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Oxford University Hospitals NHS Foundation Trust
Urology

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Pelvic Cancer

Pelvic Cancer team

 

Specialist conditions we manage

The prostate

Prostate disease is common in middle-aged and elderly men. The prostate gland lies just below the bladder and wraps around the urethra ('water pipe') as it exits the bladder, a bit like a doughnut with a hole in the middle. It is necessary for having children since it makes some important constituents of the semen fluid.

Beyond the reproductive years of a man's life it may just cause trouble!

The two most common forms of prostate disease are benign (non-cancerous) enlargement of the prostate, known as benign prostatic hyperplasia (BPH), and prostate cancer (PC). Usually, men will seek advice from their GP if they develop urinary bladder symptoms, such as a weak flow or needing to get up a few times at night to pass urine. These are symptoms that could be caused by BPH or PC. PC can also be diagnosed without symptoms, related to a blood test, prostate specific antigen (PSA). The only part of the prostate gland, which is available for a doctor to examine with a gloved finger, is its back surface, which is located in front of the back passage (rectum). Such an examination is uncomfortable but shouldn't be painful; it is known as a digital rectal examination (DRE).

Prostate cancer

If PC is confined to the prostate, it may be treated with curative intent by surgery (robotic radical prostatectomy), radiotherapy (external beam or brachytherapy implant), focal ablation (within a clinical trial only) or increasing often by careful monitoring, known as active surveillance.

If PC is not confined it may have grown locally into surrounding tissues, or it may have spread away from the prostate gland. In these circumstances treatment is less likely to involve surveillance or surgery, except when the PC is causing troublesome bladder symptoms.

Treatment of PC usually involves a multidisciplinary team of healthcare professionals, including urologists, cancer nurse specialists, oncologists, pathologists and radiologists.

We may offer the following types of management for PC.

  • Open retropubic radical prostatectomy (ORP)
  • Robot-assisted radical prostatectomy
  • Transurethral resection of the prostate (TURP)
  • Radiotherapy (external beam or brachytherapy)
  • Active surveillance
  • Patient information on surgical options
  • Open retropubic radical prostatectomy (ORP) (pdf, 327 KB)
  • Robot-assisted radical prostatectomy (pdf, 00 KB)

For excellent unbiased information about all aspects of PC and benign prostate disease, please visit the Prostate Cancer UK website, where up-to-date information for patients is freely available:

Bladder cancer

The Urology department in Oxford offers a modern, evidence-based practice for managing bladder cancer and has national recognition for the high level of service provided.

Rapid diagnosis

Most diagnosis of bladder cancer are made in patients who present with haematuria (blood in the urine). This blood may be visible to the naked eye and seen by the patient or may be picked up via GP testing a patient's urine (non-visible haematuria).

Patient information on haematuria

In Oxford we were one of the first units in the UK to set up a rapid access, CT scan based, service for investigating haematuria. The unit has published extensively in this field and remains proud of the service we offer to our patients.

The goal of investigation is to exclude significant pathology including bladder, prostate and renal cancer and urological stone disease.

Following referral by a GP, patients are seen in dedicated haematuria clinics where a full history and examination is performed. Investigations will include imaging (X-rays) to look at the kidneys and a cystoscopy under local anaesthetic to examine to bladder.

Patient information on local anaesthetic flexible cystoscopy

Depending upon whether any abnormality is found patients will be referred to the appropriate specialist urology clinic or for treatment. With a diagnosis of bladder cancer this will neccesitate a general or spinal anaesthetic and an endoscopic, transurethral resection of the tumour (TURBT).

Patient information on TURBT

A multidisciplinary approach to bladder cancer management

All cases of bladder cancer are discussed in our multidisciplinary cancer team meeting held on Friday afternoon. This meeting benefits from input of urologists, radiologists, histopathologists, nurse specialist and oncologists and allows patient management to be discussed and optimised.

Following on from this meeting a patient will be offered either a consultation with our cancer nurse specialist or a joint clinic appointment with a urologist and oncologist to discuss management options.

More detailed information on bladder cancer staging and management can be found on the Action on Bladder Cancer website:

Provision of management options for bladder cancer

The successful management of bladder cancer requires a patient to be provided with a range of management options and to tailor treatment to the needs of individual patients. In Oxford we can provide patients with the full range of options based upon the stage of their disease and delivered by specialised clinicians.

Management of non-muscle invasive bladder cancer (NMIBC)

In the management of NMIBC patients can be offered:

For more advanced bladder and transitional cell cancer patients, Oxford benefits from experienced urological surgeons working closely with both medical and clinical oncologists. Our department provides one of the highest volume services for radical bladder cancer surgery and cystectomy in the UK with over 40 cystectomies performed each year. Most patients will be offered the choice of either radical surgery or radical radiotherapy with the additional option on neoadjuvant chemotherapy (before either surgery or radiotherapy). Although ileal conduit diversion remains the commonest form of urinary diversion approximately 20 percent of our patients who undergo radical bladder surgery will be offered the option of a new bladder formation (orthotopic neobladder).

Patient information on radical cystectomy (bladder removal)

The introduction of robotically assisted, minimally-invasive surgery is an exciting new development, which we hope to introduce as an option for radical surgery in Oxford in the near future.

Close surveillance and follow-up

After initial bladder cancer treatment, patients will be offered a close, protocol-driven follow-up regimen to check that there is no recurrent transitional cell cancer in the bladder or upper tracts (ureter and kidney).

This will require regular checks of the bladder with local anaesthetic flexible cystoscopy and also X-ray imaging to look at the kidneys and ureters.

Suspicion of and recurrence in the ureter or kidney may require a general anaesethetic and ureteroscopy.

Patient information on ureteroscopy

Non-urological pelvic disease

The organs within the pelvis may be affected by disease and pathology for which a patient is under the care of other specialties including gynaecology, colorectal surgery or the sarcoma team. The Pelvic Cancer team provides an extended service, offering help with pelvic surgery to our colleagues from other specialties. This help may take the form of advising them and their patients on the best management of bladder issues or may require more complex involvement in major, joint, pelvic procedures.

Patient Support Group

All of our patients are invited to join the Oxfordshire Prostate Cancer Support Group (OPCSG), which is a support group for prostate cancer patients and their relatives and friends

Charitable donations

Links to information