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Dr. NKWAM Michael NKWAN – Consultant urologist surgeon –
King’s College Hospital NHS Foundation Trust – United Kingdom

Prostate Cancer

Prostate cancer is the second
most common cancer
in men worldwide.

Prostate cancer begins when cells in
the prostate gland start to grow out of control.
The prostate is a gland found only in males.
It makes some of the fluid that is part of semen.

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Prostate cancer care management

Prostate cancer care management is a long term and personalized approach
that involves multidisciplinary team.

This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists
(radiotherapy and chemotherapy specialists),
radiologists, pathologists, radiographers and specialist nurses.

Patient involvement is key in prostate cancer management. Beyond therapist teams,
other physicians and stakeholders can also assist the patient through their disease management.
This team includes psychologist, sexologist, nutritionist, family, patient organizations.

It is highly recommended to men over 50 to be proactive in the prostate surveillance
during their general practitioner (GP) appointments.

In case of prostate cancer diagnosis, your referral doctors will inform you
about the treatment options that will depend on:

The stage and grade of the cancer
The patient age, health status, and expectations (quality of life)
And with respect to the best benefit/risk ratio including expected
treatment outcomes and potential short and long-term side effects

Treatment options

Active surveillance


This is for localized cancer
and low risk patients.

Active surveillance does not actively treat prostate cancer. It monitors the disease progression with
regular PSA tests (every six month) and biopsies.

The PSA or Prostate Specific Antigen is a blood test.
This is specific to the prostate
and helps track changes
– an increase can be a marker
of cancer progression.

If these tests (biopsy and PSA) reveal the cancer is changing
or progressing, the referral doctor can then make a decision
about further treatment.



This if for localized and locally advanced cancer.

Surgery is also called radical prostatectomy. It is the surgical removal of the prostate gland.

There are different types
of technique for a radical prostatectomy:

– Open prostatectomy
– Laparoscopic prostatectomy
– Robotic-assisted laparoscopic.

Radiation therapy


This is for localized and locally advanced cancer.

Radiation therapy can be used in association with hormone therapy.

The radiation therapy can be
used after surgery if the cancer
is not fully removed or if it
returns. (cancer relapse)

Radiation therapy uses high-energy rays to kill or slow the progression of cancer cells.

There are two primary kinds
of radiation therapy used for prostate cancer:
• External radiation therapy
• Internal radiation therapy.
Also called brachytherapy is
the fact that radioactive material (131iodine seeds) is placed
directly into the prostate.

Medical therapy


This for localized, locally advanced
and metastatic cancer.

Hormone therapy: is often used in combination (before and/or after) radiotherapy.
It is used to block the effects of testosterone,
either by stopping its production or by stopping
the patient body being able to use testosterone.

Chemotherapy: is often used to treat prostate cancer that’s spread to other parts of the body (metastatic prostate cancer).
It is a method of destroying cancer cells by interfering with the way they multiply.

Image guided therapy


This is for metastatic advanced cancer.

Cryotherapy, or cryoablation: is a palliative treatment to take care of painful bone metastases.
It is a method of killing cancer cells by freezing them. It is done under anesthesia.

HIFU: this a procedure guided by MRI which consist of high intensity focused ultrasounds that can destroy cancer cells by mechanical effect. And it can be used for cancers relapsing after radiotherapy. (local salvage treatment)

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