Prostate cancer is the most common cancer to affect men in the UK with over 40,000 men being diagnosed with the disease each year. Common primary treatments employed to treat prostate cancer include surgery to remove the prostate, radiation therapy (external beam radiation therapy (EBRT), brachytherapy), cryotherapy and High Intensity Focused Ultrasound (HIFU).
Regardless of the initial treatment, a proportion of men will experience primary treatment failure exhibiting evidence of recurrent prostate cancer (RPC), usually demonstrated by a rising PSA (Prostate Specific Antigen) reading after therapy.
The proportion of men experiencing recurrent prostate cancer (RPC) after primary treatment ranges from 10 to 50% depending on the initial treatment they received in addition to the extent and aggressiveness of their prostate cancer at initial diagnosis.
Traditionally patients experiencing recurrent prostate cancer after primary treatment have been initiated on palliative hormone therapy. However, a significant proportion of men with recurrent prostate cancer may still be candidates for potentially curative therapy.
At Guy's hospital in London, a number of prostate cancer clinicians with a specialist interest in recurrent prostate cancer have founded the Recurrent Prostate Cancer (RPC) clinic in order to offer men with recurrent disease access to the latest in diagnostic and therapeutic techniques for the treatment of their disease.
Diagnostics for men with Recurrent Prostate Cancer
Men attending the RPC clinic will have access to advanced imaging and biopsy strategies. Men will often undergo advanced multiparametric Magnetic Resonance Imaging (MRI) of the prostate to evaluate the local extent of their recurrent disease as well as undergoing Positron Emission Tomography (PET) imaging using a range of novel radio-nucleotides to evaluate for the presence of metastatic disease (distant spread).
If men require a prostate biopsy, they will have access to transperineal techniques with or without the use of MRI fusion registration as opposed to standard transrectal biopsy. The transperineal approach is well known to be associated with a much lower risk of sepsis as well as being a more accurate method of sampling the prostate gland. At Guy's, men have the option of undergoing transperineal biopsy either under general anaesthetic or local anaesthetic.
Salvage robotic assisted laparoscopic radical prostatectomy
Surgery to remove the prostate after prior treatment such as external beam radiation therapy is known as a 'salvage radical prostatectomy'. Salvage prostatectomy is regarded as a technically demanding procedure. Surgeons at Guy's hospital are highly experienced in the technique of salvage radical prostatectomy and have performed surgery in men who have had a large range of primary prostate cancer treatments including external beam radiation therapy, brachytherapy, High Intensity Focused Ultrasound, cryotherapy, electroporation and combinations of the aforementioned treatments. All salvage prostate surgeries for recurrent prostate cancer are performed using one of two Da'Vinci robotic systems co-located in adjoining robotic theatres on the Guy's hospital campus.