ENProstate cancer surgery in Germany usually means radical prostatectomy: removal of the whole gland, an alternative to radiotherapy when the tumour has not spread beyond the prostate. If your doctor has offered this choice, you will want to know how the paths differ and what surgery involves. In short, for a confined tumour both give comparable control of the disease; they differ in side effects and in how recovery unfolds.
This page explains who is offered surgery, which approaches German departments use, how long the stay lasts, what happens to urination and erections and when radiotherapy is needed afterwards. It does not choose the method for you; for the disease and other treatments, see prostate cancer treatment in Germany.
When surgery is chosen
Surgery is usually chosen for a confined tumour when the risk is not low and many years of life lie ahead. Localised disease has three paths: active surveillance (regular checks instead of immediate treatment), surgery and radiotherapy; the German prostate cancer guideline recommends surveillance at low risk and offering surgery or radiotherapy at intermediate and high risk. The choice rests on the risk group (PSA, a prostate protein in the blood; Gleason score, the grade of the cancer cells; extent on MRI), age, other illnesses and what matters most to the man.
Younger, otherwise healthy men are often offered surgery, and it has clear advantages. The pathologist examines the whole removed gland. PSA should fall to undetectable levels, so follow-up is easy to read: any new rise shows clearly. If the disease returns, radiotherapy remains available.
Before deciding, the picture is clarified: prostate MRI, a biopsy guided by it and, at high risk, PSMA-PET, a scan looking for tumour in lymph nodes and bones. Decisions are not made on outdated results. See prostate cancer diagnosis in Germany.
What the surgeon actually does
The surgeon removes the whole prostate with the seminal vesicles and then joins the bladder to the urethra. Where the risk of lymph node involvement is meaningful, the nodes are removed in the same operation.
Nerve-sparing means keeping the nerve and vessel bundles along the sides of the gland, which erections depend on, unless this compromises complete removal of the tumour. It depends on the case: with a high risk that the tumour has breached the capsule on one side, sparing that side is not recommended. The surgeon should tell you before the operation, not after.
There are three approaches: open, through an incision in the lower abdomen above the pubic bone; laparoscopic, through small punctures; and robot-assisted, now the most widely used in Germany. None has proved superior in oncological or functional results; the evidence suggests the outcome depends less on technique than on the surgeon’s experience. Robot-assisted surgery, like laparoscopic, is linked to less blood loss and a shorter stay. More under robotic surgery in Germany.
The hospital stay and the first weeks
Patients usually spend several days on the ward. The operation takes a few hours under general anaesthetic (open surgery sometimes under spinal anaesthetic). A catheter stays in for some days while the join between bladder and urethra heals and is removed on the clinic’s schedule, which decides how long you stay in the country.
The pathologist examines all removed tissue, and that report (tumour at the cut edge or not, nodes involved or not) decides whether additional therapy is needed. It takes several days and is worth waiting for.
You go home with a pelvic floor exercise plan, the date of the first PSA test, lifting rules and the warning signs that mean calling the clinic.
Urination, erections, recovery
Leaking urine after catheter removal is expected, not a complication; in most men it lessens over weeks and months. The main tool is regular pelvic floor training with a physiotherapist. In Germany a rehabilitation programme, the Anschlussheilbehandlung (AHB), is usually offered after this operation.
Erections depend on whether the nerves were spared, on age and on prior function. Recovery is slow, up to a year and beyond, supported with medication and aids. Fathering a child naturally is no longer possible once the gland is removed, so discuss this beforehand.
Follow-up means PSA tests on a schedule. A rise is the signal to discuss further treatment, most often radiotherapy to the area of the operation, sometimes with hormone therapy. See prostate cancer radiotherapy in Germany for this possible next step.
Who operates, and what to ask
A urologist operates in a department working as a uro-oncology centre with pathology, radiology and radiotherapy. One example among AlenMed’s partners is Prof. Boris Hadaschik, director of the urology clinic and head of the uro-oncology centre at University Hospital Essen.
Ask how many such operations the surgeon does a year, whether nerve-sparing and node removal are planned, which approach and why, when the catheter comes out, who runs rehabilitation and what the written estimate covers.
Frequently asked questions
How many days do I need to spend in Germany for the operation?
The clinic sets the exact time in its plan: consultation and further tests, the operation, several days on the ward and catheter removal. The histology report, which decides on further treatment, is worth waiting for, so book the return journey with a margin.
How long does urine leakage last after prostate removal?
In most men it lessens gradually over weeks and months after the catheter comes out. How long cannot be said in advance; it depends partly on age and on continence before surgery. The main help is regular pelvic floor exercise, first with a physiotherapist, then at home.
Will erections come back after the operation?
No one can say in advance. Chances are better if the nerves were spared on both sides, the man is younger and erections were good before surgery. Recovery is slow, up to a year and beyond. Tablets come first; if they fail, injections into the penis or a vacuum pump can help.
How AlenMed arranges the operation in Germany
AlenMed arranges the whole trip: reviewing documents, matching a department, booking the consultation and tumour board, translating reports and images, a written estimate before travel, the visa invitation, and an interpreter at appointments and on the ward.
Plan for the days the work-up, surgery and catheter removal take, where to stay meanwhile, how to get the operation report and histology in a language you read, and how to continue follow-up at home. For what the bill covers, see the cost of prostate cancer treatment in Germany.
This material is for information only and is not an offer. The indication and the method are decided by a doctor in person.
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