Prostate Health Clinic

Prostate HealthBenign Prostatic Hyperplasia

Innovations in Benign Prostatic Hyperplasia (BPH) Surgery

If patients develop symptoms related to benign prostatic hyperplasia (BPH) which do not respond well to medications, surgery can be considered. Traditionally, transurethral resection of the prostate (TURP) can be offered to alleviate symptoms related to BPH. During the surgery, prostate tissue will be resected endoscopically, resulting in a wide channel for urination. Usually TURP would require spinal or general anaesthesia, and patients can be discharged within 3-4 days.  Recently, there have been a lot of advances in BPH surgery, and they include Rezum, Urolift, Aquablation, Bipolar / Holmium laser enucleation of the prostate, GreenLight laser vaporization and prostatic artery embolization. For patients who are concerned about the peri-operative risks of surgery, minimally invasive treatment such as Rezum and Urolift may be considered. Rezum works by delivering water vapour into the prostate gland, the prostate tissue will be ablated and resorbed. Urolift works by placing implants which can compress the prostatic tissue and result in a widened channel for urination. General anaesthesia is usually not needed for these procedures, and patients can usually be discharged on the same day of surgery. Both procedures are more suitable for men with mild to moderate BPH. Rezum   Urolift For patients with very big prostates, it is usually more difficult to ensure a good removal of prostate tissue. Treatment options such as Aquablation and Bipolar / Holmium laser enucleation of the prostate may be considered. During Aquablation, prostate contour can be marked on ultrasound, and then ablated by a robotically controlled waterjet technology. During Bipolar / Holmium laser enucleation of the prostate, the prostatic capsule is first identified during the procedure, and then the prostate tissue will be enucleated and removed.     Aquablation   Enucleation of the prostate For patients with recurrent hematuria or at high risk of bleeding (e.g. on anti-coagulants), treatment options such as GreenLight laser vaporization and prostatic artery embolization may be considered. GreenLight laser has the property of vaporizing the prostate tissue and controlling bleeding at the same time. Prostatic artery embolization works by occluding the blood supply to the prostate gland, hence reducing bleeding and causing shrinkage of the prostate tissue. Apart from good hemostatic effects, both procedures are able to improve lower urinary tract symptoms at the same time. GreenLight laser vaporization Prostatic Artery Embolization The above are just general information about the various types of BPH surgery. Patients should seek advice from urologists, understand the pros and cons of each treatment option before deciding on the most appropriate treatment plan. 

Prostate HealthProstate Cancer

Imaging and Diagnosis of Prostate Cancer

Traditionally, men with elevated PSA would require transrectal ultrasound-guided prostate biopsy to look for any prostate cancer. However, transrectal approach has a 1-2% chance of severe infection, and the biopsy procedure may also be prone to sampling error.  Recently, there have been a lot of advances in prostate cancer diagnosis. For men with elevated PSA, a MRI scan can be arranged to look for any tumours or suspicious lesions within the prostate gland. The MRI images can be fused into the ultrasound image during prostate biopsy, and targeted biopsy of the prostatic tumour can be performed. This will increase the accuracy of the biopsy procedure. On the other hand, if the MRI scan shows a completely normal prostate gland, prostate biopsy may also be safely avoided.    Conventional transrectal prostate biopsy requires puncture of the rectal wall, and bacteria within the rectum may enter the body and result in infection. In order to reduce the risk of infection, transperineal prostate biopsy can be performed. The perineum will first be disinfected during the procedure, and the perineal skin will be punctured in order to sample tissue from the prostate gland. The rectal wall remains intact during the whole prostate biopsy procedure, therefore bacteria within the rectum would not be able to enter the bloodstream. In recent years, transperineal prostate biopsy has gained increasing interest and adoption globally. For patients with confirmed prostate cancer, it is important to look for any distant metastasis before deciding on the appropriate treatment. PSMA PET-CT scan is an accurate imaging for staging prostate cancer. In patients with localized disease, curative treatment such as robotic surgery, radiotherapy and focal therapy can be considered. In patients with metastatic prostate cancer, medical treatment such as hormonal therapy and chemotherapy may be considered. Information about the different types of prostate cancer treatment can be found here.

Prostate HealthProstate Cancer

Advances in Prostate Cancer Treatment

Curative treatment can be considered for patients with localized prostate cancer. The choice of treatment depends on patient’s age, his general condition and cancer aggressiveness. Different treatment options including robotic surgery, radiotherapy and focal therapy may be offered. At CUHK Medical Centre, Versius, the next-generation surgical robot has been installed to perform robotic surgery. Robotic surgery aims to remove the whole prostate gland and render a cure for prostate cancer patients. Prostate gland is located between the bladder and the urethra. After removal of the prostate gland, suturing is needed to reconnect the bladder neck with the urethra. In patients with more aggressive prostate cancer, lymph node dissection may also be needed. Since the prostate gland is located deep inside the pelvis, the use of robot will allow surgeons to have more precise dissection and suturing during the whole procedure.   Radiotherapy uses ionizing radiation to destroy prostate cancer cells. For men with localized prostate cancer, radiotherapy can be used alone or in combination with hormonal therapy. MR-Linac system integrates the power of high-field Magnetic Resonance Imaging (MRI) with precision radiation therapy. The capability of locating the tumours provides confidence for oncologists to place a high dose to the prostate gland. To further minimize potential rectal toxicities, transperineal injection of hydrogel can be considered before radiotherapy. MR-Linac system Hydrogel Focal therapy aims to achieve good oncological control with functional preservation. This treatment option is usually considered in patients with focal and low-risk prostate cancer. Different energy modalities such as high-intensity focused ultrasound (HIFU), cryotherapy and microwave ablation can be used for destroying the prostate tumour. After focal therapy, regular monitoring with MRI scan and prostate biopsy is needed to ensure adequate cancer control. Case selection is crucial in deciding this treatment option. Schematic Diagram of Focal Therapy As low-risk prostate cancer is usually slow growing, active surveillance is also a viable option. The prostate cancer status is regularly monitored by PSA blood taking, physical examination, MRI scan and repeated prostate biopsy. If there are any early signs of disease progression, curative treatment will have to be re-considered. For patients with metastatic prostate cancer, various medical treatment such as hormonal therapy, chemotherapy and oral novel hormonal agents can be considered. In patients with low number of metastatic sites, additional radiotherapy to the prostate gland can also be considered. Transperineal injection of hydrogel may further reduce radiotherapy-related rectal toxicities. The above are just general information about the different treatment options of prostate cancer. Patients should seek medical advice, understand the pros and cons of each treatment option before deciding on the most appropriate treatment plan.