{"product_id":"preventative-prostate-removal-hope-for-high-risk-men-living-in-fear-of-prostate-cancer","title":"Preventative Prostate Removal: Hope for High-Risk Men Living in Fear of Prostate Cancer","description":"\u003cp\u003eThis study from the Martini-Klinik Prostate Cancer Centre in Hamburg, Germany, examined seven men who chose to have their prostate gland surgically removed as a preventative measure because of their high risk of developing prostate cancer (PCa). The researchers found that 71% of these men actually had prostate cancer in their removed prostates, and all seven achieved excellent functional outcomes — full continence and erections firm enough for intercourse at 12 months after surgery. The men's distress scores dropped dramatically from 7.7 before surgery to 1.3 afterward, and no patient regretted the decision. This rare procedure offers hope for a select group of men whose fear of prostate cancer significantly affects their quality of life.\u003c\/p\u003e\n\n\u003ch1\u003ePreventative Prostate Removal: Hope for High-Risk Men Living in Fear of Prostate Cancer\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#background\"\u003eWhy This Research Matters: The Fear of Prostate Cancer\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#patients\"\u003ePatient Characteristics: Who Were the 7 Men?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#outcomes\"\u003eKey Findings: Functional and Cancer Outcomes\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#interviews\"\u003eThe Patient Experience: Insights From In-Depth Interviews\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#discussion\"\u003eWhat Do These Results Mean?\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations: What This Study Couldn't Prove\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations: What This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn a study of seven high-risk men, 71% had prostate cancer in prostates removed preventatively.\u003c\/li\u003e\n\u003cli\u003eAll seven men achieved full continence and erections firm for intercourse 12 months after surgery.\u003c\/li\u003e\n\u003cli\u003eDistress scores fell from 7.7 to 1.3 after preventative prostate removal, with no decision regret.\u003c\/li\u003e\n\u003cli\u003eNo cancer was clinically insignificant; cancers had potential to progress given patients' young ages.\u003c\/li\u003e\n\u003cli\u003ePreventative prostate removal is rare, experimental, and requires experienced surgeons and careful selection.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eWhy This Research Matters: The Fear of Prostate Cancer\u003c\/h2\u003e\n\n\u003cp\u003eProstate cancer is one of the most common cancers in men, but not every man faces the same risk. This study focuses on a specific group: men with a strong family history of the disease who live in constant fear of developing it. \u003cstrong\u003eThe risk of prostate cancer is substantially higher for men with affected relatives\u003c\/strong\u003e. The relative risk is 2.6 for a man with one first-degree relative (father, brother, or son) who has been diagnosed with prostate cancer, and it jumps to 5.1 for men with two or more first-degree relatives previously diagnosed with the disease.\u003c\/p\u003e\n\n\u003cp\u003eKnowing about one's own elevated risk creates emotional and mental stress, and can even lead to mental health conditions such as depression. This anxiety is not unfounded — men with a genetic risk often witness the progression and suffering of prostate cancer through the experience of a relative, which creates a significant mental burden.\u003c\/p\u003e\n\n\u003cp\u003eSome men respond to this burden by actively seeking ways to deal with the possibility of getting prostate cancer and to control the consequences of treatment. For women, preventative surgery is already an accepted option — \u003cstrong\u003eprophylactic ovariectomy (removal of the ovaries) and mastectomy (removal of the breasts) are sometimes proposed for women with BRCA2 gene mutations\u003c\/strong\u003e to avoid the risk of organ cancer. But until now, no studies had evaluated preventative treatment options for men at higher risk of developing prostate cancer. This study is the first to explore whether preventative radical prostatectomy (pRP) — surgically removing the prostate before a cancer diagnosis — could be a viable option for these men.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eStudy Methods: How the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eResearchers at the Martini-Klinik Prostate Cancer Centre, part of the University Hospital Hamburg-Eppendorf in Germany, searched their prospectively maintained database to identify patients who underwent radical prostatectomy between 2012 and 2021 without having a prostate cancer diagnosis before surgery. From a database of \u003cstrong\u003emore than 23,500 patients treated with surgery during this period\u003c\/strong\u003e, they found just seven such patients, highlighting just how rare this procedure is.\u003c\/p\u003e\n\n\u003cp\u003eAll patients had at least one of the following: a strong positive family history of prostate cancer, suspicion of prostate cancer on magnetic resonance imaging (MRI), or persistent suspicion of prostate cancer despite negative prostate biopsies. Every surgery was performed by one of two highly experienced, high-volume surgeons.\u003c\/p\u003e\n\n\u003cp\u003eTo be eligible, patients had to meet specific criteria. Each patient was seen by the treating surgeon at least twice — usually together with their spouse — and gave personal consent for pRP surgery. After giving consent, a \u003cstrong\u003e4-week waiting period\u003c\/strong\u003e was left before surgery to give all patients sufficient time to think over their decision.\u003c\/p\u003e\n\n\u003cp\u003eFunctional outcomes were measured using the \u003cstrong\u003eExpanded Prostate Cancer Index (EPIC-26)\u003c\/strong\u003e questionnaire, a validated tool that assesses quality of life, continence, and erectile function at 12 months after pRP. All patients were prescribed penile rehabilitation following the results of the REACTT trial: \u003cstrong\u003e3 months of 5 mg tadalafil (Cialis) taken daily\u003c\/strong\u003e. All seven patients adhered to this recommendation.\u003c\/p\u003e\n\n\u003cp\u003eContinence was defined as using up to one safety pad per day. Distress was measured using the \u003cstrong\u003eNational Comprehensive Cancer Network (NCCN) distress thermometer\u003c\/strong\u003e, a scale from 0 to 10, taken the day before surgery and again at 12 months after pRP. Decision regret was assessed at 12 months using a five-item instrument with answers on a 5-point scale from \"absolutely agree\" to \"absolutely disagree.\"\u003c\/p\u003e\n\n\u003cp\u003eOncological outcomes were evaluated as survival free from prostate-specific antigen (PSA) recurrence — defined as \u003cstrong\u003ePSA less than 0.1 ng\/ml\u003c\/strong\u003e — and overall survival. Complications within 90 days were classified using the Clavien-Dindo classification system.\u003c\/p\u003e\n\n\u003cp\u003eIn addition to the quantitative measures, the researchers conducted \u003cstrong\u003esemistructured interviews\u003c\/strong\u003e with all seven patients between August and September 2023. These in-depth interviews explored each patient's entire experience — from motivation and decision-making to post-surgical quality of life. The recordings were transcribed into 67 pages of text, and each interview lasted an average of 30 minutes (range 16 to 53 minutes). All recordings were anonymised in accordance with data protection regulations.\u003c\/p\u003e\n\n\u003ch2 id=\"patients\"\u003ePatient Characteristics: Who Were the 7 Men?\u003c\/h2\u003e\n\n\u003cp\u003eThe seven men ranged in age from \u003cstrong\u003e37 to 57 years, with a median age of 54\u003c\/strong\u003e at the time of surgery. Six of the seven (86%) had a positive family history of prostate cancer. Their median PSA level was 2.5 ng\/ml (range 1.5 to 7.0 ng\/ml). Notably, all seven patients were highly educated — five were medical doctors, one held a master's degree in engineering, and one had a background in business administration.\u003c\/p\u003e\n\n\u003cp\u003eEach patient had a unique story, as detailed in the study:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 1\u003c\/strong\u003e (47 years old, surgery in 2012): PSA 2.5 ng\/ml, one family member with prostate cancer. He had a previous 12-core biopsy showing ASAP\/HGPIN and an MRI with a PI-RADS 2 score. The removed prostate showed HGPIN only, not cancer.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 2\u003c\/strong\u003e (54 years old, surgery in 2014): PSA 5.5 ng\/ml, father with prostate cancer. Previous biopsy showed ASAP, MRI showed PI-RADS 3. The removed prostate had pT2, R0, Grade Group 1 cancer.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 3\u003c\/strong\u003e (55 years old, surgery in 2015): PSA 1.7 ng\/ml, three brothers with prostate cancer. Previous biopsy showed HGPIN, no MRI performed. The removed prostate was benign (no cancer found).\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 4\u003c\/strong\u003e (56 years old, surgery in 2016): PSA 2.1 ng\/ml, brother and father with prostate cancer. Previous fusion biopsy showed HGPIN, MRI showed PI-RADS 4. The removed prostate had pT2, R0, Grade Group 2 cancer. He used tadalafil on occasion to improve erectile function.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 5\u003c\/strong\u003e (37 years old, surgery in 2017): PSA 1.5 ng\/ml, grandfather and father with prostate cancer (one died of the disease). No prior biopsy or MRI. The removed prostate had pT2, R0, Grade Group 1 cancer.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 6\u003c\/strong\u003e (49 years old, surgery in 2019): PSA 6.1 ng\/ml, one family member with prostate cancer. No prior biopsy or MRI. The removed prostate had pT2, R0, Grade Group 2 cancer. He used tadalafil on occasion to improve erectile function.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePatient 7\u003c\/strong\u003e (57 years old, surgery in 2021): PSA 7.0 ng\/ml, one family member with prostate cancer. No prior biopsy, MRI showed PI-RADS 4. The removed prostate had \u003cstrong\u003epT3a, N0, R0, Grade Group 2 cancer\u003c\/strong\u003e — meaning the cancer had spread slightly beyond the prostate capsule (non-organ-confined disease).\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eFour of the seven men had undergone at least one prostate biopsy before pRP, which revealed high-grade prostatic intraepithelial neoplasia (HGPIN — a pre-cancerous condition) or atypical small acinar proliferation (ASAP — abnormal cells that are suspicious but not diagnostic of cancer). All seven patients underwent pRP with \u003cstrong\u003ebilateral nerve-sparing\u003c\/strong\u003e, a technique that preserves the nerves on both sides of the prostate that are essential for erectile function.\u003c\/p\u003e\n\n\u003ch2 id=\"outcomes\"\u003eKey Findings: Functional and Cancer Outcomes\u003c\/h2\u003e\n\n\u003ch3\u003eWhat the Pathology Showed\u003c\/h3\u003e\n\n\u003cp\u003eDespite none of the men having a prostate cancer diagnosis before surgery, \u003cstrong\u003efinal pathology revealed prostate cancer in 71% of cases\u003c\/strong\u003e (five of seven patients). Two patients had International Society of Urological Pathology (ISUP) \u003cstrong\u003eGrade Group 1\u003c\/strong\u003e disease (the least aggressive form), and three had \u003cstrong\u003eGrade Group 2\u003c\/strong\u003e disease. One patient had pT3a disease, meaning the cancer had extended beyond the prostate capsule. Notably, none of these cancers was considered clinically insignificant, suggesting a relevant cancer burden existed at the time of surgery with high potential to progress given the patients' young ages and long life expectancy.\u003c\/p\u003e\n\n\u003cp\u003eTwo patients had no prostate cancer in their removed prostates at final pathology. One of these had HGPIN. It remains uncertain whether these two men would have developed prostate cancer at an older age if their prostate had not been removed.\u003c\/p\u003e\n\n\u003ch3\u003eFunctional Outcomes at 12 Months\u003c\/h3\u003e\n\n\u003cp\u003eAt 12 months after pRP, the functional results were excellent across the board:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003e100% of patients were fully continent\u003c\/strong\u003e (defined as using no more than one safety pad per day)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003e86% had no problems with voiding\u003c\/strong\u003e, and 14% had only very slight problems\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAll seven men had erections firm enough for intercourse\u003c\/strong\u003e, and erections were possible whenever they wanted\u003c\/li\u003e\n  \u003cli\u003eOnly two patients used \u003cstrong\u003e5 mg tadalafil on occasion\u003c\/strong\u003e; the other five did not need any medical support for erectile function\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese outcomes are particularly impressive because the pRP was performed at younger ages (range 37 to 57 years) than typical prostate cancer surgery. The study notes that because full bilateral nerve-sparing is possible during pRP — since there is no cancer to limit surgical margins — the chances of preserving erectile function are even better than with standard radical prostatectomy for diagnosed cancer. Previous research by Tilki and colleagues demonstrated that radical prostatectomy performed in patients younger than 45 years is associated with good functional outcomes.\u003c\/p\u003e\n\n\u003ch3\u003eCancer Control and Survival\u003c\/h3\u003e\n\n\u003cp\u003eAt a median follow-up of \u003cstrong\u003e76 months\u003c\/strong\u003e (over 6 years):\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\u003cstrong\u003eAll seven patients were alive\u003c\/strong\u003e\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNone had developed metastases\u003c\/strong\u003e (cancer spread to other parts of the body)\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eAll had PSA levels below 0.1 ng\/ml\u003c\/strong\u003e, meaning no biochemical recurrence\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNo 90-day complications\u003c\/strong\u003e occurred in any of the seven patients\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch3\u003eDistress and Decision Regret\u003c\/h3\u003e\n\n\u003cp\u003eThe psychological benefits were dramatic. On a scale from 0 to 10 (the NCCN distress thermometer), the \u003cstrong\u003emean distress score was 7.7 points before pRP\u003c\/strong\u003e — a very high level of distress — and it dropped to \u003cstrong\u003ejust 1.3 points after surgery\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eWhen asked about decision regret, \u003cstrong\u003e86% of patients (6 of 7) absolutely agreed\u003c\/strong\u003e with the statement \"I would take the same decision again if I had to do it again,\" and the remaining 14% (1 of 7) agreed. No patient regretted his decision.\u003c\/p\u003e\n\n\u003ch2 id=\"interviews\"\u003eThe Patient Experience: Insights From In-Depth Interviews\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers identified six key domains from their analysis of the seven interview transcripts, offering a rich picture of what drives men to choose this drastic preventative measure and what they experience afterward.\u003c\/p\u003e\n\n\u003ch3\u003e1. Personal Reasons and Motives\u003c\/h3\u003e\n\n\u003cp\u003eSix of the seven patients had a family history of prostate cancer, and for most, at least one first-degree relative was affected. One patient learned of his risk through his own medical practice. \u003cstrong\u003eAll had personally experienced prostate cancer-related deaths\u003c\/strong\u003e within their families, which deeply underscored the seriousness of the disease. There was a strong focus on actively managing their own risk — going beyond generally accepted preventative measures such as a healthy lifestyle and early detection.\u003c\/p\u003e\n\n\u003ch3\u003e2. Additional Influences on the Decision\u003c\/h3\u003e\n\n\u003cp\u003eAll of the men had excellent medical knowledge or outstanding personal skills in actively searching for national and international information, including guidelines, published articles, and congress papers. They reported experiencing genuine competence at the Martini-Klinik and felt that their need for preventative treatment was taken seriously. One man specifically emphasised the support he received from his private-practice urologist in seeking an alternative path.\u003c\/p\u003e\n\n\u003ch3\u003e3. Internal and External Resistance in the Decision-Making Process\u003c\/h3\u003e\n\n\u003cp\u003eThe most frequent resistance came from consulting physicians who insisted on guideline-compliant procedures — which would involve a (repeat) biopsy in cases with persistent suspicion of prostate cancer. Two patients with high-grade PIN experienced serious complications after their initial biopsy:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eOne developed \u003cstrong\u003esepsis\u003c\/strong\u003e that required a stay in the intensive care unit\u003c\/li\u003e\n  \u003cli\u003eThe other experienced \u003cstrong\u003erectal bleeding\u003c\/strong\u003e that required rectoscopic intervention and a blood transfusion\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese complications made the decision to undergo pRP easier for those two men. The interviewees also described ambiguity in the statements made by consulting physicians about whether to wait and see, actively observe, or decisively act. They noted a lack of scientific research on the subject and criticised the great effort involved in searching for information and finding relevant contacts. Several also discussed the challenges of \u003cstrong\u003econvincing insurance companies of the benefits of preventative treatment\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003ch3\u003e4. Psychosocial Factors and Social Environment\u003c\/h3\u003e\n\n\u003cp\u003eAll patients reported a very positive attitude from their families towards preventative treatment, and they received immense psychosocial support before, during, and after treatment. The topic was approached in an extremely open and solution-oriented manner in their social environments.\u003c\/p\u003e\n\n\u003ch3\u003e5. Short- and Long-Term Consequences of pRP\u003c\/h3\u003e\n\n\u003cp\u003eEvery patient reported \u003cstrong\u003epsychological and emotional relief from taking action to mitigate their own risk\u003c\/strong\u003e of developing prostate cancer. Immediately after surgery, they experienced some physical sensitivity that resolved over the course of the first year.\u003c\/p\u003e\n\n\u003cp\u003eThe consequence most feared by the men was incontinence — but it was not a problem for any patient in the short or long term. Regarding potency, the ability to be sexually active was described as a given. Maintaining potency was important to most of the men, and supportive use of tadalafil, either continuously or as needed, was reported. Several men mentioned that increasing age naturally plays a role in addressing reduced sexual desire and sexual challenges. Interestingly, despite the excellent outcomes, patients reported that \u003cstrong\u003ePSA blood tests still induced stress\u003c\/strong\u003e even after surgery.\u003c\/p\u003e\n\n\u003ch3\u003e6. Patient Perspective: Ideas for Improving Preventative Treatment\u003c\/h3\u003e\n\n\u003cp\u003eAll patients expressed a wish to emphasise the individuality of prostate cancer risk and the importance of the patient perspective. They stressed the courage needed to go beyond the usual standard of care. Their recommendations included:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eReviewing and readjusting guideline recommendations for specific scenarios\u003c\/li\u003e\n  \u003cli\u003eStrengthening research on preventative treatment\u003c\/li\u003e\n  \u003cli\u003eEncouraging knowledge transfer from other disciplines that are significantly more advanced regarding prevention (such as breast cancer research)\u003c\/li\u003e\n  \u003cli\u003eAddressing the lack of contacts and specialised experts in this field\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eMany patient statements centred on \u003cstrong\u003etrust in the patient's ability to make decisions\u003c\/strong\u003e and taking the fear of developing cancer seriously.\u003c\/p\u003e\n\n\u003ch2 id=\"discussion\"\u003eWhat Do These Results Mean?\u003c\/h2\u003e\n\n\u003cp\u003eThis study provides several important insights, even with its small patient group. First, the fact that only seven pRP cases were found in a database of more than 23,500 surgical patients over a decade underscores that \u003cstrong\u003epreventative prostatectomy is an exception, even at the highest-volume centres\u003c\/strong\u003e. Yet the finding that 71% of these men actually had prostate cancer — and none had clinically insignificant disease — suggests that their fears were justified: a relevant cancer burden existed at the time of surgery with high potential to progress given their long life expectancy.\u003c\/p\u003e\n\n\u003cp\u003eSecond, the excellent functional outcomes demonstrate that \u003cstrong\u003epRP is feasible in experienced hands\u003c\/strong\u003e. Full bilateral nerve-sparing is possible during pRP because surgeons are not limited by the need to achieve cancer-free margins around a tumour. This means the chances of preserving erectile function are better than in standard RP for diagnosed cancer. Additionally, performing surgery at younger ages (37–57 years) would be expected to produce better functional outcomes than treating older patients.\u003c\/p\u003e\n\n\u003cp\u003eThird, the dramatic reduction in distress — from 7.7 to 1.3 on a 10-point scale — highlights the psychological value of active risk management. This finding aligns with what has been reported in women at risk of breast cancer, where the opportunity to actively address one's risk can minimise distress and create a sense of control.\u003c\/p\u003e\n\n\u003cp\u003eFourth, patients universally reported that \u003cstrong\u003etheir quality of life improved after pRP\u003c\/strong\u003e, not despite the surgery, but because of the mental relief and maintenance of physical functioning it provided. The interviews revealed that reliable information and competent guidance are enormously important for patients facing cancer threats. The authors argue that medical fixation on treatment guidelines should be replaced by a more differentiated consideration of individual patient history in the context of patient-centred care.\u003c\/p\u003e\n\n\u003cp\u003eFinally, the fact that \u003cstrong\u003eno patient regretted his decision\u003c\/strong\u003e — even though two had no cancer found in their prostates — is a striking finding. It suggests that, for these well-informed men, the psychological benefit of eliminating the fear of prostate cancer outweighed the risks of surgery and the potential loss of function.\u003c\/p\u003e\n\n\u003cp\u003eOngoing research is needed. The authors note that, to their knowledge, \u003cstrong\u003eone clinical trial on this topic is currently being planned\u003c\/strong\u003e, and recruitment of the first patients is expected to start soon.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations: What This Study Couldn't Prove\u003c\/h2\u003e\n\n\u003cp\u003eThis study has several important limitations that must be considered before drawing broad conclusions:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003e\n\u003cstrong\u003eVery small sample size:\u003c\/strong\u003e Only seven patients were included, which limits how much these results can be generalised to other men. However, because pRP is so rare, it is unlikely that larger data sets will be available in the near future.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRetrospective design:\u003c\/strong\u003e The findings must be interpreted in the context of the study's retrospective nature, which means it looked back at data rather than following patients forward in a controlled way.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNo control group:\u003c\/strong\u003e There was no comparison group of men who did not undergo pRP, so we cannot directly compare outcomes with watchful waiting or other approaches.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSingle-centre setting:\u003c\/strong\u003e All surgeries were performed at one high-volume centre by experienced surgeons. Complications and functional outcomes might be different if the procedure were done by less-experienced hands.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSelection bias:\u003c\/strong\u003e It is likely that had any patient experienced complications, their perception of pRP might have been less favourable. All patients here had excellent outcomes, which may not be typical.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eNo genetic testing:\u003c\/strong\u003e Despite the positive family history for most patients, genetic testing was not performed, so it is unknown whether these men carried specific gene mutations (such as BRCA2) linked to prostate cancer risk.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eRelatively short follow-up:\u003c\/strong\u003e The median follow-up was 76 months, and longer outcome data are needed to confirm the durability of both cancer control and functional preservation.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations: What This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eFor men with a serious fear of prostate cancer that causes them distress and negatively affects their quality of life, \u003cstrong\u003epreventative radical prostatectomy could be a good option outside of guideline recommendations\u003c\/strong\u003e — provided it is performed by experienced surgeons on well-informed patients. The authors are clear that this approach is not currently a standard recommendation, and the legal framework for this scenario needs to be improved.\u003c\/p\u003e\n\n\u003cp\u003eIf you or a loved one is considering this path, the study offers several takeaways:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow your risk.\u003c\/strong\u003e A family history of prostate cancer — especially with two or more first-degree relatives — raises your relative risk to 5.1, and this knowledge alone can cause significant distress that deserves to be taken seriously.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eSeek expert opinions.\u003c\/strong\u003e The men in this study were refused preventative surgery elsewhere before finding the Martini-Klinik. If you are considering this approach, a high-volume centre with extensive experience in nerve-sparing prostatectomy is essential.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eInvolve your support system.\u003c\/strong\u003e All patients in this study had strong family support and most brought their spouse to their consultations. This support was described as invaluable.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUnderstand the trade-off.\u003c\/strong\u003e The men in this study experienced temporary physical sensitivity after surgery, but it resolved within the first year, and their greatest fears — incontinence and loss of potency — did not materialise. Still, individual outcomes can vary.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eExpect psychological relief.\u003c\/strong\u003e The distress scores in this study fell by more than 80% after surgery, and all men described feeling emotionally relieved by taking active control of their risk.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eBe aware of the current evidence gap.\u003c\/strong\u003e This is a highly experimental approach supported by a single small study. Clinical trials are being planned, and more research is needed before this can become a standard recommendation.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe authors conclude that for well-selected, well-informed patients in experienced hands, pRP offers an opportunity to actively deal with the fear of prostate cancer and can restore quality of life. However, they stress that \u003cstrong\u003eprospective trials are warranted\u003c\/strong\u003e to confirm their findings, and that improvements in the legal foundation for this approach are needed to protect both patients and physicians.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is preventative prostate removal?\u003c\/h3\u003e\n\u003cp\u003ePreventative prostate removal, also called preventative radical prostatectomy, is surgery to remove the prostate gland before a cancer diagnosis. In a study of seven men at high risk due to family history, it was offered to reduce fear of developing prostate cancer. It is a rare, experimental approach, not yet a standard recommendation.\u003c\/p\u003e\n\u003ch3\u003eWhat were the functional outcomes after surgery?\u003c\/h3\u003e\n\u003cp\u003eAt 12 months after preventative prostate removal, all seven men were fully continent, defined as using no more than one safety pad per day. All could have erections firm enough for intercourse. Only two occasionally used tadalafil. These excellent outcomes were likely due to young age and full nerve-sparing surgery in experienced hands.\u003c\/p\u003e\n\u003ch3\u003eHow did distress and decision regret change?\u003c\/h3\u003e\n\u003cp\u003eBefore surgery, the men's average distress score was 7.7 out of 10, which is very high. One year after preventative prostate removal, it dropped to 1.3. No patient regretted the decision; six of seven strongly agreed they would choose it again. The psychological relief was a major benefit.\u003c\/p\u003e\n\u003ch3\u003eWhat are the limitations of this study?\u003c\/h3\u003e\n\u003cp\u003eThis was a small, retrospective, single-centre study of seven men with no control group. All surgeries were performed by highly experienced surgeons, so results may not apply elsewhere. Genetic testing was not done, and follow-up was about six years. More research and trials are needed to confirm these findings.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal Article Title:\u003c\/strong\u003e Preventative Function-sparing Radical Prostatectomy Experience in a Tertiary Referral Centre Martini Clinic Preisser\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Alexander Haese, Markus Graefen, Aliaksandra Pott, Felix Preisser\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eJournal:\u003c\/strong\u003e European Urology Oncology, Volume 9 (2026), pages 150–155\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication Details:\u003c\/strong\u003e Article received 14 October 2024, accepted 8 February 2025, available online 10 April 2025. Published by Elsevier B.V. on behalf of the European Association of Urology. DOI: https:\/\/doi.org\/10.1016\/j.euo.2025.02.005\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eInstitution:\u003c\/strong\u003e Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAssociate Editor:\u003c\/strong\u003e Guillaume Ploussard, MD\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c\/strong\u003e The authors reported no conflicts of interest and no external funding for this study.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. It does not constitute medical advice. Anyone considering preventative prostate surgery should consult with qualified specialists to discuss their individual risk factors and treatment options.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47423023022236,"sku":null,"price":0.0,"currency_code":"JPY","in_stock":true}],"url":"https:\/\/diagnosticdetectives.tw\/products\/preventative-prostate-removal-hope-for-high-risk-men-living-in-fear-of-prostate-cancer","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}