The complete removal of the prostate (radical prostatectomy) is a possible therapy when the cancer is contained inside the prostate. This operation is at present the most frequently used and proven method. It is the method for the treatment of localised prostate cancer for which the most experience has been gathered.
The Martini-Klinik is the world-wide leader in the number of prostatectomies performed. Doctors here have already operated on 22,000 patients. Since 2011, more than 2,200 prostatectomies have been carried out annually in the Martini-Klinik.
These figures are all the more impressive considering that in Germany less than 40 radical prostatectomies are carried out in half of the urological departments each year. A centre does not need to provide a minimum sum of operations when applying for a quality certificate. It is, however, generally accepted that a large number of operative experiences are an absolute key factor for successful tumor control and optimal quality of life after such an operation.
Side effects and risks
Many patients are hesitant to have this operation due to their fear of losing continence and/or potency. These side-effects occur when the neurovascular bundles which are situated very close to the prostate are damaged or removed during the operation, or when the sphincter muscle for urine control cannot be completely spared.
However, removal of the tumor from the prostate while retaining the prostate is not an option. More than 80% of all prostate cancers are multifocal, i.e. there are many small tumor sources in the prostate. These cannot be seen with the naked eye during the operation. In order to establish if the tumor has extended through the capsule we perform a so-called frozen-section examination (NeuroSAFE) during the operation. This informs us if the nerves adjacent to the prostate can be spared or if they must also be removed.
The potency-preserving removal of the prostate and the retention of a fully undamaged sphincter muscle are strong points of the Martini-Klinik. The very fine layer which contains the neurovascular structure for continence and erectile function is carefully separated from the prostate and thus remains as an intact structure in the body. The sphincter muscle is retained in its full length. In most cases, continence and potency remain at pre-operation levels.
Various surgical procedures
The Martini-Klinik offers various surgical procedures:
- The full, open-surgical removal of the prostate, the so-called radical retropubic prostatectomy. In this procedure, the prostate is removed via a small incision in the lower abdomen. The operation is performed with micro-surgical technology and microscopic enlargement.
- Minimally-invasive, robot-assisted surgery with the da Vinci operation system. With the world-wide most modern laparoscopic operation system, the surgeon operates with the help of an “operation robot” which has at its disposal micro-surgical instruments and a camera system providing a three-dimensional picture. Three da Vinci operation systems are installed in the Martini-Klinik.
Being able to offer both surgical procedures in order to achieve the good results with regard to cancer recovery rates, continence and potency is an advantage of the Martini-Klinik. Either of the surgical procedures can be used to suit the individual patient’s symptoms. For most patients, both methods are equally suitable.
The surgeons of the Martini-Klinik are all specialized in the operation and conduct this procedure about 200 to 300 times a year. All together, the nine surgeons of the clinic completed more than 14.000 operations throughout the past 20 years.
The necessity of a blood transfusion after the operation is very low (3 - 5%). Therefore, patients who donate blood before theoperation do so for no reason and are weakend before the operation. For this reason, we do not advise to donate one's own blood beforehand.
No, the whole scope of modern treatment, compliant with the guidelines, is offered at the Martini-Klinik: Operation (open surgery or da Vinci-method), Radiation Therapy (Brachytherapy, external radiation), Active Surveillance and Hormonetherapy.
Yes, the Martini-Klinik is one of the few surgical clinics that retrieves the results of the patients having been treated here after one week, three months and afterwards yearly and that analyzes its data annually. The Martini-Klinik hires four employees to organise this - a service that is not included in most of the other surgical clinic's budgets. Results concerning the rate of cure, continence and virility are shown here. These results can be explained to every patient based on his tumor's individual characteristics.
Almost every patient's nerves are protected during operation to preserve the erectile function. This is not possible if single cells of the tumor have already spread to the nerves, which are delicately attached to the prostate gland's sides. As the only clinic in Germany, the Martini-Klinik investigates during the operationwhether the sides of the gland, touching the nerves, contain cancerous cells (Neuro-Safe-Technique).
Based on this finding it is then decided whether the nerves on both sides can be preserved or have to be removed. By this procedure, developped in the Martini-Klinik, 88 to 99 % of patients, depending on the tumor stadium (97 % in total) could undergo this nerve preserving procedure.
Already during the first weeks after surgery some patients have good urinary continence. After 3 months 2/3 of our patients reach a nearly perfect continence already. For some patients, the regain of urinary control may take longer than 3 months. This also depends on the individual risk factors involved, e.g. the size of the prostate prior to operation, previous operation on the prostate, age and accompanying illness.
Luckily, the infection rate is very low in our clinic. Consequently, the rate of infections with multi-resistant germs is rather low. The reason for this lies in the specialization of the clinic. Moreover, strict strategies of precaution concerning these infections are being met at the Martini-Klinik.
The stationary stay takes about a week.
We predict about 2 to 3 weeks for further recovery after discharge from our clinic. After this time, you are usually recovered to take up your daily procedures.
Yes, during every operation method a catheter is inserted. In general, it remains for one to two weeks after the operation.