Prostate cancer is the most common male cancer in the UK with over 40 000 new diagnoses made yearly. It presents most commonly in older men. It is uncommon in men under the age of 50 years and may be suspected because of urinary symptoms or a raised prostate cancer blood test (Prostate Specific Antigen or PSA). Common urinary symptoms are a weak or hesitant urinary flow, daytime and night-time frequency of passing urine and post voiding dribble. However, these symptoms are the same for benign enlargement of the prostate. PSA is only produced by the prostate gland and is commonly raised in prostate cancer. It may also be raised in other non cancer related prostate conditions but if over the recommended age related level it represents a high risk of prostate cancer. The prostate is situated at the bladder neck and is in close proximity to the rectum. It can therefore be examined by placing a finger in the rectum. If the prostate feels firm or clearly nodular, a cancer may be suspected. Therefore either a raised PSA or abnormal rectal examination represents a high risk for prostate cancer. A biopsy of the prostate may be performed by placing an ultrasound probe into the rectum and directing a needle firstly to give local anaesthetic and secondly to take multiple biopsies of the prostate gland. This is then examined under a microscope by a pathologist to see if there is harmless benign enlargement of the prostate or cancerous enlargement.
Once a prostate cancer is diagnosed various radiology tests may be performed depending on the PSA level and the biopsy results. These tests may include a Magnetic Resonance Scan (MRI) or bone scan. These look for the local extent of the disease, the presence of lymph node enlargement or distant bony spread.
Conventional management for localised prostate cancer include active surveillance, radical prostatectomy, external beam radiotherapy and brachytherapy (radioactive seed placement). West Sussex Urology offers all these options. All prostate cancer patients are discussed either within the local or specialist multi-disciplinary team (MDT) where all results are checked and treatment options discussed with surgeons, oncologists, radiologist and pathologist.
Laparoscopic radical prostatectomy is a new service with West Sussex, performed by James Hicks and Simon Woodhams. Brachytherapy is provided by Paul Carter.
Metastatic or spread prostate cancer is treated by switching off the male hormone, testosterone, thus removing the driver that makes prostate cancers grow. This most commonly, involves daily tablets or 3 monthly injections or a combination of both.
Oncology support, including External Beam Radiotherapy (EBRT), for West Sussex Urology prostate cancer patients is provided by Dr Ghassan Khoury, at the Nuffield Health Chichester Hospital, and Dr Ashok Nikopota at Goring Hall Hospital.
MRI is increasingly being used in the assessment of Prostate cancer risk and prostate cancer assessment and management.
WSU has access to modern multi-parametric MRI through private services at Western Sussex Hospitals Foundation Trust, the Nuffield group and Goring Hall Hospitals.
The indications for prostate MRI are; The staging of prostate cancer in biopsy proven disease. The assessment of prostate cancer risk in patients with elevated PSA, prior to prostate biopsy The follow up of prostate cancer patients on an active surveillance treatment plan.
This gives the option for targeted biopsy of the prostate, if necessary, through the trans-rectal or perineal routes. Biopsy of the prostate can be avoided in low risk disease on MRI. The MRI scans are reported by our prostate specialist radiologists and where necessary reviewed in local and regional multi-disciplinary team meetings.
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