Frequently asked questions: PSA, biopsy, prostate-cancer surgery · robot-assisted urology section Hamm

Question 1

My PSA level is raised – what happens next?

Accepted Answer

The MRI shows the suspicious area — the fusion biopsy samples it precisely. Through the perineum, under local anaesthesia. The basis is your multiparametric MRI. The finding is graded by PI-RADS — the scale for how suspicious an area is. We take the conspicuous areas as our target. Previous findings and medication are discussed in the consultation.

Question 2

Can I assess my own risk with an online tool?

Accepted Answer

The nomograms of the Memorial Sloan Kettering Cancer Center (MSKCC) assess the risk. The tool belongs to MSKCC and is used on mskcc.org; it is no substitute for a consultation — please discuss the result with us.

Question 3

I have been diagnosed with prostate cancer – what are the options?

Accepted Answer

The German S3 guideline on prostate cancer names four options. What is right for you, we discuss together – based on the findings, risk group, age and your life situation. The choice is not a one-way street. Some men combine options, others switch. What matters is that the decision fits you and your findings.

Question 4

How do I get a second opinion?

Accepted Answer

A cancer diagnosis forces a decision few people are prepared for. A second look costs you one conversation and a few days — and it confirms the chosen path just as often as it points to another one. Either is a good outcome. You do not have to switch hospitals and you do not have to decide anything. You remain in the care of your own urologist.

Question 5

What should I bring to the second opinion?

Accepted Answer

Referral from your urologist — with Knappschaft, the insurance card is sufficient; privately insured and self-paying patients do not need one; Your PSA history — ideally every value with its date, not just the most recent one; The biopsy report and, if available, the number of the tissue block; MRI or CT images on CD or DVD — the images themselves, not just the written report; Doctors' letters from your treatment so far; A list of your medications If something is missing, come anyway. Much of it can be requested afterwards — the appointment need not fail because of it.

Question 6

What is an MRI fusion biopsy?

Accepted Answer

The MRI shows the suspicious area — the fusion biopsy samples it precisely. Through the perineum, under local anaesthesia. MRI and ultrasound work together: the MRI knows the target, the ultrasound shows the prostate live, and the software lays one over the other.

Question 7

Is the biopsy painful?

Accepted Answer

You stay awake and responsive: we numb the perineum and the prostate locally — no general anaesthesia.

Question 8

How will I learn the biopsy result?

Accepted Answer

The samples go to the laboratory. We discuss the result with you in person and plan the next steps together.

Question 9

Does the robot operate on its own?

Accepted Answer

It transmits. Every movement of the hand is passed on to the instruments precisely and freed of tremor — and the instrument tips are more mobile than a human wrist. Nothing happens automatically; with no hand on the controls, nothing moves.

Question 10

What does NeuroSAFE mean?

Accepted Answer

How much nerve tissue can be preserved without leaving tumour behind? That question is answered on the tissue itself — while the operation is still under way.

Question 11

Will I be continent again after surgery?

Accepted Answer

of patients in large studies from experienced centres are continent again one year after the operation — no pad, or at most one pad per day. With advanced tumours it more often takes longer at first; between the third and the twelfth month the results largely converge. Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2012;62(3):405–417 — and Ficarra V, Novara G, Ahlering TE, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012;62(3):418–430. The share of around 68% comes from NeuroSAFE PROOF (Lancet Oncol 2025). These figures come from large published studies; your personal result depends on tumour stage, age and baseline function.

Question 12

Will erections still be possible?

Accepted Answer

regain an erection sufficient for intercourse one year after bilateral nerve-sparing surgery — depending on age and baseline function. With the intraoperative frozen section this share rises to around 68%, because nerve-sparing surgery becomes possible far more often. Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2012;62(3):405–417 — and Ficarra V, Novara G, Ahlering TE, et al. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy. Eur Urol 2012;62(3):418–430. The share of around 68% comes from NeuroSAFE PROOF (Lancet Oncol 2025). These figures come from large published studies; your personal result depends on tumour stage, age and baseline function.

Question 13

How experienced is the surgeon?

Accepted Answer

Experience can be measured. Published learning curves show the number of operations beyond which results no longer improve appreciably: surgical margins from roughly 200 to 250 procedures, potency results from roughly 600 to 700, continence results from roughly 700 to 800. Your surgeon is above all of these thresholds. Vickers AJ, Bianco FJ, Serio AM, et al. The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst 2007;99(15):1171–1177.

Question 14

How long will I stay in hospital after prostatectomy?

Accepted Answer

After five to six days. Before you leave, you talk to your surgeon once more. The histology result is discussed with you separately.

Question 15

How do I prepare for surgery?

Accepted Answer

Start pelvic floor training before the operation. Prepared tissue recovers faster afterwards. Have the exercises shown to you instead of guessing them. Exercise, stopping smoking and stable control of any accompanying conditions improve the starting position for the operation and the recovery after it.

Question 16

When does the follow-up rehabilitation start?

Accepted Answer

The rehabilitation programme should be applied for during your inpatient stay. The rehabilitation programme usually lasts three weeks and typically begins a few weeks after discharge. The costs are usually carried by the German pension insurance (Deutsche Rentenversicherung). It includes, among other things, physical reconditioning, pelvic floor training, dietary advice and psychological support.

Question 17

Is an enlarged prostate cancer?

Accepted Answer

Benign prostate enlargement is not cancer and does not become cancer. It arises in the inner part of the gland, which grows over the years and narrows the urethra. Prostate cancer typically arises in the outer part — they are two different diseases that can only coincidentally occur side by side.

Question 18

Which operation helps with benign enlargement?

Accepted Answer

Both procedures relieve the obstruction and improve symptoms and urinary stream equally. It is not the technique that decides. Both procedures are equivalent in their effectiveness. What suits you follows from the size of the gland, from what the bladder additionally shows, and from what matters to you. We will tell you openly if the procedure without the robot is the better one for you.

Question 19

I had blood in my urine – what will be investigated?

Accepted Answer

The most common first sign — and usually painless. That is exactly why it is often watched for too long. Even a single episode of blood that has disappeared again should be investigated. Transurethral resection of a bladder tumour (TURBT) is diagnosis and treatment in a single step. An instrument about the thickness of a pen is passed into the bladder through the urethra — with no external incision. The visible tumour is removed and examined histologically.

Question 20

Why is the muscle layer of the bladder so important?

Accepted Answer

Without involvement of the muscle layer, the bladder can as a rule be preserved. Treatment is carried out through the urethra, often supplemented by a therapy instilled directly into the bladder; regular check-ups follow. With involvement of the muscle layer, complete removal of the bladder is the established approach with curative intent. What that means in practice is described on the page on

Question 21

What does „completely intracorporeal“ mean?

Accepted Answer

The new urinary diversion, too, is created entirely inside the body — not through an additional abdominal incision.

Question 22

Which urinary diversion is the right one?

Accepted Answer

The guideline is unambiguous on this point: ileal conduit, continent cutaneous diversion and orthotopic neobladder are to be discussed with every patient unless something speaks against them. We keep to that. Which route fits depends on the tumour, on kidney function, on comorbidities — and on how you live and what you feel able to manage. We state the medical limits clearly; within those limits, the decision is yours.

Question 23

Can my kidney be preserved?

Accepted Answer

Where the findings allow it, only the tumour is removed and not the organ. For tumours up to about 7 cm the oncological safety of partial nephrectomy is equivalent. NCCN, AUA and EAU recommend it as the standard for these findings wherever it is technically feasible.

Question 24

What is a pyeloplasty?

Accepted Answer

When urine backs up in the kidney, it suffers silently. The narrowing can be corrected.

Question 25

How do I get an appointment?

Accepted Answer

Appointments are arranged by the urology secretariat. +49 2381 681-1589. Book an appointment online: https://www.doctolib.de/urologie/hamm/sami-ramzi-leyh-bannurah-731c5f05-a922-48c8-9188-ccff1f461f23

Question 26

When is the consultation hour?

Accepted Answer

Tuesday · 09:00–14:00, Thursday · 08:30–16:00. Appointments are arranged by the urology secretariat.

Question 27

Can you call me back?

Accepted Answer

Leave your name and number. The urology secretariat will call you back within one working day (Monday to Friday).

Question 28

Where do I find the section?

Accepted Answer

Urologie, Ebene 1, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073 Hamm

Question 29

What do I do in an emergency?

Accepted Answer

In an emergency, please dial 112 or contact the emergency department. This page is for appointments and second opinions, not for acute symptoms — e-mails are not read around the clock.

Frequently asked questions about prostate, bladder and kidney

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