Aftercare

Immediately after the operation, the patient is transferred back to the ward during the course of the day, where his condition and vital signs (blood pressure, temperature and pulse) are monitored. For the duration of the stay, the patient has a bladder catheter lying down so that the surgical wound on the urethra can heal. Already on the first day after the operation, the patient can get up under supervision and move slowly.

Medications are administered to relieve the pain as required. In the following days, regular pelvic floor exercises and micturition training with a physiotherapist are carried out, as these measures are important for the development of continence. As a rule, a patient must remain in hospital for 14 days after prostate surgery.

Within six to twelve weeks after the operation, the tumour marker PSA (prostate specific antigen) in the blood is checked and examined to see whether it has decreased sufficiently. The PSA value should be below the detection limit. If the values are inconspicuous, blood samples are then taken at quarterly intervals.

What are the risks/side effects of the surgery?

A prostatectomy is a major procedure and, like any other operation, involves a number of risks and side effects. One complication is that after removal of the prostate, the patient suffers from urinary incontinence, i.e. involuntary loss of urine. It is perfectly normal for patients to suffer from incontinence for several days or weeks immediately after the operation.

Normally, this can be treated very well with medication and disappears after some time. Permanent incontinence occurs much less frequently. In such a case, a small post-operative operation must be performed to restore the function of the urethral sphincter.

Furthermore, sexual disorders such as erectile dysfunction (erectile dysfunction) or orgasm disorders are also possible. This can happen if nerves or vessels are severed during the operation which are important for erectile function. The disturbances are either temporary or permanent and can be easily treated with medication. Since a prostatovesiculectomy involves the removal of the seminal vesicles as well as the prostate, patients are infertile after the operation and cannot conceive children. In addition, prostatectomy can lead to further complications, such as heavy bleeding during the operation, wound infections and fever.

What happens during radiation therapy?

Patients who have been diagnosed with a localized prostate carcinoma can be treated with radiotherapy (radiotherapy). The aim of the therapy is a curative treatment, which means that the patients are cancer-free afterwards. During radiation therapy, the tumour tissue is destroyed by radioactive radiation and the tumour shrinks.

The radiation does not differentiate between healthy tissue and tumour cells, which is why it is important that only the tumour tissue is irradiated. In order to spare the healthy tissue as much as possible, the radiation dose required to destroy the tumour is divided into several sessions (fractions). The tumour can be irradiated from “inside” or “outside”.

The classical radiation is administered from the outside through the skin (percutaneous radiation). Here, the patient is irradiated every day for seven to nine weeks, and the patient can go home after each treatment (outpatient treatment). Irradiation is performed by a specific machine, a linear accelerator.

Using the latest computer technology, the radiation dose and the radiation field are calculated and the tumour is irradiated precisely. Percutaneous irradiation is painless and usually only takes a few minutes. Brachytherapy is an alternative radiation option.

Seeds are small radioactive particles that are inserted into the tissue via a long needle and emit radioactive radiation from inside the prostate. The implantation is a small procedure that takes place under local anesthesia. Afterwards the patients are discharged.

The radiation of the seeds lasts for several weeks. Afterwards, a follow-up treatment is performed, during which the results are examined. If the treatment was successful, the seeds do not need to be removed again.

The acute side effects of radiation therapy for prostate cancer are mainly caused by damage to healthy tissue. Percutaneous irradiation can cause reddening of the skin and inflammation at the irradiated area. Since the bladder and rectum are in close proximity to the prostate, irritation of the mucous membranes in these organs can also occur.

Patients then suffer from cystitis or inflammation of the lower sections of the intestine. In most cases, however, these are temporary events that subside quickly after the end of treatment. The side effects of brachytherapy or seed implantation are minor.

It is possible that after the seeds have been implanted there may be a slight irritation of the bladder or intestine. Much less frequently, permanent damage to the bladder, urinary tract or rectum can occur as a result of the treatment. Late effects include incontinence, potency problems and chronic diarrhoea. Unfortunately, it is not possible to say before the start of treatment whether long-term damage will occur.