A full consultation regarding the symptoms and signs of prostate cancer is undertaken. This includes examination, PSA testing, IPSS (Prostate symptom score), a flow test (if needed) and a discussion of the pros and cons of testing, what happens if your tests are positive and potential outcomes. A rectal ultrasound scan and prostate biopsies are carried out if needed. More advanced tests such as PSA ratio and PCA3 testing are also available for managing a persistently raised PSA.
Prostate cancer treatment
A discussion will take place on all available treatment options depending on the extent of the disease. This may include Active Surveillance (No treatment with monitoring), Radical Prostatectomy (Surgery), Radiotherapy (External beam and brachytherapy) with or with out anti-hormone treatment, Anti-hormone treatment (LHRH analogues) alone, or newer therapies such as HIFU and Cryotherpay. Access is provided to regional or national experts who may be able to treat your condition.
Recurrent prostate cancer
Treating prostate cancer recurrence depends on the facts surrounding your initial diagnosis (for example your initial PSA, Gleason score and stage), your PSA since treatment and, your current stage and which treatment you initially underwent. A discussion regarding this will be undertaken and the pro and cons of options discussed, for example Continued Monitoring, Anti-hormone Treatment, Radiotherapy (external beam), HIFU and Cryotherapy.
The Management of Superficial (early) Bladder Cancer
Some types of superficial bladder cancer have a high risk of progression whilst most have a high risk of recurring. Your bladder will be examined, at the first diagnosis, under a general anaesthetic. You will require further x-ray type imaging if it has not already been undertaken. It is likely that you will have medicine put into the bladder after this. The medicine can stop the disease from coming back. In some instances you may have the medicine on a weekly basis for 6 weeks and in other instances this may be for 8 weeks. You will require long term bladder checks to ensure the disease does not come back or get worse. This will be discussed with you. In some cases new tests can be undertaken, such as NMP22, that can sometimes help decide whether a local anaesthetic or general anaesthetic bladder check is indicated.
The Management of Invasive (late) Bladder Cancer
Invasive or late bladder cancer treatment starts with an accurate assessment of you and your disease. Then a discussion on treatment options can take place. Briefly the options include organ preservation using radiation therapy protocols or surgery, which involves removal of the bladder. The latter requires diversion of the urine into either a reconstructed bladder or a stoma. Long tern follow-up is required with both these forms of treatment to ensure either no disease returns or to ensure no complications of the treatment arise.
The Management of Renal (Kidney) Cancer
Kidney cancer is becoming more common. Its management can include surveillance and removal of part or the entire kidney. In cases where there is spread out side from the kidney then other therapy can be given in addition e.g. interferon, sutent etc. Your case can be discussed and the most appropriate treatment identified. Minimally invasive (key hole surgery) may be an option for you and we can discuss this also.