Mr Jonathan Lewin MBBS, MRCS, MD, FRCS(Urol), FRACS Consultant Uro-Oncological Surgeon

 Common ( 1:5 men)  diagnosed per year  3000 deaths per year  Increases with age

 PSA blood test  Rectal examination

 Who?  Men over 50  Men over 40?  Refer if:  PSA above range  PSA rising quickly  Concerns regarding DRE

Patient Factors Disease Factors

 For low risk prostate cancer  3 monthly PSA measurement  Repeat Biopsy at 12 months  Detect signs of cancer worsening  Grade progression  Stage progression

Cure the cancer Minimise side effects

 Surgical removal of the:  Prostate  Seminal vesicles  Sometimes the lymph nodes ( glands)

 Specialised uro-oncologist  Surgeon volume> 30/year  Ask about outcomes  Erections  Nerve spare  Penile rehabilitation  Continence  Nerve spare, BN preservation, Rocco suture  Urethrogram?  Pelvic floor physio?

 Limit the length of catheterisation  X-ray to confirm healing  Early use of pelvic floor exercises

Advantages Slightly shorter hospital stay and earlier return to work No difference Cancer cure rates Incontinence Rates Impotence Rates Need for blood transfusion Disadvantages Cost Accessibility