Declan Cahill

Indications, results and safety profile of transperineal sector biopsies (TPSB) of the prostate: a single centre experience of 634 cases

To describe a protocol for transperineal sector biopsies (TPSB) of the prostate and present the clinical experience of this technique in a UK population.

Transperineal Sector Prostate Biopsies: A Local Anesthetic Outpatient Technique

OBJECTIVE To describe our technique and determine the feasibility and tolerability of transperineal template prostate (TP) biopsies under local anesthesia (LA). METHODS Fifty consecutive patients underwent TP biopsies under LA for investigation of an elevated prostate-specific antigen level or risk stratification as part of our active surveillance protocol. Tolerability was evaluated with a visual analog scale assessing probe discomfort, LA infiltration, and the biopsy procurement. Patients were also asked if they would have the procedure again, and in those who had undergone previous transrectal biopsies, how the TP technique compared. Pathologic data, clinical outcomes, and complications were recorded at 2 weeks. RESULTS Mean age was 62.8 years (standard deviation [SD], 6.34 years) and the mean prostate-specific antigen level was 8.49 ng/mL (SD, 6.36 ng/mL). Mean prostate volume was 48.2 mL (SD, 19.4 mL). Mean visual analog scale scores for discomfort caused by the ultrasound probe, LA injections, and biopsies were 3.08 (SD, 1.64), 3.29 (SD, 1.13), and 2.88 (SD, 1.28), respectively. Thirty-four of 50 men (68%) had positive histology, 26 men had Gleason score≤3+4, 5 men had Gleason score≥4+3, and 3 had recurrent adenocarcinoma after radiotherapy. There were 2 complications: 1 Clavien score 1 and 1 Clavien score 3a. CONCLUSION LA TP biopsies are well tolerated, acceptable, and feasible when carried out within an outpatient setting.

High-intensity focused ultrasound for treating prostate cancer.

Animal studies using the highly metastatic Dunning R3327 model in rats showed that HIFU could be used to destroy prostatic carcinoma without causing metastasis [2,3]. Subsequent canine studies showed that foci could be applied transrectally to the prostate without damaging the rectal wall [4]. Initial in vivo human studies showed defined margins of tissue necrosis in benign tissue before a Millin prostatectomy [5], and studies on cancerous prostates several days before radical prostatectomy showed delineated areas of coagulative necrosis in the treated areas [6,7]. HIFU is repeatable, and it is not uncommon for more than one treatment session to be needed for a satisfactory response. The gland must be small enough for the anterior part to be reached by the lesion ( < 40–50 mL), and with no large calcifications ( > 5 mm) that might interfere with the ultrasound signal.

Causes of death in men with prostate cancer : an analysis of 50,000 men from the Thames Cancer Registry.

To investigate causes of death in a UK cohort of patients with prostate cancer.

Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: a report of national outcomes.

To determine current radical prostatectomy (RP) practice in the UK and compare surgical outcomes between techniques.

Clinical investigation of the role of Interleukin-4 and Interleukin-13 in the evolution of Prostate Cancer

Prostate cancer is the most common cancer in men, both in the USA and Europe. Although incurable, metastatic disease can often be controlled for years with anti-androgen therapy. Once the disease becomes castrate resistant, the median survival is 18 months. There is growing evidence that the immune system, and in particular cytokines, play an important role in prostate cancer immunosurveillance and progression. Here, we have undertaken a clinical investigation of the role of two closely related cytokines, IL-4 and IL-13 in prostate cancer. In the largest series studied to date, we show that serum IL-4, but not IL-13 is significantly elevated in castrate resistant, compared to androgen sensitive disease. Notably however, serum IL-4 levels are also raised in patients with benign prostatic disease. Analysis of benign and malignant prostate tissue demonstrates that the source of IL-4 is epithelial cells rather than infiltrating leukocytes. Together, our data are consistent with a dual role for IL-4 in prostate cancer development. In benign disease, our data add to the evidence that IL-4 serves a protective role. By contrast, the data support a direct role for IL-4 in the progression of prostate cancer from androgen responsive, to advanced castrate-resistant disease.

Demonstration of erectile management techniques to men scheduled for radical prostatectomy reduces long‐term regret: a comparative cohort study

Study Type – Outcomes (case series)

Low-grade phyllodes tumor of the seminal vesicle treated with laparoscopic excision.

Background A 43-year-old man presented with a 2-year history of hematospermia and dull ache in the left testis. On physical examination he had left epididymal tenderness and a normal digital rectal examination.Investigations Transrectal ultrasonography and MRI.Diagnosis Low-grade phyllodes tumor of the left seminal vesicle.Management Laparoscopic excision of the left seminal vesicle.

Pre-biopsy 3-Tesla MRI and targeted biopsy of the index prostate cancer: Correlation with robot-assisted radical prostatectomy

To study whether pre‐biopsy 3‐Tesla prostate magnetic resonance imaging (MRI) with targeted biopsy allows accurate anatomical and oncological characterization of the index prostate tumour, and whether this translates into improved positive surgical margin (PSM) rates after radical prostatectomy.

Introducing the productive operating theatre programme in urology theatre suites

Background: The Productive Operating Theatre (TPOT) is a theatre improvement programme designed by the UK National Health Service. The aim of this study was to evaluate the implementation of TPOT in urology operating theatres and identify obstacles to running an ideal operating list. Method: TPOT was introduced in two urology operating theatres in September 2010. A multidisciplinary team identified and audited obstacles to the running of an ideal operating list. A brief/debrief system was introduced and patient satisfaction was recorded via a structured questionnaire. The primary outcome measure was the effect of TPOT on start and overrun times. Results: Start times: 39-41% increase in operating lists starting on time from September 2010 to June 2011, involving 1,365 cases. Overrun times: Declined by 832 min between March 2010 and March 2011. The cost of monthly overrun decreased from September 2010 to June 2011 by GBP 510-3,030. Patient experience: A high degree of satisfaction regarding level of care (77%), staff hygiene (71%) and information provided (72%), while negative comments regarding staff shortages and environment/facilities were recorded. Conclusions: TPOT has helped identify key obstacles and shown improvements in efficiency measures such as start/overrun times.