Prokar Dasgupta, Professor of Urology discusses prostate cancer and innovations in treatment including The London Clinic’s da Vinci robot.

He pioneered robotic urological surgery in the UK.

About prostate cancer

Prostate cancer is a cancer that starts in a walnut sized gland called the prostate, at the base of the bladder in men.

1 in 8 men will be diagnosed with prostate cancer in their lifetime. Prostate cancer has overtaken breast cancer as the third biggest cancer killer in the UK.

More awareness has led to more men being diagnosed. Changes in environment and lifestyle such as an increase in obesity has also increased the incidence.

Who is most likely to get prostate cancer?

Prostate cancer only affects men. More than half of the men diagnosed in the UK are aged 70 or over. It is more common in Caribbean and African men and less common in Asian men.

Those with a family history of prostate or breast cancer also have a higher risk of developing prostate cancer

Common symptoms

In the early stages there are often no symptoms at all.

Symptoms can include difficulty with passing urine, waking up at night to pee, passing urine more often, urgency, leakage of urine, blood in the urine or semen, erectile dysfunction and pain in the bones in patients where it has spread outside the prostate.

If you are experiencing any of these symptoms it is important you seek medical advice from your GP.

Checking for prostate cancer

Although there is no national screening programme, there is a blood test called the Prostate Specific Antigen (PSA) which if raised is combined with clinical examination, a urine test and a MRI scan. This may be followed by a biopsy, typically through the perineum, if there is a suspicion of cancer.

Treatment options

In some men, small, early cancers can be watched carefully without affecting survival or quality of life. In patients where the disease is more aggressive and still within the prostate there are a number of options available such as:

· Radical prostatectomy (surgical removal)

· External beam radiotherapy combined with hormone therapy

· Permanent seed brachytherapy (implanting radioactive seeds into the prostate gland)

· Focal treatments such as high-intensity focused ultrasound or freezing

If the cancer has spread outside the prostate gland we use hormone treatment and chemotherapy.

There are a number of new treatments such as abiraterone, enzalutamide and immunotherapy that have improved survival even in those where the cancer has spread.

Robotic surgery: the da Vinci Surgical System

Robotic surgery is commonly used to treat prostate cancer (radical prostatectomy).

The London Clinic was the first private hospital in the UK to introduce robotic surgery.

Robotic surgery is a form of keyhole surgery. The surgeon sits at a computer console and the computer-enhanced robot mimics the surgeon’s hands and wrist movements and enables our surgeons to perform keyhole operations with greater accuracy.

Robotic surgery allows the surgeon to operate with enhanced vision, precision and control. Rather than making a big cut on a patient we can achieve the same effect through tiny key holes.

This benefits patients as they have a shorter hospital stay, less blood loss and pain. We are able to see the organ we are operating on in 3D, high definition which is beneficial for areas that have a lot of nerves and blood vessels that need to be avoided.

At The London Clinic we also have specialist robotic surgeons who are able to perform gynecological, colorectal, hepatobiliary and urological surgery using the advanced da Vinci Surgical System.

3D printed models of a patient’s prostate

One drawback of robotic surgery is loss of touch. In radical prostatectomy we’ve overcome this by producing bespoke 3D printed models of the patient’s prostate.

By creating this model, the surgeon is able to feel their way around the real prostate when they perform the surgery. This reduces the risk of leaving cancer cells behind.

The London Clinic was the first UK hospital to use image guided “hyper accurate robotic surgery” where the surgeon is able to remove the disease while reducing the risk of damage to nearby structures.

Ask the expert

Professor Prokar Dasgupta is the UK’s first modern robotic urological surgeon. He introduced the da Vinci robot assisted radical prostatectomy at The London Clinic and consults in the NHS at Guy's Hospital, King's College London. He offers a wide range of Urological services and has special interests in minimally invasive surgery and robotics.