Prostate Cancer: Diagnosis and Treatment

Transcript

Hello, I’m Associate Professor Phillip Stricker, Prostate Cancer Specialist and Director of the St Vincent’s Prostate Cancer Centre. I joined the Editorial Advisory Board of the Virtual Cancer Centre over one year ago and today I would like to share with you my insights on diagnosis and treatment of prostate cancer.

Approximately one in ten men will develop prostate cancer in his life time and 2500 Australian men will die of this condition. It’s more common in people with a family history and this increases the chance of developing it by two-fold, if you have a father or a brother with the condition.

We have some knowledge about the prevention of this cancer now, and it has been shown that a low fat, healthy cardiac diet with low calories, as well as the use of selenium tablets, which is a micro elements in the soil, lycopene, which is the red component of tomatoes, soy and vitamin E  and sunlight, may indeed reduce the likelihood of developing this cancer.

In order to detect prostate cancer at an early, curable stage, one needs to perform a PSA blood test and a digital rectal examination. If either of these are abnormal, it is generally recommended that a biopsy be performed under a general anaesthetic. The technique I personally use is the transperineal technique under general anaesthetic, in order to minimise any chance of infection. I personally have the largest experience in treating prostate cancer currently in Australia.

If a prostate cancer is diagnosed then the treatment options on offer include nerve sparing surgery to minimise the chance of impotency, which means loss of erections, of which I have the largest series in Australia and one of the largest series in the world at over 1500 cases. Logostraight brachytherapy is another option, which is a minimally invasive therapy which can treat less aggressive cancers as a day only procedure with very mild side effects. High dose rate brachytherapy is another more invasive form of treatment using radiotherapy, which can treat more aggressive cancers which are difficult to treat with surgery. And finally the newest confirmed therapies which I’ve introduced include robot assisted keyhole surgery, which allows patients to recover quicker from their operations to get back to normal activities, while still maintaining the results I’ve achieved with the open technique.

As well as the above I’ve recently introduced high intensity focused ultrasound, which is again a less invasive form of treatment with heat, which can treat prostate cancer, aiming to cure it, in patients deemed unsuitable or refusing surgery or radiotherapy. Many patients these days are also monitored and indeed not treated for their cancers, particularly if they are elderly or unwell with a less aggressive type of cancer.

The Gleason Score of a tumour is a measure of the aggressiveness of the tumour and in general terms Gleason 6 tumours are regarded as less aggressive, Gleason 7, intermediate, and Gleason 8-10 as aggressive. When deciding between treatments, careful consideration of the type of tumour you have, the size and symptoms of the prostate, our particular expertise, and your own personal priorities, including sexual priorities are considered, to tailor the treatment to you and maximise the outcomes. My team at our institution at St Vincent’s in Sydney include clinical nurse consultants, sexual rehabilitation specialists, pelvic floor physiotherapists, radiotherapists, oncologists and counsellors, to allow us to give you a truly multidisciplinary care, which is now necessary to give best outcomes.

For more advanced cancers of the prostate, the medical oncology department includes all treatments, including clinical trials to test new treatments, which are currently in an exciting stage of development. Finally a problem such as urinary incontinence or erection problems do occur under treatment, we are now able to offer all the newer treatments for both of these complications.

Urinary incontinence that does not respond to simple pelvic floor exercises, we treat the mild incontinence with an InVance® sling and the more severe incontinence with what we call an artificial sphincter, which is a type of surgery.

If you develop erection problems which don’t respond to normal methods, we use the viagra-like medications, penile injections, vacuum devices and/or counselling through our sexual rehabilitation section. With this multidisciplinary approach I hope to maximise the outcomes for all patients and tailor a treatment option for each and every patient.

Thank you for watching and have a great day.

More information

For more information on this type of cancer, visit Prostate Cancer: Overview.