[Possibilities of surgical therapy in prostatic carcinoma]

Radical surgical treatment of localized prostate cancer is performed to heal the patient of his malignant disease. Surgery for advanced prostate cancer, e.g. transurethral resection for obstruction or hemorrhage, is always a palliative modality and has to be seen in the context of systemic treatment. Radical prostatectomy is a major intervention which allows complete removal of the prostate gland and the seminal vesicles at the same time. Due to resection at the distal end of the prostatic urethra, the bladder sphincter system is partially destroyed. In general, to guarantee radicality, the erectile nerves and vessels are sectioned, resulting in erectile impotency. Preservation of these structures to maintain potency is indicated only exceptionally. Radical prostatectomy is today a routine operation with minimal mortality (0.5-1%) and minor complication rate. Average hospitalization is about 10 days. Long-term postoperative morbidity is characterized by urinary incontinence and erectile impotency. Incontinence takes a long time to heal. A certain number of patients will keep a generally not very bothersome stress dribbling; however, some may show complete leakage, necessitating an anti-incontinence operation. For an indication of radical prostatectomy, two essential factors have to be considered: the usually extremely slow growth of prostate cancer and the high prevalence of clinically insignificant latent carcinomas. It is for these reasons and for the consequences on live quality that radical prostatectomy should not be performed on patients with a life expectancy of less than 10 years.