Prostate Cancer - state of the art
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PROSTATE CANCER - STATE OF THE ART
Mr Jonathan LewinMBBS, MRCS, MD, FRCS(Urol), FRACSConsultant Uro-Oncological Surgeon
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The prostate
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Prostate cancer - epidemiology Common ( 1:5 men)
20 000 diagnosed per year
3000 deaths per year
Increases with age
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Prostate cancer screening
PSA blood test
Rectal examination
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Prostate cancer screening Who?
Men over 50 Men over 40?
Refer if: PSA above range PSA rising quickly Concerns regarding DRE
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Prostate Biopsy
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Treatment options for Prostate Cancer
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Treatment options for prostate cancer
•Patient Factors •Disease Factors
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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
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Aims of Radical Prostatectomy
• Cure the cancer
• Minimise side effects
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Curing the cancer
Surgical removal of the:
Prostate Seminal vesicles Sometimes the lymph
nodes ( glands)
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Minimising side effects
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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?
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Erectile Function
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Penile rehabilitation
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Incontinence
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Incontinence Limit the length of catheterisation X-ray to confirm healing Early use of pelvic floor exercises
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Peri-catheter urethrogram
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Robotic Surgery ?
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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
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Targeted therapy