Prostate problems are very
common and become more common with increasing
Symptoms should be investigated
promptly as there is considerable overlap
of symptoms of benign prostatic enlargement
and prostate cancer.
What makes The Prostate Clinic different?
'Probably the leader in the field of keyhole radical prostatectomy'.
- according to a poll of 40 British Urologists (The Daily Mail, 02 November 2010).
Latest published results for radical prostatectomy
- Overall potency in 500 men having nerve-sparing laparoscopic radical prostatectomy (2006-2008) was 86.9%.
- Overall continence was 97.4%.
- Complication and recurrence rates were 4.2% & 1.2% (Eden
et al., J Endourol 2011;25:815-819).
Salvage radical prostatectomy
- Recurrent prostate cancer following radiotherapy is now the 4th commonest cancer in men in the USA (Jones JS. Eur Urol 2011;60:411-412).
- In a recent study comparing surgery with cryotherapy following failed radiotherapy the authors concluded that 'Young, healthy patients with recurrent prostate cancer after radiation therapy should consider salvage radical prostatectomy as it offers superior biochemical disease-free survival and may potentially offer the best chance of cure' (Pisters et al. J Urol. 2009;182:517-525).
- Laparoscopic salvage prostatectomy is an option after non-surgical treatment (usually radiotherapy) has failed and staging investigations (MRI or CT and a bone scan) demonstrate no evidence of distant spread.
- Salvage surgery is always more difficult to perform technically because of the scarring caused by radiotherapy and should only be performed by very experienced surgeons.
Surgery for high-risk prostate cancer
- Patients with a PSA ≥20, Gleason grade ≥8 or stage ≥T3 prostate cancer have historically been treated with radiotherapy and hormones.
- There is now an increasing recognition that 'a multimodal approach seems the best way to achieve acceptable outcomes for high-risk prostate cancer patients' (Bastian et al. Eur Urol 2012;61:1096-1106) and that when this approach is used surgery must come first.
- Extended pelvic lymph node dissection is an integral part of this surgery and has been shown to improve cancer survival in men with involved nodes by 23% and in men with no lymph node involvement by 15% (Heidenreich et al., Eur Urol 2007; 52: 29-37).
- Our results presented at the European Assocation of Urology annual meeting in 2010 showed tumour down-grading in 46.4% of patients, continence in 96% and, at 30 months follow-up, a recurrence rate of only 4%.
Extended pelvic lymph node removal (ePLND) for intermediate- and high-risk prostate cancer
- This encompasses men with a PSA ≥10, Gleason grade ≥7 or stage ≥T3 prostate cancer.
- Current American Urological Association & European Association of Urologists guidelines recommend ePLND for more aggressive and higher stage prostate cancers.
- Worryingly, the rate of surgeons performing any form of lymph node removal during prostate (especially keyhole) surgery appears to be declining worldwide, probably due to its difficulty and time-consuming nature (Bolenz et al., Eur
Urol 2010; 57: 453-458).
- Our results (submitted for publication) showed an overall incidence of lymph node involvement in 500 such operated patients of 12.4%.
- Extended pelvic lymph node dissection has been shown to improve cancer survival in men with involved nodes by 23% and in men with no lymph node involvement by 15% (Heidenreich et al., Eur Urol 2007;52:29-37).
Our work in this area was Highly Commended and awarded Runner-Up in the prestigious 2012 UK national Quality in Care oncology awards.
Prostate cancer: call to test men in their 40s
- A Swedish study of 21,277 men between 1974-1984 published recently in the British Medical Journal has attracted a great deal of interest in the press as it showed that 'Screening men at the age of 45-49....spotted nearly half (44%) of the cancers that went on to be deadly'.
- It suggest that men should have 'a PSA test in their mid-to-late 40s. Those with a high result should return for frequent screening and checks (and treatment if necessary), while those with normal results could wait until their early 50s for their next PSA test.'
- To read the BBC article click here.
- To read the paper itself click here.
Christopher Eden discusses on video....
- benign prostatic hyperplasia (enlargement).
- prostate cancer.
Clinic provides treatment and complete care for
all diseases and conditions affecting the
prostate, urinary and reproductive systems.