Typical prostate cancer treatment plans include a high dose of radiotherapy that aims to effectively kill cancer cells so they cannot spread any further.

However, due to the prostate being close to other organs and tissues, such as the rectum, there is a risk of long-term damage and side effects such as rectal pain, bowel and urinary leakage and sometimes erectile dysfunction.

How can we overcome the challenge of the prostate’s location?

In addition to the proximity of the prostate and important body parts, “the prostate moves when a patient breathes,” says Professor Bahl, Consultant Clinical Oncologist and Clinical Director based at The Bristol Haematology & Oncology Centre.

“And despite all technical advances, it means we just can’t be that accurate with radiotherapy.”

However, a new technique is actually giving about a centimetre of additional space, for the clinician to see a clearer margin between the organs during radiotherapy.

This is achieved when a water-based hydrogel – inserted via a fine needle into the prostate, under anaesthetic – fills the cavity between the prostate and rectum.

Being able to administer radiotherapy with this added space “means that essentially the outcomes are the same, but the long-term side effects are much better” says Bahl. In studies, its use has been shown to reduce life-changing side effects, such as rectal pain, by more than 70%.

Alan’s experience with prostate cancer treatment

That was certainly the case for 71-year old Alan Clarke, who was the first patient to have the hydrogel treatment at Bristol earlier this year.

“My diagnosis came about after a random check on my PSA level; my GP sent me for a biopsy as my results were borderline and it turned out that there were cancer cells within my prostate. I had to have 37 doses of radiotherapy, five days a week for seven weeks.”

We have always been big on travel in my family, so I’m very glad the treatment allowed me to continue with my plans so quickly with no real side effects.

Alan’s treatment worked; over the past 9-years, he has had regular check-ups, but earlier this year, his PSA results showed that something was wrong.

“When I heard that the cancer had come back, I knew that there would be complications because of my previous treatment. I had a big holiday to Australia coming up to celebrate my step-daughter’s and great-granddaughter’s birthdays, so I just hoped I would be able to go.”

“Day surgery allowed me to continue my travel plans”

Alan met Professor Bahl at The Bristol Haematology & Oncology Centre and was told about the gel. Alan was deemed the perfect patient to receive the spacer as he was more likely to receive potential side effects due to his previous treatment.

Alan was allowed home the same day as his procedure, and, after one dose of high-intensity radiotherapy, he was allowed to travel the next month.

“We have always been big on travel in my family, so I’m very glad the treatment allowed me to continue with my plans so quickly with no real side effects. I’ve now got a cruise booked to Canada in October and can’t wait to see what it’s like in the autumn.”

Spacer gel being rolled out across NHS England

Now the spacer gel is available in several hospitals across England, and is covered by all major private insurance providers, but Professor Bahl is hoping it will be made available more widely in the future.

“If it is not being offered in your local hospital, then discuss with your clinical oncologist other avenues for receiving this treatment.”

The ITP programme aims to approve a reimbursement for all men considered eligible to have the new spacer gel inserted.

Alan highly recommends the treatment. He says: “I had an epidural so, from waist down I was numb. I was little uncomfortable over the next few days, but that was to be expected. Now, my life is back to normal; I go on long haul flights, shopping trips with the wife and do the gardening. If you’re considering radiotherapy: go for it.”

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.
There are risks associated with all medical procedures. Please talk with your doctor about the risks and benefits associated with SpaceOAR Hydrogel. Potential complications associated with SpaceOAR Hydrogel include, but are not limited to: inflammatory reactions, infection, bleeding, and pain or discomfort from the injection.
CAUTION: The law restricts these devices to sale by or on the order of a physician. Indications, contraindications, warnings and instructions for use can be found in the product labelling supplied with each device. Information for use only in countries with applicable health authority registrations. This material not intended for use in France.

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For some men, the diagnosis of erectile dysfunction can feel like a death sentence to their love life, but there are treatments available for this condition and therefore there could be a solution for it.

Erectile dysfunction is still an embarrassing issue for men, but one that is increasingly common. While there are many treatments to try first, for some men, the only alternative will be a surgical procedure such as a penile prosthesis.

Clinical nurse practitioner, Clare Akers, advises men on the various treatment options available for men with erectile dysfunction, no matter their age. It’s something she feels both the medical profession and the media have a role in making less taboo.

She says: “All too often, a patient will come to us with erectile dysfunction. This could have developed after surgery for prostate cancer, for example, or by having diabetes. The sad thing is they believe that they’re not entitled to surgical help because they are too old or not in a relationship. But there isn’t an age limit and you don’t have to be in a relationship to have a penile prosthesis.

Within three months, men should be able to return to normal activity and regain their sex life.

I have to bust a lot of myths to help patients understand their options

Clare finds it important to be truthful to the men who come to see her, often having heard rumours of a bionic penis but not sure of the mechanics.

Her role as a clinical nurse practitioner is to make sure that all other medical treatments and options have been exhausted, and then to explain the alternatives if they are fit enough for surgery. It is essential that the men understand that a penile prosthesis is irreversible and, like with any surgery, carries some risks, all of which she explains carefully to ensure men remain fully informed.

She says the main difference between the two types of penile prosthesis available is that one maintains an erection at all times (malleable prosthesis), which can be concealed, “I often describe it as ‘bendy rods’ that are inserted into the penis. Whereas, the other type consists of a mechanical device (inflatable prosthesis) that is fitted into the penis, scrotum and pelvis, which can be inflated and deflated through a pump in the scrotum.” The inflatable penile prosthesis is not detectable from the outside, whereas the malleable looks less concealable, and yet after surgery men can return to a normal life with sensation and orgasmic function.

Making men feel whole again

Clare often finds men are worried about the possibility of embarrassment, such as walking through an airport scanner or not being able to continue their hobbies, but that’s not the case.

She says: “There is often discomfort from the procedure in the first four to six weeks and then if they have the inflatable penile prosthesis they must be taught how to inflate and deflate the device, but, within three months, men should be able to return to normal activity and regain their sex life.

The post Penile prosthesis: what are they and who can get one? appeared first on Health Awareness.

While there might not be an underlying cardiovascular cause identified, the risk factors associated with erectile dysfunction include smoking, alcohol, obesity, high blood pressure, high cholesterol levels, reduced levels of exercise and depression.

It can be difficult, more than difficult for some, to go to your GP and talk about a problem with your ‘downstairs’.

But, stigma and embarrassment aside, a number of us may not necessarily know which parts of the body ‘urology’ specifically refers to, with the UK lagging behind the rest of Europe on patient education.

That’s according to Consultant Urological Surgeon, Mr Duncan Summerton, from The University Hospitals of Leicester NHS Trust.

What does ‘urology’ actually refer to?

“Essentially, we’re talking about the urinary tract, comprising of the kidneys, the bladder, the prostate, urethra, testes and the penis.” Urology also covers non-cancerous as well as cancer of these organs.

Erectile dysfunction (ED) is just one of a number of many medical complaints that fall under the tag of being a urological issue, with bladder and prostate problems also making up a large percentage of the complaints dealt with by GPs in the UK.

However, it appears to be the most difficult to talk about, with men’s partners often playing a big part in encouraging their other halves to talk to their GP.

A visit to the GP is important, as erectile dysfunction can be an indicator of more serious underlying cardiovascular problems.

Erectile dysfunction may be a sign of poor cardiovascular health

The arteries that supply blood to the penis are roughly the same diameter of those that supply the heart, so, an issue downstairs may suggest the patient needs to be investigated more fully from a general and cardiac viewpoint.

“Around 6% of men who complain of ED will have some form of cardiovascular episode (twice the rate of those men who don’t suffer from ED) within three years, so it’s really important that men from middle-age upwards do talk about it with their GP.

“Once someone presents with erectile dysfunction, invariably they’ll have a full health screening to ensure that there isn’t anything more serious at play.”

With the links to other potential underlying issues with the heart, slightly older men may have a reason to finally take that jump. Yet, Mr Summerton believes all sufferers would benefit from more public figures talking about their erectile issues.

“Prostate cancer had the likes of Buzz Aldrin and Stirling Moss act as role models in talking about their illness, yet erectile dysfunction still carries that stigma.”

Indeed, until recently, very few men had spoken publicly. Now though, England cricket legend, Ian Botham, has gone on record, describing how much treatment for his erectile dysfunction has helped him, saying it was the “best health decision he’d ever made.”

So, the message is clear. Going and seeing your GP could both open up a range of options and may even save your life.

The post The discussion of some urological problems is still taboo appeared first on Health Awareness.

Vaibhav Modgil

Consultant Urological Surgeon and Andrologist (Specialist in male Sexual and Reproductive Health)

One patient reveals how erectile dysfunction caused by an underlying condition made his life a misery — and how an implant procedure gave him back his confidence… and his sex life.

Michael Moore was a married man of 28 when he began experiencing issues with erectile dysfunction (ED), which shattered his confidence and affected his mental health. “I began feeling extremely depressed,” he remembers.

When Michael finally went to see his doctor (“It took me six months to find the courage”), he was given various treatments, but none of them worked.

This went on for more than 20 years.

Michael’s erectile dysfunction wasn’t psychological, however. It was being caused by an underlying neurological condition, which he discovered when he was finally diagnosed with multiple sclerosis in 2015/2016.

MS was the cause of my erectile dysfunction

By the time he was referred to Mr Vaibhav Modgil, Consultant Urological Surgeon and Andrologist — a specialist in male sexual and reproductive health — Michael admits he was in a dark place psychologically. “I wanted to get back some control,” he says. “And I wanted normality again for myself and my wife.”

I lost any kind of sex life from my late twenties through to my early fifties.

“It’s far more common than people think, and doesn’t just affect older men,” says Mr Modgil. “The vast majority of cases I see in my clinic are organic, rather than purely psychological; although there is no doubt psychogenic ED is more common among younger men, it can be linked to diabetes, conditions affecting the nerves and even sleep-rated issues, for instance. Cancer treatments such as pelvic surgery, chemotherapy and radiotherapy, can also cause ED.”

Treatment options for erectile dysfunction

First-line therapy tends to be tablet treatment. “If patients don’t respond to tablets, injections into the penis and topical treatments are available to produce erections,” says Mr Modgil. “While these might work for some people, others don’t want to inject into their penis, as it kills spontaneity.” Vacuum pump devices designed to engorge the penis are also available; but, again, these are neither discreet nor spontaneous enough for some patients.

If these solutions don’t work, and all other options have been exhausted, penile implant surgery — a procedure that is available on the NHS in specialised centres — may be a consideration.

“There are two types of penile implants,” says Mr Modgil. “With the semi-rigid or malleable implant, two malleable rods are placed within the penis that can be pulled up into the erect position.

“Then there’s the inflatable penile implant, which involves fitting two cylinders into the body of the penis. A pump sits within the scrotum and a reservoir sits within the abdomen. When the patient squeezes the pump in the scrotum, fluid leaves the reservoir and makes it way to the cylinders to provide an erection. This results in an on-demand erection, when the patient wants, for as long as they want. No part of the device is externally visible with what is usually a very small scar either above or below the base of the penis.”

Return to positive self-worth and body image

Michael, now in early fifties, chose this option and underwent surgery in March. In the vast majority of cases, patients are able to return home a day later. More recently, the team at Manchester Royal Infirmary have started performing ‘day-case’ procedures for selected patients, allowing them to return home the same day as their surgery. “However, people should understand that this, like any operation, is a significant undertaking,” says Mr Modgil.

“The operation must be carried out at a specialist centre under the care of an experienced team. It’s also the point of no return, because surgery eviscerates erectile tissue in the penis — so the only way a patient will get an erection afterwards is with an implantable device.

“It’s a last resort option for most patients, but it works incredibly well.” Its availability is not well-known, however. In fact, Mr Modgil often speaks to healthcare professionals, and even GPs, who are unaware of this type of surgery.

Michael’s been impressed with the results of the surgery, from both a physical and mental standpoint. “My sex life hasn’t been this good since I was 18! Psychologically, it’s boosted me, too, changing my overall mental health. In fact, the procedure has done more than cure my ED. It has also had a positive effect on my feelings of self-worth and body image.”

“Let’s be honest,” says Michael. “Erectile dysfunction isn’t an easy subject for men to talk about with anyone — let alone admit to in the pages of a national newspaper.

“Even though ED was a result of my MS, it doesn’t make it any easier that my friends and family will know about it! That said, there must be hundreds of men who have felt the way I was feeling for years. So, if there’s anything I can do to change that, I will.”

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Creating awareness of urological health is not easy, as issues such as incontinence, bladder cancer, kidney disease or erectile dysfunction are rarely covered in the mainstream press, nor are they topics easily discussed over the dinner table.

We set up Urology Awareness Month because there is a lot of stigma surrounding urology health, fuelled by a lack of public information about urological conditions.

We decided it was high time to make the public familiar with urology health risks, and to help them take responsibility so that they do not suffer in silence.

Removing the stigma and ending suffering

Urological conditions are extremely prevalent (one in two of us will suffer from them), affecting the kidneys, bladder, prostate and male reproductive organs.

This prevalence, plus the rising cases of urological cancers, is why it is important to remove the associated stigma and encourage conversations that could end the suffering that severely impacts quality of life.

Diagnosing a urology cancer early is crucial to one’s chances of survival. Similarly, opening up about ‘embarrassing’ symptoms will help sufferers to get the right treatment quicker.

Yet, public polling has shown us that a significant proportion (circa 40%) say they would avoid or delay seeking treatment or talking to people about a urological problem.

Polling also shows us that the public are more inclined to self-medicate for symptoms such as UTIs and incontinence rather than to go to a GP for a diagnosis or help.

While this is understandable, we would inject a note of caution, which is to say that persistent or recurrent UTIs should be properly investigated by your GP so that the correct medication can be administered, and also to check that symptoms are not masking a more serious underlying problem. GPs can also help to improve bladder function to reduce incontinence.

Increasing knowledge through Urology Awareness Month

Early intervention is the key to saving lives but also to ensuring that people can live better and live well through managing their conditions effectively.

Now in its sixth year, Urology Awareness Month has taken on a life of its own. Throughout the month, teams of experts and patients aim to increase public awareness of our urology health and also to raise funds for much needed research into these diseases.

So, join us this September in raising awareness and removing the negative connotations and taboos around urology health. No one should feel they have to deal with these diseases in silence.

The post Urological conditions: do not suffer in silence appeared first on Health Awareness.

Dennis Allen was a prostate cancer patient who was diagnosed with the disease last year and opted for proton beam therapy after doing his own research.

“I was diagnosed with prostate cancer in March 2018. A PSA test came back as high and I was referred to the Churchill Hospital in Oxfordshire, where I had a biopsy.

“The biopsy confirmed that it was cancer. As a very healthy person, I was shocked. I was referred to a number of consultants and oncologists and they spoke to me about conventional radiotherapy and a prostatectomy, but nobody mentioned proton beam therapy.

Many prostate cancer sufferers are risking dreadful side effects, including impotence and incontinence, and it could potentially be avoided.

No one had told me Proton Beam Therapy (PBT) was an option

“Here I was, facing a high chance of extreme side effects such as impotence and incontinence with conventional treatments (40% chance of both occurring) and yet I had no symptoms to suggest there was anything wrong with me. I did my own research and met a friend who had heard about proton beam therapy and, after investigation, I decided to opt for the treatment. I was shocked and frustrated that up until that point, no one told me about this treatment, despite the enormous benefits.

I received proton treatment at the Rutherford centre in Newport in October 2018, which lasted for four weeks. Each treatment session under the beam only lasted for a few minutes – it takes longer to make a slice of toast – and I felt no pain or discomfort throughout. I feel absolutely normal, as if I have been cured of a disease I never knew I had. I had no symptoms, felt nothing during the treatment and had no side effects afterwards.

“I was very fortunate to receive this treatment. Many prostate cancer sufferers are risking dreadful side effects, including impotence and incontinence, and it could potentially be avoided. It is crucial that people are aware of this option.”

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Prostate cancer is now the most common cancer in the UK. Each year in the UK, 47,000 men are diagnosed with prostate cancer. It accounts for 26% of all new cancer cases in men, and the disease kills more men than breast cancer kills women.

Approximately one in eight men will get prostate cancer at some point in their lives[1]. While survival rates for prostate cancer have been improving, there has been a significant increase in incidence. Since the early 1990s, prostate cancer incidence has increased by 41% and is projected to rise further in the coming decades.

The most common treatments for men with localised prostate cancer are surgery, to remove the prostate gland, and radiotherapy. The treatment of localised prostate cancer is effective, and most men will be cured of their disease. A key challenge, however, is minimising side effects from treatment, which is important to help men maintain a good quality of life.

A new type of treatment with more accurate radiation

High energy proton beam therapy (PBT) is now available in the UK to treat men with localised prostate cancer. Conventional radiotherapy uses high energy X-rays called photons to destroy cancer cells. PBT uses beams of protons to achieve the same effect.

Side effects from conventional radiotherapy are as a result of radiation damage to the normal tissues near the cancer. Unlike conventional radiotherapy, the properties of protons allow them to enter and travel through tissue with minimal dose deposition in normal tissue on the way to the target, and minimal dose to the tissues beyond the target. This means PBT can reduce the risk and severity of side effects compared to conventional radiotherapy.

Proton beam therapy is the preferred treatment option for children

Because of the precision of PBT treatment, it is currently the preferred option for treating cancers in children because there is almost always less radiation dose to normal tissues compared to conventional radiotherapy, and this reduces the chance of serious complications. In adults, PBT is used to treat cancers that are near critical structures, such as the optic nerve or spinal cord, where conventional X-ray treatment may cause damage.

As demand for precision radiotherapy grows, there is debate about the benefits that PBT can offer other cancer patients, including those with prostate cancer. A recent study by the University of Pennsylvania revealed that the risk of side effects was two-thirds lower for PBT patients compared to those treated with conventional radiotherapy. Researchers leading the study also highlighted that reduced toxicity with PBT did not come at the expense of reduced effectiveness.

Three centres in the UK able to offer PBT therapy

In early 2018, the Rutherford Cancer Centre in South Wales became the first clinic in the UK to treat prostate cancer patients with high energy PBT. There are now two new Rutherford PBT centres in Reading and Newcastle. In addition, there is an NHS PBT facility at The Christie NHS Foundation Trust in Manchester.

Dr Jason Lester, an oncologist from the Rutherford Cancer Centre South Wales, who has treated a number of patients with PBT, including prostate cancer patients, says: “While proton beam therapy is not a magic bullet that can treat all cancers, we have seen that it can be a very effective treatment for prostate cancer. To date, we have seen no significant long-term side effects from treatment.”

[1] Prostate Cancer UK

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Whether it’s celebrities talking or something you see on the TV, urinary incontinence is becoming more well-known. But that doesn’t mean we’re doing anything about it.

For one in three women, urinary incontinence is something they will have to endure throughout their lives. Whether it was the outcome of pregnancy or the onset of menopause, there is certainly more acceptance these days that it can happen. However, little is mentioned about the psychological effects suffering can have.

Incontinence can cause anxiety and embarrassment

The anxiety that women can feel while suffering from urinary incontinence is a personal interest for Urology and Continence Nurse Specialist, Jane Brocksom, President of The British Association of Urological Nurses. “Mental health and incontinence go hand-in-hand,” she says.

“I have ladies who can only plan a trip into town if they know where all the toilets will be. It is even stopping previously outgoing ladies from leaving the house because they are scared they might leak and embarrass themselves. It really is debilitating.”

Women just need to know that there is someone there who cares about them. Mentally, that can make all the difference.

It can often seem like there is little choice for women but to suffer in silence. However, that’s not the case says Brocksom.

“Often, I find that the act of speaking up and talking to your GP or a specialist nurse is half the battle. I find that, for a lot of ladies, being able to have a good chat and examine why you might be suffering often goes a long way to resolving some of the problems.”

Feel yourself again with lifestyle re-training

With women often juggling young families and older parents, there can be little opportunity to think of their own health. But often a frank and honest chat with a professional can help women to re-evaluate their drinking and toilet habits.

“I can’t remember learning to drink or go to the toilet” says Brocksom. “Sometimes we just need a bit of re-education. We might drink five cups of tea a day and think we’re hydrated, but we’re not getting the good stuff that we need. Equally, our lives are more sedentary, so if we’re sat on an office chair for most of the day, our pelvic floor muscles just aren’t getting any training. And it’s this lifestyle evaluation that a health professional can offer.”

A work out for your pelvic floor

Today’s women have little training on the pelvic floor, or the need to rest after childbirth, so with the onset of the menopause causing the pelvic floor to weaken, it can often come as a shock that the body is not as robust as it once was.

“It’s being able to evaluate and say I can’t do at 60 what I could do at 18, but how can I improve and continue to live my life?” adds Brocksom. “If I can help a woman to feel able to leave the house or pick the grandkids up, that’s a huge step forward.”

Certainly for Brocksom, making sure that women have access to specialist continence nurses is a big concern of hers. She says: “Women just need to know that there is someone there who cares about them. Mentally, that can make all the difference.”

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On an evening session hosted by The Urology Foundation, Stephen Fry spoke about how the words that we consider taboo are often a poor reflection of what should be considered taboo.

He asked us to imagine an alien visitor, “one of those so beloved by the ethicists of our world” and what that alien might consider to be taboo words in our language. Probably they would assume that the most taboo words would be those words that reflect the very worst of humanity, things like ‘murder’ and ‘torture’.

Yet, how often do we say things like “the traffic was torture today” or, “I could murder him for saying that”. We very blithely use words that reflect the very worst of what humanity has to offer, and yet we shy away from words that reflect some of the most beautiful and some of the mundane parts of our lives. Often those words are urological, referring to sex or to going to the toilet.

Where is the sense in that?

The shame we feel

Stephen also took some time to question why we should feel any shame about our bodies. We all have them and bodies come with things like a penis, a clitoris, a rectum, a prostate, so why should we be ashamed to talk about these parts of us? 

While prostate cancer surgery can sometimes lead to some unpleasant consequences, it isn’t something we should be ashamed to talk about.

Stephen’s point was that we should break down the taboos that surround urology disease. He said that he himself didn’t feel particularly awkward over talking to those close to him about his prostate cancer diagnosis and that his only concern was to reassure them that he would be fine, so as not to cause them undue worry.

While prostate cancer surgery (Stephen underwent a robotic prostatectomy that was performed by TUF-trained surgeon, Mr Ben Challacombe) can sometimes lead to some unpleasant consequences, such as having to use a catheter, it isn’t something we should be ashamed to talk about.

The way we communicate

On an evening that was all about life’s awkward conversations, Stephen was at pains to say that discussion is a worthy thing and should be encouraged, provided that it is 50/50. Our discussions should always be 50% talking and 50% listening.

Stephen took time to point out that one of the things he valued so highly from his TUF-trained urologists was that they were good communicators and took time to explain to him very carefully what his diagnosis and treatment would mean.

Whether you are talking about prostate cancer or any other topic, the message here is to be patient, to be willing to explain carefully what you mean, and, just as importantly, be willing to listen and to try to understand what is being said.

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Do you know what benign prostatic enlargement (BPE) is? If not, you are not alone.

A survey was recently conducted in the United Kingdom, France and Germany, which found that, out of the 1,002 male respondents in the UK, aged 50 and above, 37.5% did not know what BPE is. France reported 33%, while in Germany 45% of men were unfamiliar with BPE.

BPE, also known as benign prostatic hyperplasia (BPH), is a non-cancerous increase in the size of the prostate gland. The symptoms include frequent urination (including at night), difficulty in urinating and/or a weak stream of urine, and pain while urinating.

You need to know what your prostate is

The results of the survey also showed that 75% of men above the age of 50, did not know what the prostate’s main function is.

The prostate is a gland vital to men’s sexual health as it produces prostatic fluid which nourishes and protects the sperm.

During ejaculation, the prostate squeezes this fluid into the urethra and it is then expelled with sperm as semen.

It’s time to talk about urological health

Having an enlarged prostate does not only affect the men who suffer from it, but their partners as well. In the past, it was considered taboo to talk about urological and sexual health issues, but times have changed.

Campaigns such as Urology Week encourage open discussions among patients, their partners and/or family, and their urologists.

Urology Week is an annual initiative of the European Association of Urology (EAU) where national urological societies, urology practitioners, urology nurses and patients organise diverse activities to spread the word on the importance of urological health.

From 23rd to 27th September this year, Urology Week aims to increase awareness of BPE: What the condition is, symptoms to look for, its treatability despite its prevalence, and the importance of consulting a urologist.

Urologists and other healthcare providers all over Europe are preparing a wide range of activities for Urology Week 2019 such as television and radio press conferences; marathons; open days at clinics and many others.

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