# Preventative Prostate Removal: Hope for High-Risk Men Living in Fear of Prostate Cancer This 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. # Preventative Prostate Removal: Hope for High-Risk Men Living in Fear of Prostate Cancer ## Table of Contents - Key Points - Why This Research Matters: The Fear of Prostate Cancer - Study Methods: How the Research Was Conducted - Patient Characteristics: Who Were the 7 Men? - Key Findings: Functional and Cancer Outcomes - The Patient Experience: Insights From In-Depth Interviews - What Do These Results Mean? - Study Limitations: What This Study Couldn't Prove - Recommendations: What This Means for Patients - Frequently Asked Questions - Source Information ## Key Points - In a study of seven high-risk men, 71% had prostate cancer in prostates removed preventatively. - All seven men achieved full continence and erections firm for intercourse 12 months after surgery. - Distress scores fell from 7.7 to 1.3 after preventative prostate removal, with no decision regret. - No cancer was clinically insignificant; cancers had potential to progress given patients' young ages. - Preventative prostate removal is rare, experimental, and requires experienced surgeons and careful selection. ## Why This Research Matters: The Fear of Prostate Cancer Prostate 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. **The risk of prostate cancer is substantially higher for men with affected relatives**. 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. Knowing 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. Some 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 — **prophylactic ovariectomy (removal of the ovaries) and mastectomy (removal of the breasts) are sometimes proposed for women with BRCA2 gene mutations** 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. ## Study Methods: How the Research Was Conducted Researchers 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 **more than 23,500 patients treated with surgery during this period**, they found just seven such patients, highlighting just how rare this procedure is. All 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. To 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 **4-week waiting period** was left before surgery to give all patients sufficient time to think over their decision. Functional outcomes were measured using the **Expanded Prostate Cancer Index (EPIC-26)** 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: **3 months of 5 mg tadalafil (Cialis) taken daily**. All seven patients adhered to this recommendation. Continence was defined as using up to one safety pad per day. Distress was measured using the **National Comprehensive Cancer Network (NCCN) distress thermometer**, 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." Oncological outcomes were evaluated as survival free from prostate-specific antigen (PSA) recurrence — defined as **PSA less than 0.1 ng/ml** — and overall survival. Complications within 90 days were classified using the Clavien-Dindo classification system. In addition to the quantitative measures, the researchers conducted **semistructured interviews** 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. ## Patient Characteristics: Who Were the 7 Men? The seven men ranged in age from **37 to 57 years, with a median age of 54** 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. Each patient had a unique story, as detailed in the study: - **Patient 1** (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. - **Patient 2** (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. - **Patient 3** (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). - **Patient 4** (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. - **Patient 5** (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. - **Patient 6** (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. - **Patient 7** (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 **pT3a, N0, R0, Grade Group 2 cancer** — meaning the cancer had spread slightly beyond the prostate capsule (non-organ-confined disease). Four 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 **bilateral nerve-sparing**, a technique that preserves the nerves on both sides of the prostate that are essential for erectile function. ## Key Findings: Functional and Cancer Outcomes ### What the Pathology Showed Despite none of the men having a prostate cancer diagnosis before surgery, **final pathology revealed prostate cancer in 71% of cases** (five of seven patients). Two patients had International Society of Urological Pathology (ISUP) **Grade Group 1** disease (the least aggressive form), and three had **Grade Group 2** 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. Two 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. ### Functional Outcomes at 12 Months At 12 months after pRP, the functional results were excellent across the board: - **100% of patients were fully continent** (defined as using no more than one safety pad per day) - **86% had no problems with voiding**, and 14% had only very slight problems - **All seven men had erections firm enough for intercourse**, and erections were possible whenever they wanted - Only two patients used **5 mg tadalafil on occasion**; the other five did not need any medical support for erectile function These 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. ### Cancer Control and Survival At a median follow-up of **76 months** (over 6 years): - **All seven patients were alive** - **None had developed metastases** (cancer spread to other parts of the body) - **All had PSA levels below 0.1 ng/ml**, meaning no biochemical recurrence - **No 90-day complications** occurred in any of the seven patients ### Distress and Decision Regret The psychological benefits were dramatic. On a scale from 0 to 10 (the NCCN distress thermometer), the **mean distress score was 7.7 points before pRP** — a very high level of distress — and it dropped to **just 1.3 points after surgery**. When asked about decision regret, **86% of patients (6 of 7) absolutely agreed** 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. ## The Patient Experience: Insights From In-Depth Interviews The 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. ### 1. Personal Reasons and Motives Six 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. **All had personally experienced prostate cancer-related deaths** 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. ### 2. Additional Influences on the Decision All 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. ### 3. Internal and External Resistance in the Decision-Making Process The 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: - One developed **sepsis** that required a stay in the intensive care unit - The other experienced **rectal bleeding** that required rectoscopic intervention and a blood transfusion These 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 **convincing insurance companies of the benefits of preventative treatment**. ### 4. Psychosocial Factors and Social Environment All 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. ### 5. Short- and Long-Term Consequences of pRP Every patient reported **psychological and emotional relief from taking action to mitigate their own risk** of developing prostate cancer. Immediately after surgery, they experienced some physical sensitivity that resolved over the course of the first year. The 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 **PSA blood tests still induced stress** even after surgery. ### 6. Patient Perspective: Ideas for Improving Preventative Treatment All 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: - Reviewing and readjusting guideline recommendations for specific scenarios - Strengthening research on preventative treatment - Encouraging knowledge transfer from other disciplines that are significantly more advanced regarding prevention (such as breast cancer research) - Addressing the lack of contacts and specialised experts in this field Many patient statements centred on **trust in the patient's ability to make decisions** and taking the fear of developing cancer seriously. ## What Do These Results Mean? This 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 **preventative prostatectomy is an exception, even at the highest-volume centres**. 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. Second, the excellent functional outcomes demonstrate that **pRP is feasible in experienced hands**. 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. Third, 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. Fourth, patients universally reported that **their quality of life improved after pRP**, 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. Finally, the fact that **no patient regretted his decision** — 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. Ongoing research is needed. The authors note that, to their knowledge, **one clinical trial on this topic is currently being planned**, and recruitment of the first patients is expected to start soon. ## Study Limitations: What This Study Couldn't Prove This study has several important limitations that must be considered before drawing broad conclusions: - **Very small sample size:** 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. - **Retrospective design:** 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. - **No control group:** There was no comparison group of men who did not undergo pRP, so we cannot directly compare outcomes with watchful waiting or other approaches. - **Single-centre setting:** 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. - **Selection bias:** 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. - **No genetic testing:** 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. - **Relatively short follow-up:** The median follow-up was 76 months, and longer outcome data are needed to confirm the durability of both cancer control and functional preservation. ## Recommendations: What This Means for Patients For men with a serious fear of prostate cancer that causes them distress and negatively affects their quality of life, **preventative radical prostatectomy could be a good option outside of guideline recommendations** — 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. If you or a loved one is considering this path, the study offers several takeaways: 1. **Know your risk.** 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. 1. **Seek expert opinions.** 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. 1. **Involve your support system.** All patients in this study had strong family support and most brought their spouse to their consultations. This support was described as invaluable. 1. **Understand the trade-off.** 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. 1. **Expect psychological relief.** 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. 1. **Be aware of the current evidence gap.** 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. The 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 **prospective trials are warranted** to confirm their findings, and that improvements in the legal foundation for this approach are needed to protect both patients and physicians. ## Frequently Asked Questions ### What is preventative prostate removal? Preventative 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. ### What were the functional outcomes after surgery? At 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. ### How did distress and decision regret change? Before 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. ### What are the limitations of this study? This 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. ## Source Information **Original Article Title:** Preventative Function-sparing Radical Prostatectomy Experience in a Tertiary Referral Centre Martini Clinic Preisser **Authors:** Alexander Haese, Markus Graefen, Aliaksandra Pott, Felix Preisser **Journal:** European Urology Oncology, Volume 9 (2026), pages 150–155 **Publication Details:** 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 **Institution:** Martini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany **Associate Editor:** Guillaume Ploussard, MD **Funding:** The authors reported no conflicts of interest and no external funding for this study. *This 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.* --- Publisher: Diagnostic Detectives Network (https://diagnosticdetectives.com) — independent multi-expert medical second opinions, worldwide, private-pay. Author byline: Anton Titov, MD, PhD. Contact: https://diagnosticdetectives.com/pages/contact Canonical page: https://diagnosticdetectives.com/products/preventative-prostate-removal-hope-for-high-risk-men-living-in-fear-of-prostate-cancer