Prostate cancer.

What are the advantages and disadvantages of surgical removal of the prostate in cases of prostate cancer?

Surgical removal of the prostate (prostatectomy) with the tumour tissue is considered an effective treatment for prostate cancer. Prostate removal promises the greatest success if the tumour has not yet spread and the biopsy has revealed that the tumour has not progressed too much. With a radical prostatectomy, i.e. the complete removal of the prostate gland, the goal is to cure the cancer. This operation involves the removal of the entire prostate, together with the urethra that runs through it, the seminal vesicles and the vas deferens, part of the bladder neck and possibly adjacent lymph nodes.

The operation is performed via a lower abdominal incision, a laparoscopy with an endoscope, or via the perineum. The choice of surgical technique depends on the results of the preliminary examination and the aggressiveness of the tumour.

Prostate surgery can lead to incontinence and impotence despite improvements in methods

Despite improved surgical techniques, incontinence and erectile dysfunction remain the most common side effects of prostatectomy surgery. Incontinence means that the man may be unable to control the flow of his urine properly. In such cases, the operation affects the delicate functional balance between the sphincter at the outlet of the bladder, the pressure of a filled urethra on the prostate, and the urethral sphincter system below the prostate. If erectile dysfunction occurs after surgery, spontaneous erectile function is impaired. This does not mean that sexual pleasure and orgasm are no longer possible. However, after removal of the prostate, semen can no longer be produced, and therefore only a “dry” orgasm is possible.

Minimally invasive procedures can reduce the side effects of a radical prostatectomy

The ability to obtain an erection is impaired if the urologist responsible for removing the prostate is unable to preserve the nerve fibres surrounding the gland. The surgeon always has to strike a balance between preserving these nerves and removing the tumour completely. Modern medical research has long been focusing on how to avoid these very stressful side effects for men. With new methods such as TULSA (the removal of tumour tissue in the prostate using high-intensity ultrasound), typical side effects like incontinence and impotence can potentially be avoided in patients for whom this form of therapy is suitable.