What are the options?
There are various treatment options for prostate cancer. Which approach is taken in an individual case depends on the tumor stage, general condition and age of the patient. For tumours that are localised and have not yet formed metastases, surgical removal of the prostate is the therapy of choice (radical prostatovesiculectomy).
Other options include radiotherapy (radiotherapy) or hormone treatment. In palliative situations, especially in the presence of distant metastases, chemotherapy can be initiated. Particularly in older patients, in whom the cancer does not lead to a significant reduction in life expectancy (tumour-independent life expectancy <10 years), the tumour does not necessarily have to be treated.
This palliative measure is called “watchful waiting”. Even small, low-risk findings can initially only be observed in a wait-and-see manner (“active surveillance”) and do not require immediate treatment. However, there is then a risk that a possibly necessary therapy cannot be initiated in time.
Operation
In preparation for prostate surgery, the patient is admitted to the hospital as an inpatient on the day before the operation. This is where the first examinations (e.g. ultrasound examination of the prostate), a blood sample and an informative discussion about the upcoming operation by the attending physician are carried out. Furthermore, the anaesthetist (anaesthetist) informs the patient about the anaesthesia, its induction and possible risks.
The patient must then sign a document confirming that he or she agrees to the operation. Before the operation, the abdomen is shaved generously by the nursing staff. Since the operation is performed under general anesthesia and respiration (intubation), the patient must be fasting.
This means that on the day of admission, no more solid food may be fed from midday onwards. On the day of the operation, the patient may also no longer drink or smoke. In a radical prostatovesiculectomy for the treatment of prostate cancer, the entire prostate gland including the adjacent seminal vesicles and the pelvic lymph nodes are completely removed.
The aim of the operation is to remove the tumour completely. Doctors refer to this as an “R0 operation”, where R0 stands for “no residual tumour tissue” (i.e. no residual tumour tissue). There are several different ways in which the operation can be carried out.
Usually the patient has a general anaesthetic. Either the prostate is removed through an incision at the front of the abdominal wall (retropubic prostatectomy), through a small perineal incision (perineal prostatectomy) or minimally invasive with the “keyhole technique” (laparoscopic prostatectomy). In certain cases, a minimally invasive robot-assisted procedure (prostatectomy with the Da Vinci surgical system) may also be considered.
The surgeon decides which surgical technique to use in each individual case based on the tumor findings, the patient’s general condition and age. During the operation, the tumour tissue including the prostate is removed. Since the prostate is anatomically located between the bladder and the erectile tissue of the penis, a new connection between the urethra and the bladder must then be made. Medically this is called an “anastomosis”. During the procedure, the surgeon tries to preserve as many nerves and blood vessels as possible that are important for continence and potency.
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