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
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