Prostate cancer surgery in Germany: choosing the best clinic

In recent years, medical tourists are interested in the prostate cancer surgery in Germany because of it's outstanding results and affordable price.

Prostate cancer is the most common malignant tumor and the third cause of cancer death among men in Germany and other developed countries.

The number of cases is steadily increasing, which is facilitated by the increasing life expectancy and the more active use of PSA (prostate-specific antigen) blood test.

Unlike morbidity, mortality has dropped dramatically since the mid-1990s.

Prostate tumors grow relatively slowly compared with other cancer types.

Mass screening, including a PSA blood test, usually reveals the disease in its very early stages, providing high chances for complete recovery.

Diagnosis of prostate cancer in Germany is developing rapidly.

However, if a malignant tumor is suspected, only a biopsy (analysis of a tissue sample) may give a definite answer. Tumor growth zones are best detected with new ultrasound techniques that help targeting a needle during a biopsy.

If prostate cancer is diagnosed, further studies are scheduled to evaluate the aggressiveness and disease stage (staging I-IV).

Complete removal of the prostate gland (radical prostatectomy) is the most widely used and proven method today.

Previously, prostatectomy was performed through an open access (a small incision in the lower abdomen) using an optical microscope.

The approximate cost of prostatectomy in Germany is 10,000-16,000 euros.

Today, German surgeons mainly use minimally invasive techniques, and robotic prostatectomy is available in some clinics. Da Vinci® system significantly increases the accuracy of the surgeon's hand movements, which is key to improving the procedure results and reducing the risk of complications.

Thanks to a more effective 3D visualization, the accuracy of prostate cancer surgery is steadily increasing. Severe permanent complications such as urine incontinence or erectile dysfunction are less common.

Since 2007, Martini-Klinik Prostatakarzinom Zentrum surgeons, in collaboration with the University Medical Center Hamburg-Eppendorf, have performed a robotic prostatectomy more than 2,000 times.

How to find the best clinic for prostate cancer surgery in Germany?

The best prostate cancer treatment centers are certified by the German Cancer Society as Prostatakrebszentrum. To obtain this certificate, they must meet strict standards, which go beyond the capabilities of an ordinary municipal hospital.

This includes the structure of the collaborating network, the documentation and effectiveness of every single procedure, and the number of internal standards. But even certified centers differ in statistics. Some perform 100 surgeries per year, other clinics cross over 2000 procedures annually with excellent results.

Many international studies show that the quality of prostate surgery largely depends on the experience of medical personnel. This is true not only in relation to the risk of cancer recurrence, but also in terms of pain and surgical complications.

Therefore, the best results are demonstrated by such clinics where the surgeon and the surgical team have gained enough experience in prostate removal. Regardless of other minor issues, surgical experience is the main factor. According to studies, risk of urinary incontinence (a frequent complication of prostatectomy) is 11 times higher in ordinary clinics than in specialized centers. In order to choose the best clinic and the best surgeon, it is useful for the patient to know about the number of procedures performed by particular surgical team.

The private clinic Martini-Klinik in Hamburg employs several senior specialists who can provide unprecedented quality of treatment. Each of these experienced surgeons performs 200-300 prostate surgeries annually.

Unlike most medical institutions, Martini-Klinik publishes detailed statistics of surgical procedures. This is the best indicator of treatment quality.

Is prostatectomy always necessary?

According to Dr Lars Budäus, head of the Prostate Cancer Center at the University Hospital Hamburg-Eppendorf, many men do not need prostatectomy at all.

If it comes to the treatment tactics, doctor need to consider not only cancer aggressiveness and stage. With slow-growing neoplasms, life expectancy of patients plays an important role. Older men suffering from severe comorbidities may not benefit from prostatectomy, but surgical risk is still there. In such patients with a slowly growing low-aggressive tumor (especially if it is diagnosed at a very early stage), active surveillance may be the best option.

Doctors monitor the disease progression using PSA blood test and frequent biopsies. After rapid progression, a surgery is done immediately. But you may never need it. If there is a cancer recurrence after the surgery or radiotherapy, or there are metastases in the bone, lymph nodes or internal organs at the time of initial diagnosis, the doctor will prescribe a systemic drug therapy.

Surgery in these cases is usually ineffective.

Our recommendations

Cancer care must be comprehensive. It is not limited to a surgeon, but involves numerous experts, including medical oncologist, radiologist, psycho-oncologist, radiation oncologist, anesthesiologist, physical therapist, etc.

Each medical team member must be well-trained and competent to achieve optimal results of prostate cancer treatment. Such comprehensive quality care can be obtained at specialized centers for prostate cancer surgery in Germany, including the university hospitals in Berlin, Frankfurt, Hamburg, and others.

© Analytical reviews and oncology news by K. Mokanov: clinical pharmacist and professional medical translator