New surgical technique preserves continence in men after prostate removal
20 November 2024
Publish date: 09 April 2024
Improvements to patient care underpinned the UCLH presentations at the weekend’s European Association of Urology conference in Paris.
Professor Caroline Moore was one of the authors on the Lancet Commission on Prostate Cancer which was published to coincide with the conference.
The new analysis projected that worldwide prostate cancer cases will double from the current 1.4 million a year to 2.9 million a year by 2040 and called for more planning to prepare for the upcoming surge in cases, including new and improved strategies for early detection.
The commission also called for more research involving men of different ethnicities, especially those of West African descent, to enable better understanding, detection and care in these groups.
Consultant urologist Veeru Kasivisvanathan presented the results of a UCL and UCLH clinical trial which shows that a shorter scan to diagnose prostate cancer will increase availability and reduce cost. The trial was designed and delivered with the radiology team at UCLH led by Francesco Giganti and Clare Allen.
The clinical trial, funded by the John Black Charitable Foundation and Prostate Cancer UK, reported that removing one step from a three-part MRI scan, which could make them quicker, cheaper and more accessible, had no negative impact on diagnostic accuracy.
A three-part ‘multiparametric’ MRI of the prostate is standard of care in the UK for patients suspected of having prostate cancer, which currently includes a dye injection as its third part. Abnormalities seen on the MRI scan allow targeted tissue biopsies to be taken that can improve cancer detection. A normal MRI result, which occurs in around a third of patients, is reassuring and allows men to avoid an unnecessary biopsy.
Associate Professor Kasivisvanathan said: “Since multiparametric MRI became standard of care for diagnosing prostate cancer, an important question has been whether we could streamline the scan further in order to make it more accessible, not just in the UK but in a wide range of healthcare settings and models.
“These results suggest that, providing that MRI image quality is good, we can adopt a shorter two-part biparametric MRI as the new standard of care for prostate cancer diagnosis. These results also make a strong case for prioritising work to optimise MRI quality nationally and internationally.
“I’m really proud of the team for delivering a complex, international multi-centre trial so quickly. I hope our results will soon be incorporated into clinical practice so that as many men with suspected prostate cancer as possible can benefit. Our vision is that every man who needs a prostate MRI should be able to get a high-quality one.”
And consultant urological surgeon Clément Orczyk opened the first semi-live surgical technique for focal therapy at a major conference. He showed a case of irreversible electroporation (IRE) and cases of High Intensity Focused Ultrasound (HIFU) and Cryotherapy. UCLH runs the largest cohort in the world for focal therapy, which provides more targeted treatment, and in turn leads to a better quality of life for the patient.
Associate Professor Orczyk said: “The team at UCLH is at the forefront of innovative and pioneering work in urology/prostate cancer. This illustrates our commitment to ensure equity of access to the latest novel methods of care.
“This is the first-time focal therapy has been given such exposure at a major conference, demonstrating the appetite for what we have been pioneering for more than a decade, that is a newly-designed pathway from early detection to treatment tailored to patient needs. We have shown that our pathway reduces the burden on the NHS by decreasing MRI scanner time by more than 50% and reducing operating time by 75%, without the need for a hospital stay.
Finally, consultant urological surgeon Professor Greg Shaw presented the work of his team in developing a new technique called LaserSAFE. A confocal laser microscope rapidly scans the surface of the prostate removed during a surgical operation to check that cancer cells are not present. If more cancer cells are detected, further resection takes place at the same operation.
Professor Shaw is also leading an international collaboration to evaluate this technique, which has potential to change the way prostatectomy is performed around the world.
