At Home with Dr Christian Jessen - 162

Penile and prostate
problems
Urologists, Mr Christopher Ogden and
Mr Michael Dinneen explain the future of
treating prostate and penile conditions...

Q
A

Who comes
to see you?

High-intensity focused
ultrasound can be used
to treat prostate cancer

Usually, patients
with urological
complaints such as
kidney stones, blood
in the urine, elevated
Mr Ogden
prostate-speciﬁc
antigen (PSA) related
to the screening of prostate cancer, incidental
tumours of the kidney, recurrent urinary tract
infections (UTI) in women, and prostatitis.

Q
A

Which medical ﬁeld do you
specialise in?

Cancer of the urinary tract, speciﬁcally
prostate cancer. My main interest is the
diagnosis of primary prostate cancer and the
various ways of managing it for the individual.

Q
A

What are the symptoms of
prostate cancer?

The majority of patients with early prostate
cancer don't present with symptoms, but
getting up at night more often; urinating more
frequently and urgently; and a feeling of
incomplete bladder emptying are the most
common symptoms of benign enlargement of
the prostate, but can also be a sign of cancer.

Q
A

How do you diagnose or rule
out prostate cancer?

A urologist would assess the patient
with PSA testing, magnetic resonance
imaging (MRI) which usually reassures the
patient, however, if anything suspicious
shows up on MRI then the patient would
require a biopsy. If it is moderate to low
grade we would simply recommend
observation because it does not warrant the
risk of treatment. If we do pick up an early,
aggressive cancer, we save lives by treating
it radically with surgery or radiotherapy.

Q
A

What treatments do you offer
to your patients?

The ﬁrst consideration for anyone
diagnosed with prostate cancer is active
surveillance, pioneered at the Royal Marsden,
London which involves regular checks, blood
tests and examinations, with a view to treat
the patient if the disease changes. We offer
radiotherapy, including new forms of radical
external beam radiotherapy such as the
CyberKnife or Photon Beam therapy. Then
there is surgery, which can be standard
laparoscopy, open, or radical robotic
prostatectomy, which I pioneered in the UK.
My team was the ﬁrst in the UK to be
recognised as able to perform robotic
prostatectomy, and has performed around
2,000 procedures since. I was awarded the
ﬁrst Da Vinci innovation award in the UK for
reaching the 1,000 radical robotic prostatectomy
milestone. We also have focal therapy in the
form of high-intensity focused ultrasound (HIFU).

Q
A

Can you explain what focal
therapy is and its beneﬁts?

The technology uses low impact sound
waves to speciﬁcally target the cancer.

In the past the imaging in relation to MRI
used to be so poor that using it was no
better than a blindfolded man trying to
pin a tail on a donkey. However, since
2009, MRI has greatly improved, and it
now allows us to pick up focal leads in the
prostate that we can target. This means
that we are able to diagnose people with
single lesions in their prostate.
We are now looking at trials to treat
prostate cancer with focal therapy and
the early results are very encouraging.
And although the side effects are similar
to radiotherapy or surgery, the impact
on erectile dysfunction is much less.

Q
A

Will it replace general surgery
procedures in the future?

Men will still need radical treatment
if they have multifocal high-grade
disease in their glands, and they will do
well with radical treatment. However, many
men do not have multifocal high-grade
disease, and the majority simply need
active surveillance or low impact treatment
(focal therapy). Patients who see me will not
only receive state-of-the-art treatment, but
most of them initially require just monitoring.
At Home with Dr Christian Jessen

Table of Contents for the Digital Edition of At Home with Dr Christian Jessen
