The Prostate Center

London, United Kingdom

The Prostate Center

London, United Kingdom

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Kirby M.,University of Hertfordshire | Kirby M.,The Prostate Center
Sexual Medicine Reviews | Year: 2015

Introduction: Erectile dysfunction (ED) has been significantly associated with many chronic conditions including obesity, the metabolic syndrome, hypogonadism, diabetes mellitus, cardiovascular disease (CVD), lower urinary tract symptoms, and psychiatric/psychological disorders. ED is also a well-established predictor of CVD. Aim: This review will focus on the association of ED with cardiovascular, metabolic, and cognitive conditions and discuss the effects of managing lifestyle factors in order to reduce the burden of ED and consequently outcomes in patients with chronic conditions. Methods: A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1990. Main Outcome Measures: Main outcome measures were improvements in sexual function. Results: A total of 59 reviews on the topic were evaluated. Conclusions: Targeting several lifestyle factors associated with CVD/metabolic/cognitive disorders, e.g., smoking, alcohol consumption, obesity, and physical activity, can have significant benefits, leading to an improvement in ED as well as testosterone levels and consequently CVD. © 2015 International Society for Sexual Medicine.


Billia M.,Guys And St Thomas Hospitals Nhs Foundation Trust | Billia M.,King's College London | Elhage O.,Guys And St Thomas Hospitals Nhs Foundation Trust | Elhage O.,King's College London | And 10 more authors.
World Journal of Urology | Year: 2014

Introduction: In the last 10 years, robotic-assisted radical prostatectomy (RARP) has become increasingly popular as witnessed by an increased number of publications. However, there is still little known about the long-term oncologic outcomes of this technique. The aim of this study is to assess the oncologic outcomes of patients who underwent RARP at least 5 years ago, with an emphasis on biochemical recurrence-free survival (BCRFS). Materials and methods: In 2004, RARP was introduced at our institutions. Records of all patients having RARP were prospectively collected in a dedicated database as part of the NUVOLA-BAUS project. For the present study, we selected only patients who had a follow-up of at least 5 years. Endpoints were BCRFS rate and 5-year cancer-specific survival (CSS). Results: Overall, we identified 175 patients; 61.7 % of patients had Gleason 7-9 disease and 26.9 % had pT ≥ 3 disease at final pathology. Eight patients (4.5 %) had biochemical recurrence at follow-up. Overall 5-year BCRFS rate was 95.4 %, while it was 97.6, 91 and 50 % in pT2, pT3 and pT4 diseases, respectively. Among the patients who recurred, the mean time to recurrence was 22.1 ± 8.8 months. These patients received salvage external beam radiation treatment combined with hormonal therapy (anti-androgen + LHRH analogue) or hormonal therapy alone. 5-year CSS was 98.3 % (172/175): in 2 cases, the specimen showed pT4 cancer, while lymph node metastasis was noted in one case. Conclusion: The 5-year BCRFS and CSS after RARP are encouraging even in a population with significant high-risk disease © 2013 Springer-Verlag Berlin Heidelberg.


PubMed | Prostate Center, University College London and King's College London
Type: Journal Article | Journal: BJU international | Year: 2016

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.We conducted a retrospective analysis of all men (n = 201) who underwent robot-assisted radical prostatectomy (RARP) between July 2012 and July 2014. Patients were divided into a study group (n = 63) who had undergone pre-biopsy 3-Tesla MRI, followed by visual targeted and systematic prostate biopsy, and a control group (n = 138) who had undergone systematic biopsy alone. The two groups were well matched regarding patient and cancer characteristics. The primary study objective was to assess the accuracy of pre-biopsy MRI for localizing the index tumour. Secondary study objectives were to assess the accuracy of MRI in assessing the maximum tumour diameter (MTD) of the index tumour focus and accuracy of the targeted biopsy in determining the Gleason score and primary Gleason grade of the index tumour focus and whether PSMs were improved after RARP. The reference standard was whole-gland pathology of the resected prostate gland. Continuous variables and proportions were compared using the t-test and Mann-Whitney test or contingency tables, respectively. Pearsons correlation coefficient and Bland-Altman plots were used to compare measurement of MTD.The MRI accurately located the index tumour focus in 73% of patients. Accuracies, stratified according to use of the Prostate Imaging Reporting and Data System (PI-RADS) categories 5, 4 and 3, were 94, 75 and 60% respectively. Accuracies stratified according to MTD of 0.7, 1 and >1 cm were 50, 57 and 79%, respectively. There was a positive linear correlation between MRI and histological MTD (r = 0.42, 95% confidence interval [CI] 0.16-0.63; P = 0.002), but MRI generally underestimated the MTD: the mean MRI-measured MTD was 1.51 cm (95% CI 1.29-1.72) vs a mean pathological MTD of 2.15 cm (95% CI 1.86-2.43). Targeted biopsy identified 37% more cancer per core than non-targeted biopsy. The mean maximum core length was 8.9 mm (95% CI 7.8-10) vs 6.5 mm (95% CI 5.8-7.2) for the study vs the control group (P = 0.0002; non-paired t-test). Gleason scoring was significantly more predictive after targeted biopsies, with unchanged scores in 40/63 men (63%) vs 62/138 men (45%) in the study and control groups, respectively (P = 0.001; Fishers test). The odds of Gleason upgrading were 2.5 times greater (P = 0.028) in the control group. The primary Gleason grade was not significantly different in the two groups [45/63 men (71%) vs 91/138 men (66%); study vs control group respectively (P = 0.51, Fishers test)]. Overall PSMs were nonsignificantly lower in the study group (15.8 vs 18.8%; P = 0.84, Fishers test); and the MRI location of the index tumour focus correlated with the site of PSM in 70% of men in the study group.Pre-biopsy MRI can accurately identify the index prostate tumour, especially in those with higher PI-RADS grades and tumour diameter. Targeted biopsy of this focus retrieves significantly more cancerous tissue per core, and is more accurate regarding Gleason scores, but not primary Gleason grade. MRI underestimated the MTD, and PSMs were not significantly improved in the present study.


Mostafid H.,Royal Surrey County Hospital | Kirby R.,The Prostate Center | Fitzpatrick J.M.,Irish Cancer Society | Bryan R.T.,University of Birmingham
Urology Practice | Year: 2014

Introduction: Stage Ta bladder cancer accounts for around half of all new cases of urothelial bladder cancer. It shows heterogeneous behavior with a 5-year recurrence rate of 31% to 78% and a progression rate of 0.8% to 45%. Optimal management is crucial to achieve safe and yet economical long-term outcomes. We provide an overview of such management. Methods: Using AUA, NCCN®, EAU and ICUD-EAU guidelines as the basis of this nonsystematic review we performed PubMed® searches to update the literature in this field and expand on topics of particular interest or controversy. Results: This study provides an overview for the practicing urologist of safe, economical care of stage Ta bladder cancer with regard to risk stratification, preoperative and perioperative care, subsequent adjuvant treatment, surveillance, recurrence management and long-term outcomes. While these recommendations are already incorporated in current guidelines, some aspects deserve further discussion or have been the subject of relevant research subsequent to guideline publication. Conclusions: The traditional view that stage Ta bladder cancer is invariably synonymous with low risk disease requires reevaluation. Modern management of stage Ta bladder cancer depends on initial risk stratification that allows for subsequent management based on a number of evidence-based guidelines. Given the usual long clinical course of stage Ta bladder cancer, such an approach ensures not only safe but also economical care of this group of patients. © 2014 American Urological Association Education and Research, Inc.


Santa Mina D.,University of Guelph | Santa Mina D.,The Prostate Center | Guglietti C.L.,York University | Alibhai S.M.H.,University of Toronto | And 9 more authors.
Journal of Cancer Survivorship | Year: 2014

Purpose: Recent literature has shown that preoperative physical activity (PA) can positively influence surgical outcomes. It is unknown whether the effect of meeting PA guidelines for cancer survivors can impact quality of life following radical prostatectomy for prostate cancer. Methods: We reviewed our institutional database of prostate cancer outcomes and included patients that underwent radical prostatectomy and completed the Godin-Shephard Leisure Time Exercise Questionnaire (GLTEQ), the Patient-Oriented Prostate Utility Scale (PORPUS), the International Prostate Symptom Score (IPSS), and the five-item International Index of Erectile Function (IIEF). Participants were categorized as meeting or not meeting the American College of Sports Medicine physical activity guidelines for cancer survivors (150 min of moderate intensity or 75 min of vigorous intensity PA per week). Radical prostatectomy outcomes were measured preoperatively and at 6 and 26-weeks postoperatively. Results: From June 2008 to August 2012, 509 men underwent curative, nerve-sparing radical prostatectomy for prostate cancer and completed the GLTEQ, of whom 46 % met the PA guidelines. Prior to surgery, men that met the PA guidelines reported higher quality of life (p < 0.001) and erectile function (p = 0.049) than men that did not meet the guidelines. Quality of life at all postoperative timepoints was higher for men that met the PA guidelines after adjusting for age, preoperative body mass index, and surgical approach (p = 0.02). Men that met the PA guidelines were 19 % less likely to be incontinent at 6 weeks postoperatively (p = 0.028). Conclusion: PA volume may be a useful marker at predicting postoperative recovery of quality of life and urinary incontinence following radical prostatectomy. Implications for Cancer Survivors: Cancer survivors should be encouraged to meet PA guidelines prior to surgery in an effort to attenuate the decline in HRQOL and facilitate recovery. © 2013 Springer Science+Business Media New York.


Stevens D.J.,University of Oxford | Sharma N.L.,University of Oxford | Tewari A.K.,Mount Sinai School of Medicine | Kirby R.,The Prostate Center | And 2 more authors.
Current Urology Reports | Year: 2015

Treatment possibilities for clinically localised prostate cancer include radical prostatectomy (RP), external beam radiotherapy, brachytherapy, focal therapy and active surveillance. Conflicting and methodologically flawed observational data from the last two decades have led to uncertainty as to the best oncological option. However, recently, there has been a series of high-quality studies that point to disease specific and overall survival advantages for those men undergoing RP. This article reviews the latest evidence and argues that at the current time, RP must be considered the gold standard treatment for the majority of men with clinically localised prostate cancer. © 2015, Springer Science+Business Media New York.


Study Type - Prognosis (case series) Level of Evidence 4 Whats known on the subject? and What does the study add? Septicaemia is the most frequent cause of hospitalization after transtrectal prostate biopsy; fatalities have been reported and the incidence is on the rise. This study shows that men with a history of recent international travel or antibiotic use have up to four times increased risk of septicaemia and hospitalization. When they do occur, infections are usually due to multi-resistant E coli and additional care, e.g. delay before biopsy, different antibiotic prophylaxis or transperineal biopsy, should be considered in these cases. OBJECTIVE To study the infection rate after prostate biopsy in those who have travelled overseas or used antibiotics in the 4 weeks before biopsy. PATIENTS AND METHODS A total of 316 men with a mean (range) age of 61 (45-85) years were studied. All had undergone transrectal ultrasonography (TRUS)-guided prostate biopsy after standard antibiotic prophylaxis. Before their biopsy the patients were risk stratified and a history of recent international travel or antibiotic use was recorded. Those who suffered sufficiently severe infection/sepsis so as to require hospitalization were identified at the end of the study period. The characteristics of these patients and the types of infections were explored and the relative risk (RR) of infection after recent travel or antibiotic use was calculated. RESULTS Of the 316 men, 16 were hospitalized with infection. The group with (n= 16) and without (n= 300) infection were equivalent in age, prostate-specific antigen level, disease status and number of biopsy cores taken. Either recent travel or antibiotic use were independent risk factors for infection [travel: 8/16 vs 76/300; P= 0.04; RR 2.7 and antibiotic use: 4/16 vs 20/300; P= 0.025; RR 4]. There was no significant pattern in the countries visited or the type of antibiotic used. Culture results were positive in 10/16 men, and all cultures grew multiresistant Escherichia coli. The strains were uniformly resistant to ciprofloxacin and amoxycillin, and variably resistant to gentamicin and co-amoxiclav, but nearly all were sensitive to meropenem. All patients made a full recovery after antibiotic and supportive treatment. CONCLUSIONS Either recent international travel or antibiotic use are independent risk factors for severe infection after TRUS-guided prostate biopsy. When infection does occur it should be treated aggressively as the causative agent is usually a multiresistant E. coli.


PubMed | University of Calgary and The Prostate Center
Type: Journal Article | Journal: Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine | Year: 2016

The inhibitor of growth family member 3 (ING3) is a member of the ING tumor suppressor family. Although its expression has been reported in various types of cancers, the role of ING3 and its prognostic value in prostate cancer (PCa) has not been investigated. ING3 expression and prognostic value was assessed in a cohort of PCa patients (n=312) treated with transurethral resection of prostate using immumoflourescent automated quantitative analysis (AQUA) system. In vitro studies were carried out in conjunction to investigate its expression in various PCa cell lines. ING3 knockdown was also carried out in DU145 cell lines to assess for any changes in invasion and migration. ING3 expression was highest in benign prostate tissues (mean 3.20.54) compared to PCa (mean 2.50.26) (p=0.437), advanced prostate cancer (AdvPCa) (mean 1.50.32) (p=0.004), and castration-resistant prostate cancer (CRPC) (mean 2.280.32) (p=0.285). ING3 expression was inversely correlated to Gleason score (p=0.039) and ETS-related gene (ERG) expression (p=0.019). Higher ING3 expression was marginally associated with lethal disease (p=0.052), and this was more pronounced in patients with ERG-negative status (p=0.018). Inhibition of ING3 in DU145 PCa cells using small interfering RNA (siRNA) was associated with decreased cell invasion (p=0.0016) and cell migration compared to control cells. ING3 is significantly associated with PCa disease progression and cancer-specific mortality. To our knowledge, this is the first report suggesting an oncogenic function of ING3, previously well known as a tumor suppressor protein. Further studies should investigate potential-related pathways in association to ING3.


PubMed | The Prostate Center
Type: Journal Article | Journal: The Practitioner | Year: 2011

Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men. Histological disease is present in more than 60% of men beyond their sixties, and more than 40% of men in this age group have lower urinary tract symptoms (LUTS). The prevalence increases with age. About one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically. The remainder will often be managed initially by active surveillance. The majority of these men suffer gradual progression of symptoms and increasingly require treatment. BPH is characterised by a spectrum of obstructive and irritative symptoms, known collectively as LUTS. Poor urinary flow and the sensation of incomplete bladder emptying are the two symptoms that correlate most closely with the eventual need for prostate surgery. Untreated, a significant number of men with BPH will eventually develop acute urinary retention. In addition tosymptom assessment, digital rectal examination can provide an estimate of prostate volume and exclude a palpable nodule suggestive of prostate cancer. PSA testing provides additional information about the risk of prostate cancer being present. Medical management of BPH is suitable for most patients with moderate symptoms. The two main evidence-based approaches are treatment with alpha1-blockers and 5alpha-reductase inhibitors (5-ARLs). Severely symptomatic patients may also respond to these drugs. Mild symptoms should usually be managed by active surveillance. Combination therapy with an alpha1-blocker and a 5-ARI is more effective than monotherapy in terms of symptom relief and prevention of progression.


PubMed | The Prostate Center
Type: Journal Article | Journal: The Practitioner | Year: 2013

Prostate cancer is the most common cancer in men in the UK. It accounts for nearly a quarter of all male cancer diagnoses and is the second most common cause of male cancer death. Despite a large increase in prostate cancer incidence, mortality rates have remained relatively constant through improvements in survival. Most patients present with localised disease, but there are still many who present with metastatic disease. Prostate cancers are driven by androgens, such as testosterone. Androgen deprivation therapy (ADT), which is still the mainstay of systemic treatment, effectively reduces intraprostatic androgen levels resulting in reduced androgen receptor (AR) stimulation and increased apoptosis. Medical castration using LHRH analogues has become the gold standard in managing both locally advanced prostate cancer, in ombination with radiotherapy, and metastatic disease. Eventually most men with advanced prostate cancer become resistant to ADT. This is now called castrate refractory prostate cancer (CRPC), and is associated with a poor prognosis. There is now hope for patients who progress after chemotherapy with the emergence of several new agents that have been shown to benefit patients. The first AR-targeted drug to show a definite clinical benefit is abiraterone. It markedly decreases levels of androgens in CRPC and initial trials showed promising activity. Enzalutamide has a high affinity and selectivity for AR binding, blocks nuclear translocation and reduces recruitment of co-activators. Abiraterone, enzalutamide and other AR-targeted drugs are being studied in clinical trials for patients earlier in their disease, e.g. in addition to ADT at first presentation of metastatic disease, where it is likely that greater benefits will be seen.

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