Prostate cancer

 

The prostate is only found in men and is part of the reproductive system.  It sits at the outlet of the bladder and surrounds the urethra (waterpipe) as it leaves the bladder.  This is why some men whose prostate enlarges or becomes diseased have difficulty in passing urine. The prostate produces some of the fluid that bathe the sperm as ejaculation occurs.

Prostate cancer is the most common male cancer, but as yet there is not a screening test for prostate cancer but if you have concerns about the disease then make an appointment to see your GP to discuss your concerns and have your questions answered.  To check your risk, the doctor will examine your prostate and will discuss having a blood test –PSA.

More on what we do

When you attend the urology department for consultation a member of the team will talk through any urinary symptoms you may have, assess your other medical problems and will repeat the examination of the prostate gland.  The doctor or specialist nurse will discuss the investigations needed to assess you for prostate cancer.  Investigations may include an MRI which may highlight any abnormal areas, a prostate biopsy which may be under a local anaesthetic or short general anaesthetic.

You are seen in clinic to discuss the results, if there is evidence of prostate cancer then you may require some further scans to help the Doctors determine the best mode of treatment. WE will discuss all the treatment options with you.

Treatments

The type of treatments available to you are determined by a number of factors such as grade of disease (how aggressive the cancer is), stage of disease (is it confined to the prostate), and any other medical problems you may have now or have had in the past. 

Active Surveillance

Active surveillance is offered to men who have low risk or low risk intermediate prostate cancer who want to avoid the possible side effects of prostate cancer treatments.  It involves monitoring your PSA blood test and we repeat a biopsy after the first year.  We monitor any changes in the PSA and the rate of that change and if significant alterations in PSA we will recommend a change in management.

Radical Prostatectomy

Radical prostatectomy is the surgical removal of the prostate the robotic approach is offered in RD&E. It will involve an overnight stay. We are removing a portion of the urethra (waterpipe) with your prostate, we must repair the defect and you need a catheter to allow the bladder to remain empty and also prevent scar tissue developing at the line of stitches.  The catheter stays in place for 1 week and is removed in the hospital where you had all your investigations for prostate cancer.

The complications of the surgery will be discussed with you in clinic before you are listed for surgery but there is a risk of urinary incontinence (leakage of urine) that in most men resolves at 3 months post operatively but can persist to differing degrees of severity. Because the nerves that help men gain erections lay on the surface of the prostate there is a risk that the ability to gain spontaneous erections after the surgery can be lost. We can provide treatments for this, and this will be discussed in clinic.  In lower risk patients we can offer the opportunity to leave the nerves behind but again this will be discussed in clinic with you.

HDR Brachytherapy

The Royal Devon and Exeter trust was one of the first urology units to adopt this technique of radiotherapy to treat prostate cancer. This form of treatment is offered to a number of men where the prostate cancer is localised to the prostate and the area adjacent to the prostate. This treatment is undertaken by our colleagues in oncology.  The treatment will be discussed with you in depth in clinic. This form of treatment needs hormone manipulation therapy for 3 months prior to starting the radiotherapy.

The first part of this treatment involves an overnight stay in hospital following a spinal anaesthetic to enable the placement of high intensity radioactive seeds into the prostate. The seeds are removed before you leave the radiotherapy department and a urinary catheter is in place over night. You will be commenced on a tablet to help you pass water as one of the complications can be urinary retention. The next part of the treatment is conventional radiotherapy which takes place each day for 3 weeks. Complications of this treatment include difficulties passing water, erectile dysfunction. Some men will experience symptoms of urinary tract infection, and some men will have bowel upset, blood in the urine or in their stool. These symptoms should resolve after completing the course of radiotherapy.

EBRT

External beam radiotherapy is a widely available form of treatment for prostate cancer that is undertaken by the oncology team. You will be seen in the clinic by one of the doctors who will discuss the treatment with you and all the associated side effects. The treatment starts with a 3 months course of hormone therapy.  Before commencing on the treatment you are scanned with a CT scanner to allow your anatomy to be assessed and small black dots are placed on the skin over your pelvis to help the team align the machine at each treatment.

The radiotherapy is planned for the same time each day (Monday to Friday) for between 4 and 7 weeks. Side effects include feeling increasingly tired, there may be bowel upset and some men have an urgency to pass stool, may pass mucous or blood with their motions. Some men also find that they need to pass urine more frequently and this may be associated with blood in the urine or discomfort when voiding. These symptoms should pass when the treatment has stopped but long term side effects can be intermittent blood in the urine and from the back passage. There is also a risk of damage to the nerves that enable erections and some men complain of problems urinating or having urgency and frequency of urination.

Our team

Miss Elizabeth Waine - Consultant urologist and Robotic Surgeon

Mr Miles Goldstraw - Consultant Urologist and Robotic Surgeon

Mr Malcolm Crundwell - Consultant Urologist

Mrs Jane Billing - Clinical Nurse Specialist

Mrs Claire Turner - Clinical Nurse Specialist

Mrs Katie Quainance - Clinical Nurse Specialist

Mrs Moira Anderson - Clinical Nurse Specialist

Where to find us

RD&E Wonford, Barrack Rd, Exeter EX2 5DW

Department of Urology (Level 2, Area G)

Contact us

Secretary to Miss Waine - 01392 408474

Secretary to Mr Goldstraw - 01392 404721

Clinical Nurse Specilaists - 01392 40 2747

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