured in most cases.
The more advanced the cancer is when it is first diagnosed, the higher the risk that it has already spread. Prostate cancer surgery would then only remove the primary tumor, but not the metastases (secondary tumors). In the latter case, a relapse would occur after some time despite prostate cancer surgery. This also significantly worsens the prognosis.
The maindisadvantages of prostate cancer surgery are functional disorders in the urogenital tract. Nerve damage as a result of the operation or subsequent radiotherapy can lead to incontinence and erectile dysfunction.
The consequences of the operation can possibly be mitigated by
- early continence and pelvic floor training,
- medication or
- erection-promoting aids (vacuum pump, etc.).
Whether or not you decide to have prostate cancer surgery depends on many individual factors. Talk to your doctor at an early stage about your wishes, expectations and also your fears.
This is the only way to ensure that you can make an informed decision together with your doctor.
