Prostate Surgery Abroad

Treatment for Prostate Cancer in Germany

Minimally invasive and gentle treatment techniques such as Brachytherapy can not only achieve excellent and superior cure rates, but at the same time preserve a high quality of life.

Brachytherapy Experts in Germany

Brachytherapy is a new, gentle form of treatment for patients with localised prostate carcinoma.

There are two basic techniques of brachytherapy:

  • Seed Implantation (LDR Brachytherapy)
  • Afterloading Therapy (HDR Brachytherapy)

Brachytherapy has experienced increasingly widespread use in the United States over the past 25 years.

It has established itself as a standard procedure alongside total surgical removal of the prostate.

Brachytherapy in Germany - Especially gentle for the patient

For patients, this method has decisive advantages:

  • It is minimally invasive, i.e. particularly gentle.
  • It can be done on a short-stay basis.
  • It has significantly lower side effects and higher potency rates than surgical prostate removal.

At this specialised Prostate Clinic in Germany, Brachytherapy is one of the main focuses.

Patients are cared for in close cooperation between urologists and radiation therapists.

The successful cooperative collaboration has already proven itself in over 8500 treatments.

Seed Implantation in Germany

Seed implantation is a state-of-the-art radiotherapeutic procedure that is used for patients with localised prostate cancer.

Under constant ultrasound monitoring, up to 80 short-beam, tiny radiation sources (so-called "seeds") made of iodine are implanted into the prostate under general or partial anaesthesia. This is done with the help of puncture needles, which are placed at precisely pre-calculated positions in the prostate using a coordinate targeting system. The seeds are placed at the desired position in the prostate, where they remain to develop their radiation effect on the prostate carcinoma.

Seed implantation quickly and efficiently:
  • The procedure is performed as a short inpatient procedure.
  • It lasts approx. 60 to 90 minutes.
  • The patient can usually leave the clinic the day after the procedure.
  • 4 weeks after implantation, the correct position of the seeds is checked by CT.
  • The PSA progression is determined by quarterly PSA checks.
Fewer side effects with seed implantation than with radical surgery

In the early stages of prostate cancer, seed implantation is considered to be an equally effective procedure to radical surgery, but is much gentler on the patient. Incontinence is practically non-existent and impotence is much less common (10-30 percent) after three years than after surgery. In addition, erectile dysfunction does not occur immediately as with surgical removal of the prostate, but develops graduallyAfterloading

Afterloading

The most effective and at the same time most gentle treatment for advanced or aggressive prostate cancer is Afterloading.

In this form of brachytherapy, a high-dose radiation source is briefly introduced into the prostate.

This proven treatment method is based on remote-controlled "afterloading" of the iridium radiation source into puncture needles inserted through the perineum. The radiation source is focused for a certain time at precisely calculated positions. In this way, an optimal dose distribution is achieved.

Depending on the findings, this treatment is performed 3 to 4 times under a short anesthesia, each time at an interval of about 1 week.

Internal and external irradiation - an effective combination

The most effective and useful treatment for advanced or aggressive prostate cancer is HDR afterloading combined with external beam radiation.

The advantage of HDR afterloading therapy over external irradiation alone is that a maximum dose increase can be achieved by precisely targeting the prostate while reducing the radiation dose to the surrounding organs at risk, especially the rectum and urinary bladder. Complications and stress for the patient are thus greatly reduced.

Combined afterloading therapy is particularly effective for locally advanced prostate carcinomas without distant metastases, as it includes a large safety zone around the prostate and also covers the neighboring lymph nodes. This large safety zone makes it clearly superior to surgery.

External Irradiation

External beam radiation is used in all stages of prostate cancer - Leading Prostate specialists in Europe

Whereas external beam radiotherapy was long considered a poorer alternative to prostate removal, today, thanks to state-of-the-art technology, very high radiation doses can be delivered while sparing the neighboring organs as much as possible, since the load on healthy tissue can be calculated precisely before treatment begins.

Modern Radiotherapy for Prostate Tumours

Today, external radiation therapy is only performed with modern linear accelerators. A linear accelerator is comparable to a giant X-ray tube, with which a high-energy photon and electron radiation can be artificially generated. This radiation is capable of destroying rapidly growing tumor tissue. In order to ensure that the beam destroys the tumour in a very targeted and thus gentle manner, elaborate techniques are used to produce as few side effects as possible for the patient.

Conformal 3-D irradiation

3-D conformal irradiation of a tumour is the standard therapy currently used in Germany.

In this process, a 3-D model is used to calculate an irradiation plan in the computer with special software, in which the individual irradiation fields are individually adapted or collimated to the patient's anatomy with a so-called Multi Leaf Collimator (MLC).

Such an MLC consists of 120 individual lead lamellae, which can shape the beam individually and adapt (conform) it to the position of the tumoru with millimeter precision. This can significantly reduce side effects.

Intensity Modulated Radiation Therapy (IMRT)

IMRT is a further development of 3-D conformal radiotherapy. In this innovative technique, the lead lamellae (MLC) can also move in and out of the beam path during irradiation and thus modulate the intensity of the radiation dose within the irradiation field.

This technique has great advantages, especially in the irradiation of prostate cancer, as organs that are particularly sensitive to radiation, such as the intestine and the urinary bladder, can be spared even more.

Image Guided Radiation Therapy (IGRT)

Another new innovative technique of modern radiotherapy is "Image Guided Radiotherapy" (IGRT), with which 3-D imaging (Cone Beam CT) can be generated during the ongoing irradiation and thus the accuracy of the irradiation fields can be checked even more precisely.

Thus, an extreme precision of irradiation can be achieved, which leads to a significantly lower side effect rate but also to an improved effect at the same time. This method offers great advantages, particularly in the irradiation of prostate carcinomas. Before starting the irradiation, 3 gold marker seeds are implanted in, which are detected by the Cone Beam CT and a deviation, no matter how small, can be corrected immediately.

Breath-guided irradiation (4-D irradiation)

When irradiating organs or tumours that can move during breathing, this technique makes it possible to detect the target region only when it is in a specific breathing position. This "breath gating" is particularly used in the irradiation of breast cancer to spare the lungs and in the treatment of lung tumors that move during radiation therapy.

Radical Prostate Surgery

If the prostate carcinoma is confined only to the organ, there is also the option of surgical removal of the prostate in addition to local internal or external radiation therapy.

The long-term results of surgery are equivalent to those of brachytherapy in early stages.

Radical prostatectomy (removal of the prostate) can be performed with an abdominal incision, perineal incision or laparoscopically during laparoscopy. The choice of procedure depends primarily on the surgeon's experience with each technique.

Hormone Therapy

Testosterone controls the development and activity of the healthy prostate.

Due to changes in hormone distribution, fluctuations and imbalances in the male hormone balance occur with age. The result is growth of benign but also stimulation of malignant prostate cells.

Prostate cancer cells normally require male sex hormones (androgens), especially testosterone, to grow.

This realisation results in one of the most important pillars of prostate cancer drug therapy:

Suppression of testosterone action on the prostate, leads to slowing of prostate (cancer) cell growth and, in some cases, cell death (apoptosis).

The aim of hormone therapy is therefore to deprive the tumor of these androgens. GnRH agonists or so-called anti-androgens are used. While GnRH agonists inhibit the production of testosterone in the testes, anti-androgens block the effect of the hormones on the tumor cells.

Even if no cure can be achieved with hormone therapy, tumour growth can be delayed for some time - often for years - and symptoms alleviated in 80 percent of patients.

Lymphadenectomy

If the tumour has metastised to the lymph nodes, the disease is no longer in an early stage and can only be completely cured in rare cases.

Unfortunately, computed tomography (CT) and magnetic resonance imaging (MRI) are of very limited value in detecting microscopic involvement of the lymph nodes.

If there is an increased risk of lymph node involvement - which can nowadays be calculated in advance - lymph node tissue can therefore be removed and examined by means of a small operation.

This risk of lymph node involvement depends on certain criteria (tumour stage, PSA value and Gleason score of the tumour).

The operation can be performed through a small lower abdominal incision or laparoscopically and involves a hospital stay of a few days. The side effects are very low. Lymph node tissue is taken from precisely defined locations and examined by a pathologist under the microscope.

Thanks to modern forms of radiation therapy, however, the radiation field can now be defined so precisely and limited to the lymphatic drainage pathways that the possible side effects have been extremely reduced.

PSMA Therapy of Metastatic Prostate Cancer - Prostate Treatment in Germany

Lutetium-177-PSMA therapy is a novel nuclear medicine procedure for the treatment of metastatic castration-resistant prostate cancer. It is considered in patients who have exhausted all other treatment options (chemotherapy, hormone therapy) and have further progression of the disease. 

What is PSMA therapy?

PSMA stands for Prostate-Specific Membrane Antigen, a protein that is increasingly found on the cell surface of prostate cancer cells.

According to the "key-lock" principle, the radioactive substance (lutetium-177) binds to the PSMA and is introduced into the cancer cells. The radiation accumulated there destroys the tumour cells in a targeted manner while largely sparing the surrounding tissue.

Lutetium-177 PSMA therapy cannot cure the tumour, but it can slow its growth and alleviate symptoms. The mechanism has already been used successfully for several years in the recurrence diagnosis of prostate cancer.

Benign Prostate Enlargement Treatment in Germany

Benign Prostate Elargement is not malignant and initially harmless - not to be confused with prostate cancer - and is therefore also called benign prostate enlargement or benign prostatic hyperplasia (BPH).

Nevertheless, symptoms caused by benign prostate enlargement can severely impair the quality of life of those affected and can lead to complications and late effects.

Symptoms and complaints

The increase in size and narrowing of the urethra may cause Obstructive problems eg urination issues and Irritative symptoms eg bladder urgency symptoms.

If BPH is not treated, it can lead to significant complications such as painful inflammation in the urinary tract and bladder, urinary retention or kidney failure.

Treatment for BPH in Germany

The goal of therapy should always be to eliminate problems and to eliminate the obstruction to a large extent.

The therapeutic options depend on the extent of the obstruction and the intensity of the irritative symptoms.

Medication - Natural / Prescription Medication for BPH

For early stages of BPH, therapy with herbal extracts has a long tradition and is particularly well established in Germany. Herbal preparations made from sabal fruit extract (saw palmetto), pumpkin seeds, stinging nettle roots, trembling papules, red coneflower and rye pollen have proved successful. If no success can be achieved with herbal preparations, chemically produced drugs are used, which on the one hand can relax the muscle cells located in the prostate or also cause the prostate to swell down.

Surgery for BPH

The standard procedure is the classic excision of the prostate. TURP - Transurethral prostate resection.

In this procedure, the glandular portion of the prostate around the urethra is hollowed out with an electric snare.

State-of-the art Laser Treatment for BPH in Germany

State-of-the-art Laser treatment is a gentle procedure.

Bleeding is reduced by the simultaneous tissue-removing and hemostatic effect of the procedures, and the healing time is significantly shortened. Men with a large prostate and men who are exposed to an increased risk of bleeding due to taking anticoagulant medication benefit from this in particular.

This clinic is one of the very few specialised Prostate treatment clinics in Europe to offer both TURUS reservation and vaporisation as well as state-of-the-art laser procedures including Greenlight Laser Therapy, Diode Laser Procedure and the HOLEP (Holmium Laser Enucleation) procedure.

HoLEP is currently one of the most advanced and least bleeding procedures for the treatment of benign prostate enlargement.

This world class prostate clinic is equipped with a latest generation holmium laser, the MultiPulse HoPLUS from JenaSurgical.