News

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.