Founded in 1899, King Edward VII’s Hospital is an esteemed independent charitable institution recognised for delivering exceptional surgical and clinical care globally. Situated in London’s prestigious Harley Street medical district. The hospital boasts a rich history of Royal Patronage and provides tailored diagnostic, inpatient and outpatient services to UK and international patients.
With a focus on urology, women’s health, musculoskeletal services and digestive health, King Edward VII's Hospital offers comprehensive healthcare solutions tailored to
individual needs. We have one of the largest private urology centres in the UK, with a team of world-renowned specialists offering the very latest diagnosis and treatments for a range of urological conditions, including prostate cancer, urinary tract infections and stones disease.
Our eminent consultants employ the latest focal therapy techniques for the treatment of prostate cancer, including high-intensity focused ultrasound (HIFU) and NanoKnife, as well as being a high-volume provider of robotic radical prostatectomy for men whose disease is not suitable for focal treatment. We also have a highly specialised team of consultant gynaecologists treating patients with a wide range of gynaecological conditions, with a particular specialist focus on surgical management of primary or relapsed ovarian cancer.
Demonstrating our dedication to seamless patient care, our state-of-the-art outpatient and diagnostic facility is conveniently located on the hospital estate, ensuring a cohesive experience for all our patients. At our core is a commitment to fostering collaboration among our highly specialised teams. We unite world-renowned consultants and medical experts, leveraging cutting-edge technologies to significantly improve patient lives.
As a long-standing charitable organisation, King Edward VII’s Hospital remains steadfast in providing substantial subsidised care to veterans of the Armed Forces. Our Charity extends military grants and subsidies for complex medical treatments to service or ex-service personnel and their families. The hospital’s Centre for Veterans’ Health serves as a vital support hub, offering an award-winning Pain Management Programme – a unique hospital-based service in the UK catering exclusively to veterans’ needs.
King Edward VII’s Hospital is one of the UK’s leading centres for urology, bringing together an exceptional multidisciplinary team of consultant urologists who are all leaders in their specialist field. The hospital boasts world-renowned prostate cancer specialists alongside our impressive consultant group – having invested heavily in technology and expertise they ensure their patients can access the very latest, minimally invasive prostate cancer treatments.
With the provision of a recent histology and MRI report, we provide a pre-consultation triage service to aid the assessment of patients' suitability for focal treatment. This seamless process emphasises the team’s dedication to patient care and the bespoke nature of treatment.
Professors Mark Emberton and Caroline Moore help explain more about the diagnostic and treatment techniques at King Edward VII’s Hospital:
The most important way to get an accurate assessment of your prostate cancer risk is to have a high-quality MRI scan, followed by a biopsy if needed. Suspicious areas on the MRI, and sometimes the areas where cancers are commonly seen, will need to be sampled using a biopsy needle.
Traditionally, the biopsy needle was passed through the back passage into the prostate. Not surprisingly, this could be associated with infections after the procedure, as it is difficult to clean the rectum. A transperineal biopsy – passing the needle through the perineum (the area between the back passage and the scrotum) is much cleaner and the risk of infection is greatly reduced. An ultrasound probe in the rectum is used to view the prostate in real time during the procedure.
The accuracy of targeting the MRI lesion depends upon the skill of the person doing the procedure. It can be helped by using computer software to fuse the MRI image showing a suspicious area onto the ultrasound image used during the procedure. Such MR-US fusion techniques are now regularly in use at King Edward VII’s Hospital.
The aim of focal HIFU treatment is to preserve quality of life, including erectile function, without sacrificing control over the cancer. The minimally invasive qualities of this procedure help to reduce the impact of the side effects that commonly occur after major prostate surgery.
HIFU uses sound waves, produced from high-frequency vibrations originating from a transducer, to create localised cell kill. Temperatures of up to 80-100˚C are reached in the tissue at the focus point, resulting in cell death through necrosis and cavitation. Since its development in the 1940s, HIFU has been used to treat benign and malignant lesions within a number of solid organs, including uterus, brain, kidney and liver, with the addition of prostate from the 1990s.
The procedure involves delivery of treatment using a transrectal probe, usually under general anaesthetic, with real-time monitoring of treatment effect on an ultrasound platform. The area to be treated is chosen by the surgeon, based on the prostate MRI and biopsy results.
HIFU is a means of delivering ‘focal therapy’, with treatment targeted to cancer lesion(s), rather than to the whole prostate. Preservation of some ‘normal’ prostatic tissue and surrounding neurovascular structures potentially reduces the side-effect burden associated with standard radical therapies. The outcomes of longer-term studies are now awaited.
HIFU is considered an alternative primary treatment option to traditional radical therapy (radical prostatectomy, external beam radiotherapy, seed brachytherapy). The advantages of HIFU as a prostate cancer treatment is that it is minimally invasive, delivered in the day-case setting, only requires one hospital visit for treatment and is repeatable if needed.
Furthermore, additional prostate treatment – such as cryotherapy, radiotherapy or surgery – is not precluded if cancer recurrence occurs following HIFU, albeit with a higher risk profile than in the treatment naïve gland. HIFU treatment is limited to prostates of a moderate size that can be covered by the focal length for treatment, as the anterior aspect of the gland cannot be reached in large glands.
Medium-term outcomes for HIFU have been published, reporting both cancer control and the effect on sexual and urinary function. Biochemical disease-free survival rates of 75%-84%, 63%-72%, and 45%-68% in low, intermediate and high-risk groups, respectively, were demonstrated over five to eight years of follow-up in
recent publications involving a large UK cohort. Around one in four men will have a second HIFU treatment by five years, and one in 15 men will have radical treatment with surgery or radiotherapy.
In terms of functional outcomes, 1% of men have some urine leakage after HIFU (which compares very favourably with radical treatment). Of men who have good erections without the need for tablets before HIFU, two in three men will continue to have these after treatment and one in three men will need to have tablets to support the erections. The majority of men will notice a reduction in the volume of ejaculate, and fertility can be reduced.
HIFU also has a place as a salvage treatment in cases of recurrent disease following both external beam radiotherapy and seed brachytherapy.
Also referred to as irreversible electroporation therapy for prostate cancer, NanoKnife is a focal technique used in the treatment of prostate cancer. It is used particularly for small cancers in the anterior prostate. In irreversible electroporation, quick electrical pulses are administered, with the use of electrodes, around and into the tumour to kill cancerous cells. The name ’NanoKnife’ is derived from the fact that these electrical pulses effectively cut open the cells’ membranes.
Advantages of NanoKnife treatment for prostate cancer include a short hospital stay and recuperation period, a painless procedure with minimal side-effects, and that the procedure can be repeated. Disadvantages include the requirement of a catheter for a few days, the possibility of infertility due to decreased/absent ejaculatory fluid, and the current lack of long-term data available on side-effects and outcomes.
Radical prostatectomy is a well-established treatment for prostate cancer. It has evolved over the years from open surgery into laparoscopic (keyhole) and, currently, robotic-assisted laparoscopic (RALP). In terms of cancer control it has been shown to have excellent outcomes.
The operation is performed using a keyhole technique utilising the latest da Vinci robot to aid the surgeon. Through small incisions, a special 3D camera and robotic arms are placed into the pelvis, and these are then controlled by the surgeon from a separate console within the theatre.
This set-up offers a very high-definition view of the prostate (magnified, very well-illuminated 3D, double HD) and surrounding structures, along with highly accurate and versatile movements within the body, allowing the prostate, seminal vesicle (tubes which help produce semen) and, occasionally, lymph nodes to be removed.
The robotic method has revolutionised radical prostatectomy, as it has led to a significant reduction in blood loss and has reduced the length of hospital stay for the patient over open surgery, while giving the surgeon a precision of movement not previously possible by either the open or laparoscopic techniques.
The procedure used today is called an ‘anatomical approach’ – designed to reduce blood loss and tissue trauma, and which can reduce damage to the nerves necessary for erections.
With thanks to Prostate Matters (prostatematters.co.uk),
If you are concerned about your prostate health, or you have received a diagnosis for prostate cancer and are considering private treatment, call a member of the dedicated patient services team at King Edward VII’s Hospital to discuss your options: +44 (0)20 4571 3373 (Mon-Fri, 9am -5pm).
