Starting the conversation: diagnosing and treating prostate cancer

Published by Professor Hashim Ahmed
Consultant Urological Surgeon, Bupa Cromwell Hospital

29 November 2018 . United Kingdom

Last week I was delighted to host the latest in our series of Bupa Cromwell Conversations, which aims to bring together medical professionals and members of the public. The focus was the diagnosis and treatment of prostate cancer.

Prostate cancer affects more men in the UK than any other cancer, but with quick diagnosis, intervention and tailored treatment, there is a very good chance of beating it.

As the curve of prostate cancer incidence rises, unfortunately there has been little positive impact on reducing the amount of men dying from these problems in recent years. This is something I put down to the initial diagnostic approach.

Typically, if men show high prostate specific antigen (PSA) levels in the blood when being tested, they are told they should have a biopsy. However, this is often unnecessary, and can lead to side effects such as bleeding, discomfort, mild erectile dysfunction and importantly, infection and sepsis. Biopsies can also often miss the most important and aggressive parts of cancer, such as tumours.

We’re making great strides when it comes to the early diagnosis of prostate cancer, thanks to the introduction of advanced MRI scans. MRI scans are much less invasive and give detailed pictures of the prostate, whether it’s providing clarity and stopping unnecessary treatment or finding the aggressive parts of cancer biopsies can miss, giving a clearer outlook on next steps. It’s a much safer, accurate, and streamlined diagnostic pathway which gives men a different option without having to worry about side effects. If a biopsy is then needed, it can be precisely targeted using fusion technology – and because the biopsies we do at Bupa Cromwell are transperineal and not transrectal, the risk of infection is 1 in 500, rather than 1-2 in 100.

In my experience, I know that thinking about side effects can put men off seeking help as they think they may lose quality of life. Advanced MRI scans ensure focused treatment on only the affected area can often be provided, with options including High Intensity Focused Ultrasound (HIFU) and cryotherapy. This is beneficial because, if you have prostate cancer affecting one area and have a complete removal, this can cause harm. As the tissues surrounding the prostate such as nerves, muscle, back passage, water passage and bladder are very close, whole gland treatment can also damage other organs and lead to problems such as urine leakage and sexual dysfunction.

I’m delighted that 65% of NHS Trusts have now adopted MRI scans as a first step in diagnosing prostate cancer, and we’re hopeful this will rise further in the near future.

At Bupa Cromwell, our rapid diagnostic prostate care pathway aims to help men at every step of the way. Based on the latest clinical evidence, it starts with an abnormal PSA detection at a Health Assessment in a Bupa Health Clinic or by your own local GP, and then quickly takes you through the diagnosis and treatment options with our prostate multi-disciplinary team, providing access to our world-class facilities. It also provides additional services to support individual needs, from counselling through to physiotherapy and dietary advice for prevention of cancer and recurrence after treatment.

Often, with prostate cancer you won’t have symptoms until it becomes advanced, and with prostate cancer incidence continuing to rise in the UK, it’s important that men are being more proactive than ever when it comes to their health.

Look out for future Cromwell Conversations dates on Bupa Cromwell’s website and social media channels.

Professor Hashim Ahmed

Consultant Urological Surgeon, Bupa Cromwell Hospital

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