What is Prostate cancer?
Prostate Cancer is the second most common cancer found in Australian men and occurs in approximately 1 in 7 men by the age of 85 years. While it mostly affects older men, we are diagnosing the disease at an earlier stage than previously possible.
Early detection of (localised) prostate cancer means that the disease is present in only the prostate and has not spread elsewhere in the body. Advanced prostate cancer may involve cancer spread to surrounding tissues (locally advanced) and/or metastatic disease where there are distant sites of cancer.
It is important to understand that prostate cancer usually grows very slowly and that 95% of men diagnosed with the disease live over 5 years.
Screening for Prostate cancer
Older age and a family history of the disease increase the likelihood of having prostate cancer. Earlier detection, especially in younger men, can significantly improve prostate cancer survival.
Prostate Specific Antigen (PSA) is a commonly used blood test that can aid in the early detection and monitoring of prostate cancer. While it is usually elevated in prostate cancer, other conditions such as infection, sexual activity or benign prostatic enlargement can also cause PSA to rise.
In recent years, there has been some controversy with regards to whether PSA testing makes any difference in survival and potential over-diagnosis. Many complex studies have been performed to investigate this. PSA testing reduces the number of men dying from prostate cancer and decreases prostate cancer specific mortality.
In short, the latest scientific evidence and Australian guidelines DOES support PSA testing in men who have been informed of it's benefits and shortcomings.
Magnetic Resonance Imaging (mpMRI)
Prostatic MRI is a powerful and useful imaging tool to aid detection of prostate cancer guiding accurate targeting biopsies of any suspicious areas within the prostate.
It also helps around 1 in 4 men avoid an unnecessary prostate biopsy.
Following the finding of an abnormally elevated PSA, an mpMRI is now the standard of care.
In 2018 the Australian government, in recognition of the diagnostic importance of prostate MRI added special funding for men at risk of prostate cancer.
Transperineal Prostate Biopsy
A biopsy takes a small piece of tissue for different areas of the prostate for microscopic analysis. This is performed under live imaging via a rectal ultrasound probe and special needle that pierces the perineum (the area of skin between the scrotum and anus)
Older methods of prostatic biopsy involved piercing the rectum and this carried a significant risk of life threatening sepsis in up to 3 in 100 patients.
The transperineal method dramatically reduces this to near zero and offers much more accurate targeting and mapping of all areas of the prostate.
This a day procedure and involves minimal pain
Given that prostate cancer is often slow growing, some cases can be may not need to be treated. Today, the vast majority of low risk prostate cancer is managed by active surveillance. This involves a combination of regular testing of PSA levels, imaging and prostatic biopsies if required.
By doing so, we can avoid unnecessary treatments while at the same time, catch the disease early before distant spread should it worsen.
Active surveillance may be suitable for you if you have small volume of disease, low grade disease or multiple medical problems.
For localised disease, removal of the entire prostate gland aims to cure patients of prostate cancer. At the same time, lymph nodes can be taken to assess for any potential early spread.
The open approach involves an approximately 10cm incision below the belly button to access the prostate. Once the gland is removed, dissolvable sutures reconnect the urethra to the bladder and a urinary catheter is inserted. The operation takes around 2-3 hours and most patients go home after 3 days.
Urinary continence is maintained in 95% of patients and erectile function can also be preserved in some men.
Robotic assisted surgery, where available, aims to achieve the same goals of cure, but with a minimal disruption of anatomy. The operation is performed via 5 small "keyholes" with the robotic arms under the full control of the surgeon. Benefits include less blood loss, less time off work and most patients return home the next day. 3D cameras and magnification also help identify the nerves and muscles which help improve erectile function and urinary continence.
Kenny performs both open Radical Prostatectomy and Robotic Assisted Laparoscopic Prostatectomy.