As a professor of urology at The London Clinic, I provide all investigations and treatments for problems affecting the ‘waterworks’ – the kidneys, bladder and the prostate. My special interest is cancer of the prostate – the walnut-shaped gland located just below the bladder in men.
Patients referred to The London Clinic with prostate problems usually come to us through one of three routes. The traditional route is when patients are referred after a blood test showing an elevated PSA (prostate specific antigen) score, even though they may not be showing any symptoms, and are seeking further advice. The second group of patients have urinary symptoms, such as increasing frequency of urination, particularly at night. They may also be experiencing a slow stream, waiting a long time when trying to urinate or needing to urinate more urgently.
The third group comprises those with a family history of prostate cancer, or those recommended to visit by one of our previous patients. If there is any family history then this will be examined in detail – this includes not just for prostate cancer, but also for breast cancer, as there are genetic links between these two cancers that are commonly missed.
We would then arrange a series of tests, which include a more detailed PSA test, an ultrasound scan of the water passage (ie the kidneys, bladder and prostate), an MRI scan and a flow test. The good news for patients at The London Clinic is that we are now able to provide all these tests in one place, at our new Rapid Diagnostics Centre in Harley Street.
Where an MRI scan shows an abnormality then the next step would be a transperineal biopsy, which is minimally invasive and can be carried out under sedation or local anesthetic as a day procedure. We will then see the patient a few days later to discuss the results.
For some patients we would advise active monitoring. This involves keeping an eye on their PSA score every three months and having an MRI scan after a year. If there are signs of progression then we will carry out further biopsies, although the majority of patients would maintain their quality of life and come to no harm.
Around a third of patients will have progression of their cancer and, for some, we can move from monitoring to active treatment. Every patient with a prostate cancer diagnosis is discussed in our multidisciplinary team meetings at The London Clinic, which brings together input from surgeons, radiotherapists, oncologists, pathologists, imaging experts and others.
Further treatment can involve robotic surgery or some form of energy, whether that be external beam radiotherapy or brachytherapy, in
which radioactive seeds are place in the prostate. Radiation is generally combined with hormonal treatment, because this works better than radiotherapy alone.
For overseas patients, it is now much easier for us to arrange follow-up consultations, as these can be carried out via video calls. I can offer the same level of care from my office in Harley Street, irrespective of the patient’s location.
The London Clinic was the first private hospital in the UK to bring in robotic surgery, when I introduced the da Vinci robot in 2005. We have since used every subsequent version of the da Vinci robot, including the latest – the Xi.
Having pioneered robotic surgery almost 20 years ago, my team and I have completed over 10,000 robotic procedures. The technology continues to develop, with new and improved robotic systems.
Looking ahead, there is the opportunity to automate and use artificial intelligence in surgery, which is very exciting. I have been the clinical leader for two major research programmes, funded by UK Research and Innovation, exploring automation in surgery and assessing patients’ trust in such procedures.
Another developing technology is 3D imaging, based on an MRI scan, which will enable us to look inside the prostate and find the precise location of a tumour. This will help in preserving vital structures, such as the nerve bundles, as damage to these can lead to erectile dysfunction. Such technology will give the best chance of clearing the cancer completely, while also maintaining quality of life.
To learn more about The London Clinic, visit thelondonclinic.co.uk or contact:
T: +44 (0) 20 4527 8215
E: appointments@thelondonclinic.co.uk
For international patients, contact:
E: internationaloffice@thelondonclinic.co.uk
