News

Robotic Surgery Procedure a First for the Midlands (posted April 2011)

The Royal Wolverhampton Hospitals NHS Trust has successfully performed its first robotically assisted surgery – months ahead of schedule. In doing so, the Trust becomes the first hospital in the Midlands to use such technology, adding to its growing list of innovations.

Prostate Cancer Specialist and Robotic Surgeon Peter Cooke led the team during Thursday’s surgery. The Da Vinci was used to do curative surgery on a patient with prostate cancer, which had been detected early. The surgery involved removing the prostate gland from deep within the pelvis and then reconstructing the bladder to the urethra (water-pipe).

Unveiled just last month, the Da Vinci Robot is an innovative step up from Laparascopic (keyhole) surgery. Using this procedure brings a range of benefits to the patient, resulting in less blood loss, a shorter hospital stay, a quicker recovery time and less scarring.

For more details on this announcement click here

 

New Prostate Cancer Urine test twice as good as PSA (posted March 2011)

Researchers from the University of Surrey have released exciting new results of studies into a chemical called EN2 which is found in the urine of men with prostate cancer, but rarely in men who are cancer-free.

This means that it is more specific than PSA, which can be falsely elevated after infection. Further work is needed, but the development of a urine dipstick test similar to a pregnancy test may give patients a result within five minutes. The chemical may not distinguish between slow-growing (insignificant) or fast-growing cancers that do need treatment, however.

For more information, click here 

 

Robotic Surgery arrives in the Midlands (posted February 2011)

The Royal Wolverhampton Hospitals NHS Trust has taken delivery of a da Vinci surgical robot which is a first for the Midlands.  The urological team, under the leadership of Mr Peter Cooke, will be the first team to commence da Vinci surgery across the Midlands region in Summer 2011.  

Robotic surgery is already well established in Europe and the USA but is yet to be firmly established in the UK, leaving patients missing out on the better outcomes seen elsewhere.

Peter Cooke successfully led the case for the Royal Wolverhampton Hospitals NHS Trust to become the first Trust in the Midlands to offer this cutting edge surgical technology.  On returning from an international congress in Paris in 2009, Peter Cooke, convinced of the benefits of da Vinci robotic surgery, has worked closely with Trust management to achieve his goal of bringing this innovative surgery to the Midlands. 

Peter Cooke says: "The urological team are very excited and well prepared to make the transition from laparoscopic to robotic surgery having a well established team who have performed hundreds of complex procedures together."

For more details on this announcement click here

To view the report on Midlands Today click here

West Midlands GPs receive prostate update (posted February 2011)

Over 100 family GPs took part in a weekend of specialist education at the Mill Hotel in Alverley near Bridgnorth  on 5th  and 6th February 2011, organised by the Post Graduate School of General Practice.

Peter Cooke was invited to share his knowledge of prostatic diseases and provide an update of recent developments. Topics such as benign prostatic enlargement, investigation of urinary symptoms, PSA testing and laser prostate surgery were all covered, in an interactive session which raised healthy debate and many questions.

Peter went on to  discuss recent advances in his own department at the Royal Wolverhampton Hospitals NHS Trust,  including expansion of consultant numbers to meet rising referrals, new techniques in bladder cancer treatment with fluorescent photodynamic diagnosis and da Vinci prostate cancer surgery.

Long finger associated with prostate cancer risk (posted December 2010)

Researchers from the Institute for Cancer Research and Warwick University have shown that a longer index finger may be a risk factor for the development of prostate cancer in later life.  According to data published in the British Journal of Cancer. This may provide evidence of the influence of sex hormones or other growth factors working in the womb before a man is even born.

To read more click here

Abiraterone results bring further hope for prostate cancer patients (posted November 2010)

Abiraterone is a new compound undergoing clinical trials led by the Institute for Cancer Research. It works by interfering with the production of testosterone, which causes prostate cancers to grow and spread. It is being investigated for use after standard hormone therapy has failed in patients with advanced disease.

Results from a large phase III study were released in October 2010 which showed promising results. 797 patients given abiraterone plus a steroid lived for an average of 14.8 months, compared to 10.9 months for the remainder who simply received the steroid.

Scans showed that tumour growth halted for longer in the group given the drug. Other advantages of the drug included fewer side effects compared with chemotherapy or radiotherapy, making it a far more attractive prospect for patients. Many individual patients reported significant improvement of their symptoms rapidly after starting on the drug. The drug manufacturer, Janssen will move forward in 2011 to seek a license for clinical use.

Breast cancer gene linked with high risk of prostate cancer (posted November 2010)

Preliminary results from the multinational IMPACT study have shown that carriers of the breast cancer genes BRCA 1 and 2 are at greater risk of being found to have prostate cancer if screened by PSA. Those cancers detected also tend to be in younger men and were more likely to be significant, i.e. needing treatment. This ongoing trial is being run across the world, including New Cross Hospital, Wolverhampton.

For more information click here

Royal Wolverhampton Hospital study a highlight at National Conference (posted June 2010)

A study conducted at the Royal Wolverhampton Hospitals by Peter Cooke and colleagues was cited as a conference highlight at the British Association of Urological Surgeon Annual Conference in Manchester in June 2010. The ‘Best of BAUS’ session included the study of low risk prostate cancer patients treated with surgery over a three year period.

The results showed that despite pre-operative data showing low-risk features, suitable for active surveillance as defined by the NICE Guidelines on Prostate Cancer 2008, 90 % of patients had more cancer, or more aggressive cancer than thought, on final pathological assessment of the whole prostate after its removal. Worryingly, 38% of patients had cancer spread outside the prostate despite favourable features on their biopsies.

The data highlighted the need for accurate biopsies and very careful counselling of patients. It would suggest that patients choosing active surveillance or nerve-sparing surgery must only do so, having fully considered the risks of under-treating their cancer.

Midlands Urology to offer Robot-assisted Laparoscopic Prostatectomy (posted 21/04/09)

Midlands Urology is now offering robot-assisted laparoscopic prostatectomy - the only clinic in the Midlands providing this innovative surgery.

The introduction of the Prosurgics Freehand® surgical robot, enables the surgeon to control the camera system with pinpoint accuracy and speed. This gives an image of premier stability and clarity, enabling surgical precision and efficiency which is unmatched by open surgery.

Awarded the title ‘Innovation of the year 2008’ by the Society of Laparoendoscopic Surgeons, the Freehand robot reduces operating time and surgeon fatigue, enhancing patient outcomes and minimising unwanted tissue damage.

For more information on Robot-assisted Laparascopic Prostatectomy visit our Conditions & Treatments section.

PSA screening trial shows 20% reduction in prostate cancer deaths (posted 21/04/09)

The European Randomised Study of Screening for Prostate Cancer (ERSPC) reported its most recent data analysis in the New England Journal of Medicine on 26th March 2009. This huge trial, run since the early 1990’s in seven European countries, aimed to try and answer the controversy about whether the death rate from prostate cancer could be reduced by using PSA to screen men with no symptoms.

Over 160,000 men aged between 55 and 69 were enrolled and randomly assigned to having a PSA test every 4 years or not. After 9 years, the incidence of prostate cancer was 8.2% in the screened group compared to 4.8% in the unscreened group, with a higher proportion of lower grade (less aggressive) cancers (72% v. 55%) and a 41 % lower risk of cancer spread to the bones in the screened group.

The death rate due to prostate cancer was 20% lower in the screened group, indicating the benefit of early detection and treatment of prostate cancer. The rates of death of the two groups began to diverge after 7 to 8 years and continued to diverge further over time, suggesting that the longer term difference in survival may be greater.

Critics of PSA screening point out that large numbers of men need to be screened and treated to save one life from prostate cancer. The study authors calculate that four-yearly screening would require 1410 men to be screened and 48 to be treated to save one life.

This large number needed to screen is similar to that accepted for screening of breast cancer by mammography, or bowel cancer by faecal blood testing, which are accepted and established in the UK. The authors acknowledged that four yearly screening may not be the optimal time period as more aggressive cancers may develop between screening tests. These cancers are the very tumours that are more likely to grow rapidly and require treatment than the less aggressive slow-growing cancers that may be amenable to active surveillance.

The same journal reported the first results from a similar study in the USA called the PLCO screening trial. This assessed the impact of yearly screening with a PSA test and digital rectal examination in over 76,000 men enrolled between 1993 and 2001. After seven to ten years, there was a 22% higher prostate cancer detection rate in the screened group, but the death rate was very low, and no difference was seen between the screened and unscreened group. The authors concluded that the results supported recent US Preventative Services Task Force recommendations against PSA screening over the age of 75. The risks of prostate cancer overdiagnosis, and biopsy and treatment-related side effects were discussed. A final report will be presented after all patients have been assessed for 13 years.

Further studies are ongoing in the UK and elsewhere also trying to answer the question as to the effectiveness, acceptability, cost and consequences of a PSA-based screening program. Full results will not be available for many years, by which time the treatments used will have continued to improve, and the criteria for who needs treatment or not are likely to have changed. The results may therefore be unrepresentative of the treatment options in use when they do finally become available.

Currently a screening program is not available nationally in the UK and it is recommended that patients should seek expert advice from a specialist Urological Surgeon on whether to undergo PSA testing, prostate biopsy or further treatment. Individual patients need to make their own choice having carefully considered the arguments for and against the use of PSA.

NICE recommends Sunitinib as first line treatment for advanced Kidney Cancer (posted 12/04/09)

The National Institute for Clinical Excellence (NICE) produced its final guidance on 25th March 2009, recommending the use of Sutent (Sunitinib) for patients with advanced kidney cancer.

The full guidance recommends Sunitinib as first line treatment for patients with advanced or metastatic renal cancer who are fit enough to receive it. It may be given after surgery to remove a tumour if further disease is still present, or re-occurs at a later date. Evidence from clinical trials has shown it to delay tumour growth and prolong survival.

Sunitinib is a ‘Tyrosine Kinase Inhibitor’ which causes cancer shrinkage by preventing new tumour blood vessel growth. It is one of a new class of oral anti-cancer drugs which have brought new hope to patients with advanced forms of cancer, where surgery or other conventional treatments have been ineffective. It may increase a patient’s life by 5-6 months  but costs over £20,000 per year, which led NICE initially to question its cost effectiveness.

The news was welcomed by health professionals and cancer charities who described it as a ‘victory for patients’.

NICE agrees to fund new treatment for Kidney Cancer (posted 23/02/09)

The National Institute for Clinical Excellence (NICE) has agreed in principle to fund Sutent (Sunitinib) for patients with advanced kidney cancer. The full guidance is not due until March 2009, but NICE issued a statement on 4th February stating it had reconsidered its draft decision on four new drugs, issued amid press and patient furore last August. This follows their decision in January to change the threshold at which expensive novel treatments are deemed cost effective for use in terminally ill patients. 

Doctors and patient groups alike have campaigned for NICE to reconsider their guidance as even a few extra months of life can be priceless.