Prostate cancer is the most common male cancer, with 30,000 cases diagnosed annually, in the UK. Many cancers are undiagnosed, slow growing and harmless. However other types may be more aggressive, and may grow and spread to cause symptoms and harm. The incidence of prostate cancer is rising in the UK, with more and more patients coming forward for testing. Prostate cancer can be diagnosed quickly and easily with simple outpatient tests, offering men the chance to detect tumours at an early and curable stage, often when no symptoms are present.
Symptoms
Many men may have prostate cancer without being aware of any symptoms. Some men may have urinary symptoms, with a poor flow, blood in the urine, difficulty urinating or urinating more frequently. These symptoms may occur with benign (non-cancerous) enlargement of the prostate, so specific tests are needed to differentiate if a man's symptoms are due to cancer or not. Some men may have advanced cancer, with vague symptoms such as back pain, or weight loss.
Assessment & Diagnosis
PSA
This simple blood test detects the Prostate Specific Antigen protein in the blood stream. This is a normal product of the prostate and aids fertility. It may leak into the blood stream at elevated levels due to infection, inflammation (prostatitis) or prostate cancer. Some men may have prostate cancer even with a normal PSA, so the test is not 100% accurate. However it remains the single most useful test to detect early prostate cancers. The level of PSA can be used to decide if further tests, such as a prostate biopsy are necessary.
The use of PSA testing has led to a significant increase in the diagnosis of prostate cancer in Europe and the USA over recent years, with more cancers diagnosed at an early (curable) stage. See our news section for recent exciting data on PSA screening.
Midlands Urology offer PSA testing with results available in 20 minutes upon request.
PCA3
This is a new molecular urine test for prostate cancer. It detects minute amounts of products expressed by the PCA3 gene which is found in higher levels in cancer tissue, using techniques similar to forensic scientists detecting DNA at a crime scene. A positive result indicates a higher chance of cancer being present and the need for further tests. A negative result is greatly reassuring and may save a patient the need for further investigations or repeated prostate biopsies. This novel test is not available on the NHS.
Prostate ultrasound and biopsy
The modern diagnosis of prostate cancer relies on tissue biopsies taken using accurate ultrasound guidance. This outpatient test, performed under local anaesthetic also gives information on prostate size, and the 'PSA density', which aids prostate cancer risk assessment.
Midlands Urology specialises in mapping the biopsies in 12 sectors of the prostate to identify which areas within the prostate are abnormal, allowing more accurate treatment planning and more informed decision-making by patients than unmapped biopsies.
Treatments
Midlands Urology offer options recommended by NICE (the National Institute of Clinical Excellence) as preferred treatments in their Guidance on Prostate Cancer 2008.
Robot-assisted Laparoscopic prostatectomy
This highly specialist and technically demanding operation involves the removal of the whole prostate and reconstruction of the urinary tract via tiny keyhole incisions in the lower abdomen, using delicate instruments and modern High Definition video-imaging to give unequalled operative visualisation.
Laparoscopic prostatectomy has replaced open radical prostatectomy in specialist units as the operation of choice, due to reduced bleeding, more accurate dissection, less post operative pain, shorter hospital stay and faster recovery. Most patients are treated as an overnight
or two day stay, and are able to return to full leisure and work activities within a few weeks.
Midlands Urology is one of only a small number of providers in the UK with the expertise in this field, indicating the training and skill required to offer this form of surgery.
Midlands Urology is the only clinic in the Midlands offering robot-assisted laparoscopic prostatectomy. The introduction of the Prosurgics Freehand® surgical robot (www.freehandsurgeon.com), 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.
Nerve-sparing prostatectomy
Any surgery or treatment to the prostate may entail removing, or damage to, the nerves responsible for attaining an erection. In selected patients with smaller, low risk cancers, it may be possible to preserve these nerves with precise and specialist surgical techniques. Post-operative medical therapy can enhance recovery of erections, but accuracy in surgical dissection, enabling preservation of the delicate nerves, is crucial in maintaining normal sexual activity. These techniques are not suitable for all patients, as higher risk cancers may not be cured by dissecting too close to the prostate. Careful pre-operative counselling and patient selection by an experienced surgeon are required to choose the most appropriate procedure for each individual.
Radiotherapy
External beam radiotherapy, in isolation or in combination with hormone treatment, is an effective and well tolerated treatment for patients who are not suitable for, or who prefer to avoid, surgery. It may also be offered in the minority of patients who need further treatment after surgery. This is offered by Oncology specialists, who work closely in Urology Multi-disciplinary Cancer teams.
Active surveillance
Active surveillance of early prostate cancers may be appropriate for some selected patients who are more elderly, or who have other medical problems, where the cancer is thought to pose a low risk of causing harm. This entails regular check-ups and repeat PSA testing in a carefully monitored schedule. Treatment may be offered later if there is evidence of the cancer growing, or if the patient prefers it.
Other treatments
Other treatments exist to treat early cancers, including Cryosurgery (freezing the cancer), and HIFU (High Intensity Focused Ultrasound). These treatments are not recommended by NICE as preferred treatment options, and must only be used in clinical research, as their long-term effectiveness has not yet been proven. Brachytherapy (internal radiotherapy using radio-active seed implantation) is unsuitable for patients with significant urinary symptoms, large prostates or higher risk cancers. Midlands Urology does not offer these treatments.
Medical (Drug) treatments
Some men may not be suitable for direct ('radical') treatment to the prostate, particularly if there is evidence that the cancer has grown outside the prostate. Other drug treatments exist which are effective in suppressing cancer growth and reducing symptoms. Generally, these are hormone treatments which work by starving the cancer of the male hormone, testosterone. Other drugs may be required to help bone metabolism, and chemotherapy can be offered by an Oncology specialist. This has been proven in clinical trials to reduce symptoms and improve patient survival.