Radical prostatectomy: specialists & info

When is a radical prostatectomy an option?

Prostate carcinoma is a malignant tumor that usually grows slowly. A distinction is made according to the spread

• localized prostate cancer (limited to the prostate ),
• locally advanced prostate carcinoma (grown beyond the prostate, but without metastases) and
• metastatic prostate carcinoma (with metastases).

Radical prostatectomy is the primary treatment method for localized prostate cancer. In this early stage of prostate cancer, radical prostatectomy can often remove all cancer cells. There is therefore a high probability of cure.

The more advanced the prostate cancer, the less likely it is that the tumor tissue will be completely removed by radical prostatectomy. This also reduces the chances of recovery.

Radical removal of the prostate is often only considered if the patient is expected to have a life expectancy of at least ten years.

The prostate is located below the bladder. A radical prostatectomy can lead to a cure, especially in the early stages of prostate cancer © Henrie | AdobeStock

Which specialist performs a radical prostatectomy?

A specialist in urology is responsible for radical prostatectomy.

Procedure for a radical prostatectomy

A radical prostatectomy involves the removal of the prostate gland

• including the capsule,
• the seminal vesicles (vesicular glands) and
• the ends of the vas deferens.

In the case of localized prostate cancer, there are three different ways to reach the prostate. In terms of treatment outcome, these three methods are equivalent. For most patients, it is of little importance which method is used. Locally advanced prostate carcinoma does not allow minimally invasive surgery.

• An open retropubic approach is most frequently chosen. This means access from above through an incision in the lower abdomen (retropubic radical prostatectomy). This approach is particularly suitable for severely enlarged prostates.
• A perineal radical prostatectomy is an approach from below, i.e. via an incision in the perineum. This procedure is used if, for example, a patient is very obese or has already undergone surgery in the lower abdomen.
• Laparoscopic radical prostatectomy is a minimally invasive procedure ("keyhole surgery") that is being used more and more frequently. It only requires several small incisions to be made in the abdomen, through which an endoscope and surgical instruments are then inserted. This minimally invasive procedure is particularly suitable if uncomplicated removal of the tumor is expected. Laparoscopic prostatectomy can now also be performed using a robot that is controlled by the surgeon(Da Vinci robotic system). The use of the Da Vinci system is associated with high costs and is only performed in a few large centers.

Erectile dysfunction is a common side effect of radical prostatectomy. To reduce this risk, nerve-sparing surgery is performed if the size of the tumor allows it. In cases of doubt, total removal of the tumor tissue takes precedence over sparing the nerves.

Consequences / side effects of radical prostatectomy

The most common side effects of a radical prostatectomy include erectile dysfunction and urinary incontinence. If the extent of the tumor allows it, a potency-preserving radical prostatectomy is performed. But even in this case, some men have erectile dysfunction.

Involuntary loss of urine occurs in most men after the bladder catheter has been removed. However, urinary incontinence does not necessarily have to be permanent: It usually improves after a few weeks or months.

Other possible side effects of radical prostatectomy include

• a narrowing of the urethra (urethral stricture),
• shortening of the penis,
• fecal incontinence or injuries to the rectum in the case of a perineal approach,
• neuropraxia in the case of retropubic access.

Radical prostatectomy, like radiotherapy for prostate cancer, can cause physical discomfort. You can therefore take advantage of outpatient or, under certain circumstances, inpatient rehabilitation afterwards.