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Prostate Cancer - state of the art

Prostate Cancer - state of the art. Mr Jonathan Lewin MBBS, MRCS, MD, FRCS( Urol ), FRACS Consultant Uro-Oncological Surgeon. T he prostate. 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 - state of the art

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  1. Prostate Cancer - state of the art Mr Jonathan Lewin MBBS, MRCS, MD, FRCS(Urol), FRACS Consultant Uro-Oncological Surgeon

  2. The prostate

  3. Prostate cancer - epidemiology • Common ( 1:5 men) • 20 000 diagnosed per year • 3000 deaths per year • Increases with age

  4. Prostate cancer screening • PSA blood test • Rectal examination

  5. Prostate cancer screening • Who? • Men over 50 • Men over 40? • Refer if: • PSA above range • PSA rising quickly • Concerns regarding DRE

  6. Prostate Biopsy

  7. Treatment options for Prostate Cancer

  8. Treatment options for prostate cancer • Patient Factors • Disease Factors

  9. 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

  10. Aims of Radical Prostatectomy • Minimise side effects • Cure the cancer

  11. Curing the cancer • Surgical removal of the: • Prostate • Seminal vesicles • Sometimes the lymph nodes ( glands)

  12. Minimising side effects

  13. 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?

  14. Erectile Function

  15. Penile rehabilitation

  16. Incontinence

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

  18. Peri-catheter urethrogram

  19. Robotic Surgery ?

  20. 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

  21. Targeted therapy

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