Prostate cancer is the most common form of cancer for men in the UK, with over 40,000 men diagnosed each year.
Whilst it is generally slow growing compared to other cancers, symptoms such as pain when urinating or difficulty passing urine should be addressed early to ensure the best care.
Bupa Cromwell Hospital offers a comprehensive service for prostate cancer patients, with access to all treatment techniques. Immediate treatment is not necessary for many men with early stages of the disease, but ongoing monitoring (‘active surveillance’) will be required to check that the cancer does not develop. When treatment is necessary, the aim is to cure or control the disease so it has as little impact as possible on quality of life. If the cancer is already in an advanced stage the aim is to delay symptoms and prolong life.
A multi-disciplinary approach
We have set up a multi-disciplinary team of experts to provide exceptional care for patients with prostate cancer. This includes surgeons, clinical oncologists, radiographers and radiologists. The team considers the type, size and grade of cancer, and the patient’s overall health, to recommend the best treatment options.
Introducing the London pathway for prostate care
Bupa has created a new prostate cancer diagnosis pathway that starts with an abnormal PSA (Prostate Specific Antigen) detection at a Health Assessment, and takes you through the diagnosis and treatment options. Click on the image for more details.
For detailed information describing prostate cancer and who it might affect, please read the detail available via the Bupa Health Information website (external link):
Diagnosis of prostate cancer
Patients with possible prostate cancer symptoms can be diagnosed using a number of different tests.
A blood test to measure the amount of prostate specific antigen (PSA) is a common first step. PSA is a protein that is made by both normal and cancerous prostate cells. The test can be unreliable however as a high PSA level doesn't always mean that you have cancer – it can be caused by other prostate conditions.
A digital rectal examination (DRE) involves your doctor feeling the prostate through the wall of the rectum. If you have prostate cancer it may feel harder than usual, or knobbly.
A prostate biopsy. A biopsy is a small sample of tissue, taken by a needle, that will be sent to a laboratory for testing to determine the type of cells and if these are benign or cancerous. We offer transperineal (through the skin) MRI-targeted biopsies under local anaesthetic or sedation, providing accurate diagnosis whilst enabling patients to return to normal activities on the same day. We also offer transperineal mapping biopsies under general anaesthetic for patients requiring this.
An ultrasound scan examines the prostate gland via a small device inserted into the rectum.
CT scan, MRI scan and bone scans can help the surgeon to see how far the cancer has spread (if at all).
More about our CT scan service
More about our MRI scan service
Treating different types of prostate cancer
Once the cancer has been diagnosed, the suggested treatment will depend on how fast the cancer is likely to grow and how far it has already grown. Surgery, radiotherapy and hormone therapy are the main treatments for prostate cancer. Chemotherapy can also be used.
When the cancer is contained in the prostate gland (localised prostate cancer)
- Low risk - When the cancer is unlikely to develop for many years, and may never cause any symptoms, active surveillance is usually recommended. If the cancer starts to develop during active monitoring however it becomes an intermediate risk.
- Intermediate risk - When the cancer may start to develop within a few years surgery to remove the prostate gland or radiotherapy (internal – Brachytherapy, or external – Tomotherapy) may be recommended. Hormone therapy takes place before, during and after radiotherapy.
- High risk - High risk prostate cancer may start to grow or spread within a couple of years, and surgery to remove the prostate gland or external radiotherapy to the prostate are usually recommended. Hormone therapy alone may be recommended for men who are not well enough for radiotherapy or surgery.
Cancer that is just outside the prostate gland (locally advanced prostate cancer)
Cancer that has broken through the capsule surrounding the prostate gland can be treated with external radiotherapy, with an accompanying course of hormone therapy, or surgery to remove the prostate gland. As with high risk localised prostate cancer, hormone therapy alone may be suggested if the patient is not well enough for surgery or radiotherapy.
When the cancer has spread beyond the prostate
Prostate cancer cannot be cured once it has spread beyond the prostate, but it can be controlled by lowering the level of testosterone in the body via hormone therapy (in tablet form or via injection), and any cancer deposits in bone can be treated with radiation.
During the consultation
We take a detailed history of the pain problem and associated medical conditions. We then offer an opinion as to the cause of the pain and recommend a treatment plan. This plan is followed up as appropriate.
We link with oncologist, surgeons and general practitioners to provide an integrated and coordinated approach to pain management. We also link with physiotherapists, psychologists and other specialists to help control unrelieved pain.
Methods of treatment
We will monitor your cancer without treating you. At the Cromwell this is done with regular MRI scans rather than biopsies, although a biopsy may be required if the MRI suggests a change in the cancer.
If your cancer starts to grow or you develop symptoms, we will start treatment which aims to cure the cancer, rather than controlling it. During active surveillance we will take regular blood tests to check your PSA levels and do regular rectal examinations. You should also have a biopsy at least every three years.
The surgical options undergo constant review following the results of medical research. There are currently three options and the surgeon will discuss the pros and cons of each with the patient:-
- Removing the prostate gland - The surgeon removes the prostate either via an incision in the abdomen or as keyhole surgery (sometimes using a robot). This can be an effective cure if the cancer if it has not spread beyond the prostate gland.
- High Intensity Focused Ultrasound (HIFU) - HIFU is a focal therapy which accurately targets the area containing the cancer rather than the whole prostate, and kills the cells by heating them up with high frequency sound waves. A clinical trial led by one of our prostate specialists has demonstrated excellent results using this less invasive procedure, and a significant reduction in side effects. Both HIFU and cryotherapy (see below) can be used to treat intermediate and sometimes high risk disease.
- Cryotherapy - Cryotherapy freezes and thaws the cancer cells in the prostate to kill them. It is often used for men whose prostate cancer has come back after radiotherapy treatment, but may also be an option for men who are unable to have other radiotherapy or surgical treatments (men with heart problems for example may not be able to have surgery to remove the prostate gland).
HIFU treatment for prostate cancer (external link)
Several different types of radiotherapy are used to treat prostate cancer, depending on the size of the tumour and its location:-
- Tomotherapy (a form of external radiotherapy) is one of the most advanced integrated cancer treatment systems available. It combines Intensity Modulated Radiotherapy (IMRT) with Image Guided Radiotherapy (IGRT) to provide a very effective way of treating cancer with radiation. Bupa Cromwell Hospital was the first radiotherapy department the UK to introduce Tomotherapy, and we remain the only private hospital in the country to offer it.
More about our TomoTherapy service
- Permanent seed brachytherapy (a form of internal radiotherapy) involves having tiny radioactive seeds implanted in the prostate gland. Radiation from the seeds destroys cancer cells in the prostate. This treatment may be recommended if the cancer is contained within the prostate gland (localised prostate cancer). It may be provided in combination with a form of external radiotherapy and/or hormone therapy.
Hormone therapy is used when cancer is just in the prostate gland, whilst chemotherapy is usually used when the cancer has spread.
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