25 MARCH 2018 HEALTHCARE INNOVATIONS About prostate cancer

Professor of urology and pioneer of robotic urological surgery in the UK, Prokar Dasgupta discusses prostate cancer and innovations in treatment including The London Clinic’s da Vinci robot



rostate cancer is a cancer that starts in a walnut sized gland called the prostate, at the base of the bladder in men.

One in eight men will be diagnosed with prostate cancer in their

lifetime. Prostate

cancer has overtaken breast cancer as the third biggest cancer killer in the UK. Increased awareness has led to more men

being diagnosed. Changes in environment and lifestyle such as an increase in obesity has also increased the incidence.

WHO’S MOST LIKELY TO GET PROSTATE CANCER? Prostate cancer only aff ects men. More than half of the men diagnosed with pros- tate cancer in the UK are aged 70 or over. It’s more common in Caribbean and African men and less so in Asian men. Those with a family history of prostate or

breast cancer also have a higher risk of devel- oping prostate cancer.

COMMON SYMPTOMS In the early stages there are often no symp- toms at all. Symptoms can include diffi culty with pass-

ing urine, waking up at night to pee, passing urine more often, urgency, leakage of urine, blood in the urine or semen, erectile dysfunc- tion and pain in the bones in patients where it’s spread outside the prostate. If you’re experiencing any of these symp-

toms it’s important you seek medical advice from your GP.

CHECKING FOR PROSTATE CANCER Although there’s no national screening pro- gramme, there’s a blood test called the pros- tate specifi c antigen (PSA) which if raised is combined with clinical examination, a urine test and a MRI scan. This may be followed by a biopsy, typically through the perineum, if there’s a suspicion of cancer.

TREATMENT OPTIONS In some men, small, early cancers can be watched carefully without aff ecting survival

or quality of life. In patients where the disease is more aggressive and still within the pros- tate there are a number of options available such as: • Radical prostatectomy (surgical removal) • External beam radiotherapy combined with hormone therapy

• Permanent seed brachytherapy (implanting radioactive seeds into the prostate gland)

• Focal treatments such as high-intensity focused ultrasound or freezing

If the cancer has spread outside the prostate gland hormone treatment and chemother- apy is used. There are a number of new treatments such

as abiraterone, enzalutamide and immuno- therapy that have improved survival even in those where the cancer has spread.

ROBOTIC SURGERY: THE DA VINCI SURGICAL SYSTEM Robotic surgery is commonly used to treat prostate cancer (radical prostatectomy). The London Clinic was the fi rst private hos-

pital in the UK to introduce robotic surgery. Robotic surgery is a form of keyhole sur-

gery. The surgeon sits at a computer console and the computer-enhanced robot mimics the surgeon’s hands and wrist movements and enables surgeons to perform keyhole op- erations with greater accuracy. Robotic surgery allows the surgeon to op- erate with enhanced vision, precision and

Robotic surgery allows the surgeon to operate with enhanced vision, precision and control

control. Rather than making a big cut on a patient surgeons can achieve the same eff ect through tiny keyholes. This benefi ts patients as they have a short-

er hospital stay, less blood loss and pain. Surgeons are able to see the organ they’re op- erating on in 3D, high defi nition which is ben- efi cial for areas that have a lot of nerves and blood vessels that need to be avoided. At The London Clinic we also have special-

ist robotic surgeons which are able to perform gynaecological, colorectal and hepatobiliary surgery as well as urological surgery using the advanced da Vinci Surgical System.

3D PRINTED MODELS OF A PATIENT’S PROSTATE One drawback of robotic surgery is loss of touch. In radical prostatectomy we’ve over- come this by producing bespoke 3D printed models of the patient’s prostate. By creating this model, the surgeon’s able to

feel their way around the real prostate when they perform the surgery. This reduces the risk of leaving cancer cells behind. The London Clinic was the fi rst UK hospi-

tal to use image-guided ‘hyper accurate ro- botic surgery’ enabling the surgeon to remove the disease while reducing the risk of damage to nearby structures.

ASK THE EXPERT Professor Prokar Dasgupta is the UK’s fi rst modern robotic urological surgeon. He in- troduced the da Vinci robot-assisted radical prostatectomy at The London Clinic and con- sults in the NHS at Guy’s Hospital and King’s College London. He off ers a wide range of urological services and has special interests in minimally invasive surgery and robotics. Established in 1932 and situated in the

heart of London’s medical community, The London Clinic is one of the UK’s largest

private hospitals, dedicated to providing the best, personalised healthcare with a breadth of surgical and medical expertise.

The London Clinic T: 020 7616 7693

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