Radical prostatectomy

The radical prostatectomy

Why prostate surgery (also known as radical prostatectomy, surgical removal, robotic surgery, keyhole surgery, or Da Vinci surgery) cannot “cure” prostate cancer.

It is often claimed that for prostate cancer, surgical removal of the prostate – radical prostatectomy (also referred to as prostate surgery, prostate removal or Da Vinci surgery) – is the only “safe” treatment method. Since the cancer is located in the prostate, it would be completely removed from the body, along with the prostate. Prostate gone, cancer gone.

At first glance plausible, but wrong.

Because even after the removal of the prostate, the cancer can come back, exactly where the prostate was removed. Radical with or without da Vinci robot. This is referred to as a local recurrence.

Local recurrence after prostatectomy

No contradiction but quite normal

Neben biochemischen Rezidiven und Metastasen welche traditionell gerne auf den „verpassten Zeitpunkt“ vor der Streuung geschoben werden, gibt es auch die sogenannten Lokalrezidive. Und diese Lokalrezidive treten nach der Prostataoperation häufig auf. Nach der Entfernung eines relativ ungefährlichen Prostatakarzinom wächst der Krebs innerhalb von 5 Jahren in 2 – 17% aller operierten Männer nach, bei gefährlichen Karzinomen  in 10 bis 60% aller Fälle (für genaue Angaben und einen Selbsttest siehe: Han Tables, Johns Hopkins University). Und das, wenn der Krebs noch auf die Prostata beschränkt ist, der Chirurg also den „gesamten“ Krebs zusammen mit der Prostata entfernt hat (man spricht auch von „negativen Schnitträndern“).

Prostatakrebs ist wie jeder Krebs immer systemisch

distributed throughout the body – never just locally

At the latest since the availability of the so-called “liquid biopsy”, we know that the old idea of cancer as a local ulcer is wrong. Cancer cells and their secretions and exosomes are always distributed throughout the body – and can therefore also be detected in the blood, precisely as a “liquid biopsy” by taking and analyzing blood or other body fluids. Individual cancer cells are therefore also embedded in the connective tissue around the prostate. Normally, these cancer cells are kept in check (dormant state) or killed by the immune system. If the immune defense fails, these individual cancer cells can grow into recurrences or metastases, small local cancerous tumors. Only when these growths consist of millions of cells, i.e. reach macroscopic sizes of at least a few millimeters, and have found a connection to the bloodstream can they be detected by MRI or PET.

Local therapies such as
the prostatectomy
reduce the tumor mass

only the immune system can heal

Because doctors have not yet been able to locate or reliably destroy the individual cancer cells scattered throughout the body, physicians cannot cure cancer patients. The treatment of cancer is limited to a reduction of the tumor mass – “tumor mass reduction” – an important therapeutic concept that makes it easier for the immune system to attack the remaining tumor cells in the body. The type of treatment thus becomes less important: whether radical or nerve-sparing surgery with or without da Vinci robot, radiotherapy, HiFU or irreversible electroporation, is irrelevant; what counts is the reduction of tumor mass. This makes it all the more important to minimize these and to keep the possibility open for follow-up therapies. This is the reason why we currently mainly use Irreversible Electroporation (IRE). It is the first therapy that has tissue selectivity but is repeatable and does not block subsequent therapies.

Radical” prostatectomy

as nonsensical as Halsted’s radical breast surgery

At the end of the 19th century, the American surgeon Halsted tried to cure women of breast cancer by increasingly radical operations; he removed not only the breast, but finally also larger parts of the chest and shoulders of the affected women. Without success. Today, usually only the tumor is removed from the breast (possibly in combination with chemotherapy or radiotherapy), and the breast is preserved. And the affected women live longer. The history of prophylactic removal of all lymph nodes in breast cancer was similar. Fortunately, this has also been abolished and lymph nodes are selectively removed, if at all, only according to scientifically proven guidelines.

These tragic experiences continue to be ignored in the treatment of prostate cancer. Men with prostate cancer are still mutilated, 70% become impotent, 10 to 50% incontinent – most with no significant survival benefit: operated and non-operated men live the same length of time in many cases.

This fact forms the basis for focal therapy but also the background for the Watchful Waiting and Active Surveillance recommendation of some subgroups, which however is often not sufficiently pointed out to the patient.

At the VITUS PRIVATKLINIK, we provide you with comprehensive information about all treatment options for prostate cancer and also inform you about possible alternatives.

Get in touch with us. We will be happy to advise you.

Conclusion for men with prostate cancer: