At Home Christian Jessen 2014 - 221

PROMOTION

P

rostate cancer is the most
common cancer in men in the
UK, with 40,000 new cases
diagnosed every year. One in
eight men will get it at some point in
their lives. As the disease develops
slowly, there may be no obvious signs
for many years. As with many cancers,
early diagnosis is key, and one way to
detect prostate cancer is by having a
prostate-specific antigen (PSA) test.

PSA is a protein produced by the prostate
gland and is measured with a blood test. If the
level is raised it can, in some men, indicate
prostate cancer. It can also be raised in men
with large prostates and those with infection.
There has been some controversy about
having a PSA test, as it is not always a good
marker of prostate cancer: levels can be
high in men without prostate cancer, and
normal in those with the disease.

An MRI scan
of prostate
showing lesion
missed by
the traditional
biopsy technique

An ultrasound scan of
the prostate with
targeted biopsy of lesion
seen on an MRI scan

WhO shOuld hAvE A PsA?

* Men who want to have an understanding
of their prostate cancer risk

* Men who genetically may be at an

increased risk of prostate cancer - for
example, those with a brother or father who
has had prostate cancer, or a sister or mother
with breast cancer or men who are black
* Men with urinary symptoms, such as going
to the toilet more frequently, poor flow and
getting up at night to go

WhAT WIll hAPPEN IF
ThE PsA lEvEl Is hIgh?

Your GP will refer you to a urologist for further
evaluation. Consultant urological surgeon,
Mr Christian Brown thinks all men over the
age of 45 should have a PSA test.
'Using modern state-of-the-art imaging
technology and biopsy sampling methods, it
is possible to accurately identify men who do
and those who do not have prostate cancer
with confidence,' he says. 'Some of the
traditional methods such as random transrectal
biopsies can easily miss cancers and have
a significant risk of severe infection called
sepsis (blood poisoning).'
Mr Brown uses multiparametric magnetic
resonance imaging (MRI) scanning of the
prostate, followed by ultrasound-guided
transperineal template or mapping biopsies
of the prostate to evaluate men with a raised
PSA. This leads to higher levels of diagnostic
certainty than traditional methods, and with

no risk of sepsis. Cancers are not missed and
in some cases biopsies can be avoided. It is
also possible to fuse the MRI and ultrasound
images to target lesions within the prostate
for biopsy, further increasing diagnostic
accuracy. This type of biopsy is performed
under a light general anaesthetic and most
patients are discharged one to two hours later.

WhAT hAPPENs IF I
AM dIAgNOsEd WITh
PROsTATE cANcER?

One of the concerns regarding PSA testing
is over diagnosis and over treatment of early
prostate cancer. Using these advanced
diagnostic techniques it is possible to really
understand prostate cancer and evaluate
the risk of the disease. Diagnosing prostate
cancer early doesn't always mean having
treatment, some cancers are small and
non-aggressive and can be watched but,
if treatment is required, it is curative in most.
This diagnostic accuracy using MRI and
template mapping biopsies of the prostate
avoids over-treatment in low-risk disease
where the prostate cancer is not going to limit

'One in eight men will get prOstate
cancer at sOme pOint in their lives
- early diagnOsis is a priOrity'

PROsTATE
cANcER
guIdE

MEET ThE
ExPERT

Mr christian Brown
(pictured, right) is a
consultant urological
surgeon at King's college
hospital and guy's hospital
Nhs Foundation Trusts in london
Mr Brown leads the cancer care at
King's College Hospital specialising
in prostate cancer with interest in
advanced diagnostics, active
surveillance and robotic prostatectomy.
He consults at Renaissance Urology,
19 Harley Street, BMI Blackheath
and Shirley Oaks hospitals.
life expectancy or spread. The reason for the
high PSA is then known but the patient is
spared any risk relating to treatment such as
urinary or sexual side effects. This approach
to managing low risk prostate cancer is
called active surveillance. Patients remain
under review with further PSA testing and
follow up MRI scanning and biopsies every
two years. If the disease progresses then
curative treatment is offered such as a robotic
prostatectomy (keyhole surgery to remove the
prostate gland) or radiotherapy.
Mr Brown also uses the information from
advanced diagnostics to determine which
men will benefit from radical curative
treatment and to plan treatments such as
robotic prostatectomy (with or without nerve
sparing) or radiotherapy. Treatment is offered
to men with intermediate or high risk disease
determined by the grade or aggressiveness
of the cancer shown on the biopsy and
the stage on the MRI scan.
'It is not wrong to have a PSA, as some
men with a high level will have prostate
cancer that needs treatment,' believes
Mr Brown. 'The challenge is to accurately
identify those men with low risk disease to
avoid over treatment and identify those with
intermediate or high risk disease where
treatment is required and will make a
difference for the patient.'

FOR MORE INFORMATION
Visit www.urologistinlondon.co.uk
Call 01306 640052 or
020 8318 7722.
Email info.urologistinlondon@gmail.com


http://www.urologistinlondon.co.uk http://www.urologistinlondon.co.uk

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