PROSTATE CANCER - STATE OF THE ART

Mr Jonathan LewinMBBS, MRCS, MD, FRCS(Urol), FRACSConsultant Uro-Oncological Surgeon

The prostate

Prostate cancer - epidemiology Common ( 1:5 men)

20 000 diagnosed per year

3000 deaths per year

Increases with age

Prostate cancer screening

PSA blood test

Rectal examination

Prostate cancer screening Who?

Men over 50 Men over 40?

Refer if: PSA above range PSA rising quickly Concerns regarding DRE

Prostate Biopsy

Treatment options for Prostate Cancer

Treatment options for prostate cancer

•Patient Factors •Disease Factors

Active surveillance

For low risk prostate cancer 3 monthly PSA measurement Repeat Biopsy at 12 months

Detect signs of cancer worsening Grade progression Stage progression

Aims of Radical Prostatectomy

• Cure the cancer

• Minimise side effects

Curing the cancer

Surgical removal of the:

Prostate Seminal vesicles Sometimes the lymph

nodes ( glands)

Minimising side effects

Minimising side effects Specialised uro-oncologist Surgeon volume> 30/year Ask about outcomes

Erections Nerve spare Penile rehabilitation

Continence Nerve spare, BN preservation, Rocco suture Urethrogram? Pelvic floor physio?

Erectile Function

Penile rehabilitation

Incontinence

Incontinence Limit the length of catheterisation X-ray to confirm healing Early use of pelvic floor exercises

Peri-catheter urethrogram

Robotic Surgery ?

Robotic Surgery• Advantages

• Slightly shorter hospital stay and earlier return to work

• No difference• Cancer cure rates• Incontinence Rates• Impotence Rates• Need for blood transfusion

• Disadvantages• Cost• Accessibility

Targeted therapy