UPDATE - Issue 15 - September 2003
Urology Conference highlights advances in research
The annual conference of the British Association of Urological Surgeons, held in Manchester in June, was faced with a welter of papers and poster presentations. From the abstracts of these we have picked out a number of topics prostate topics which together illustrate where much research of quality is focused and where change and progress is being made to the diagnosis and treatment of prostate diseases. We also highlight the hospitals where the research is being carried out - not just the London teaching hospitals and large research centres, but units right across the country.
Diagnostic issues
How many biopsy cores are needed? A trial showed that taking just six samples could miss 37% of cancers. By in, increasing the number and distribution to 10 only 4% were missed. Leighton Hospital, Cheshire.
It appears that just four variables age, number of positive biopsy samples, PSA reading and grade of cancer when viewed under the microscope - can be combined into an effective predictor of eventual outcome. Institute of Urology, UCL, London. This was funded by Prostate Research Campaign UK.
In view of the proportion of not completely successful radical prostatectomy operations in patients who have high initial PSA readings, is there some PSA reading above which one should decide not to conduct such operations? In the US, patients with a PSA higher than 10 are often advised not to have the operation. In the UK such patients are still accepted although only 34% of them will be PSA recurrence free after five years. Royal Free Hospital, London.
The free to total PSA ratio is useful in finding cancers in young men who would benefit from curative treatment. St. Mary's Hospital, London.
Surgical techniques
Evidence from 1000 laparoscopic (keyhole) prostate operations shows the technique is comparable to conventional surgery in its mid term outcomes. We now need a longer term follow up. Institute Montsouris, Paris.
In the last edition of Update we wrote about Declan Cahill, whom Prostate Research Campaign UK had supported while he became skilled in the operation in Paris. He now practises at Guys Hospital, London. It is clear that there are a number of surgeons in the UK now practising this technique. There were papers at the BAUS conference from teams at Kings College Hospital London, Wexham Park Hospital, the Royal Hallamshire, Sheffield and the Freeman Hospital, Newcastle and we have seen press coverage of a patient receiving treatment at the Hampshire Clinic, Basingstoke.
Brachytherapy is a relatively new technique in the UK. Evidence was presented that showed results in the UK comparable to, those achieved in the US when measured over up to four years. St Luke's Cancer Centre, Guildford.
Cryoablation (a freezing technology) of the prostate appears to be an effective alternative for patients with localised prostate cancer and for those whose cancer has recurred following radiotherapy. Medical University of South Carolina USA.
Treatment options
What treatment would the patient choose? Evidence from 356 patients with treatable prostate cancer, all of whom were informed about the choices open to them in the same way, showed that 43% elected for surgery, 37% for external beam radiotherapy, 17% for brachytherapy and just 3% for watchful waiting. Stepping Hill Hospital, Stockport.
For patients with a good prognosis conformal radiotherapy gives results comparable to surgery. Patients in poorer prognosis groups are now being treated with intensity modulated radiotherapy. Christie Hospital, Manchester.
An analysis of the records of 624 men who had received prostatectomies showed that the grading of their cancer as estimated before the operation from biopsy results did not correlate particularly well with the grading measured using the whole excised tumour. A worrying finding since so many key management decisions are made on the biopsy results. Institute of Urology and MRC Clinical Trials Unit. This was funded by Prostate Research Campaign UK.
Tamoxifen, the drug used to treat breast cancer, reduces the problem of breast enlargement and tenderness in bicalutamide therapy. Queen Elizabeth Hospital, Kings Lynn.
Benign Prostatic Hyperplasia
High powered lasers can be used as an alternative to surgery for removing obstructive prostatic tissue. Evidence shows that the technique produces results equally as good as the classical TURP operation. Auguste-Viktoria-Hospital, Berlin.