With urological cancers increasingly common, The Royal Marsden’s Urology Unit aims for swift diagnosis and comprehensive treatment
Mr Declan Cahill, Consultant Urological Surgeon, is one of the most prolific surgeons in his field in the country
of people diagnosed with kidney cancer in England and Wales survive their disease for 10 years or more (2010-11)
The Royal Marsden’s Urology Unit is a world leader in the diagnosis and treatment of prostate, kidney, bladder and testicular cancers. The hospital's multidisciplinary team has a variety of techniques at their disposal to diagnose and treat these common cancers.
The Royal Marsden has a wide range of state-of-the-art scanners for imaging of the body including MRI, CT, endoscopy, ultrasound and image-guided biopsy. The Trust has recently launched a new one-stop urological cancer Rapid Diagnostic and Assessment Centre in Chelsea. “We test men for urological cancer and, in many cases, will diagnose and decide on a treatment plan the same day. This means we can improve the patient's outcome,” says Netty Kinsella, Uro-Oncology Nurse Consultant at the hospital.
Thanks to the da Vinci Xi, robotic surgery makes a huge difference to the patient’s recovery time
Left: Mr Declan Cahill, Consultant Urological Surgeon. Right: Medical Director Dr Nicholas van As
9 in 10
cases of bladder cancer are diagnosed in people aged 60 and over (2010-12)
The Royal Marsden offers a full range of treatments for all forms of tumours related to the urinary tract, including robotic-assisted surgery. The Trust was the first in England to get the state-of-the-art da Vinci Xi robot, which allows surgeons to use the latest advances in technology to cut and manipulate tissue without the need for open surgery.
Mr Declan Cahill, Consultant Urological Surgeon at The Royal Marsden, is one of the highest volume radical prostatectomy surgeons in the country. He says: “The da Vinci Xi is the latest robotic surgery platform. The vision provided by robotic surgery is amazing. If we can see better, we can be more precise and operate better. We can manipulate the robotic arms to make microscopic incisions with far greater accuracy and control compared with open surgery or standard laparoscopy. For our patients, this means they lose less blood, experience less pain, recover quicker and leave hospital sooner.”
Retroperitoneal lymph node dissection (RPLND) is a procedure to remove abdominal lymph nodes to treat testicular cancer and establish the cancer’s exact stage and type.
Mr Erik Mayer, Consultant Urological Surgeon at The Royal Marsden, is one of two surgeons in the South East England Supranetwork Testicular Multidisciplinary Team and performs RPLND for testicular germ cell tumours.
He says: “Thanks to the da Vinci Xi, The Royal Marsden is the only trust in England offering this procedure robotically. It leaves a smaller scar than the usual 10-inch incision and makes a huge difference to recovery time.” Surgeons from the Urology Unit often work collaboratively with other surgical specialities such as the Department of Plastic and Reconstructive Surgery. Testicular cancer patients can also have an implant when the testis is removed.
Mr Erik Mayer, Consultant Urological Surgeon
Dr Vincent Khoo, Consultant Clinical Oncologist
of men diagnosed with testicular cancer in England and Wales survive their disease for 10 years or more (2010-11)
The state-of-the-art radiotherapy techniques at The Royal Marsden offer patients a personalised treatment plan for their individual cancer, leading to fewer side effects and better outcomes.
The Trust has several linear accelerator machines that can offer image-guided radiotherapy, which involves using a variety of imaging techniques, such as X-rays or CT scans, alongside radiotherapy to target the radiation more precisely.
The hospital was one of the first London NHS trusts to receive a CyberKnife to deliver stereotactic radiotherapy – a highly accurate method of targeting radiotherapy at a tumour. It is mainly used for prostate cancer patients, but in certain circumstances can also be used for metastatic renal cancer.
“Patients undergoing standard radiotherapy normally come into hospital for daily treatment sessions for up to two months, which can be gruelling. CyberKnife allows us to deliver radiation in larger doses, with pinpoint accuracy, meaning fewer hospital visits and reduced side effects,” says Dr Nicholas van As, Medical Director and Consultant Clinical Oncologist at the Trust.
The Royal Marsden offers low-dose brachytherapy to treat patients with early prostate cancer. The hospital was one of the first in the UK to use a robotic system to aid delivery of brachytherapy. It involves dozens of tiny ‘seeds’ of radioactive iodine being implanted into the prostate gland, so that the radiotherapy can destroy the cancer cells without distributing an excessive dose to the surrounding organs.
Dr Vincent Khoo, Consultant Clinical Oncologist, says: “State-of-the-art brachytherapy is now a single procedure of about two hours. It is well tolerated and patients can return to work the next day if they wish.
“While the profile of side effects of brachytherapy is similar to those of external-beam radiotherapy, bladder or rectal irritation is significantly less intense or bothersome. There is also substantially less impact on erectile function, which remains an important quality-of-life issue.”
State-of-the-art brachytherapy means that the entire treatment can be completed in one session
men were diagnosed with prostate cancer every day in 2012
A reputation for research
The Royal Marsden, together with its academic partner The Institute of Cancer Research, has an international reputation for groundbreaking research and pioneering the latest in cancer treatments and technologies.
“We are leading the way in prostate cancer research and many of our clinical trials are changing the standard practice for treating patients across the UK, and beyond,” says Dr Chris Parker, Consultant Clinical Oncologist at The Royal Marsden, who is part of the international STAMPEDE trial management group. The trial recently showed that early chemotherapy improves survival of those with advanced prostate cancer.
Research carried out at the Trust has shown that an immunotherapy drug, nivolumab, has the potential to improve treatment for advanced kidney cancer. The CheckMate 025 trial involved 821 patients from around the UK, and showed that the average survival time was increased from 19.6 months with standard therapy to 25 months with nivolumab – with fewer side effects. Dr James Larkin, Consultant Medical Oncologist who led the trial at The Royal Marsden, says:
“Nivolumab marks the first time that an immunotherapy treatment of this type has demonstrated a significant improvement in kidney cancer survival. Once this disease has spread, the outlook for patients can be very poor. Newer and more effective, tolerable treatments are desperately needed.”
Mr Alan Thompson, Head of the Urology Unit, discusses the causes and symptoms of these cancers, and the treatments used to tackle them
What are urological cancers?
These are prostate, kidney, bladder or testicular cancers.
How common are these cancers and what are the risk factors?
Prostate cancer is the most common cancer in men in the UK. The biggest risk factor is for the over-50 age group. Other risk factors can include family history and ethnicity, with black African and Caribbean men being two to three times more likely than white men to develop prostate cancer.
Kidney cancer is in the top 10 most common cancers in the UK. Older people are more at risk and the disease is more common in men than women. Being obese increases the risk of getting kidney cancer, as does being a smoker. Bladder cancer is also in the top 10 most common cancers in the UK. Black or Asian men have around half the risk of bladder cancer as white men, while black or Asian women have around two thirds the risk of white women.
Testicular cancer is diagnosed in around 2,200 men in the UK each year. The most important risk factor is an un-descended testicle.
What are the symptoms?
In general, prostate cancer does not cause symptoms in its early stages, but later symptoms can include blood in the urine, difficulty and/or pain when passing urine and a need to pass urine more frequently, particularly during the night. Kidney cancer does not always cause symptoms, but when it does, they can include blood in the urine, pain, a swelling or lump in the area of the kidney, fevers and night sweats, tiredness and unexplained weight loss.
The most common symptom of bladder cancer is blood in the urine, but there can also be muscle spasms in the bladder and a burning pain when passing urine. Early symptoms of testicular cancer are usually a lump or swelling in the testicle, along with an ache or a heavy sensation. Occasionally there may be swelling with extreme tenderness in the testicle.
Case study: Mike Collins, 68
“I was diagnosed with prostate cancer in 2008 and was told I should have radiotherapy or surgery. I looked into my options and asked to be referred to The Royal Marsden because it offers robotic surgery, which has fewer side effects than open surgery.
“When I met my consultant at The Royal Marsden, he recommended active surveillance, which I have been on ever since. At the moment, I'm as normal as I could possibly be and the cancer is not something I think about.
“Since my diagnosis eight years ago, my wife and I have completely changed our diet and lifestyle. As a result, my prostate-specific antigen (PSA) level has dropped by 50%. By taking some action myself, I felt more in control – and as a bonus, I lost a lot of weight and reduced my chances of a heart attack, which was a hereditary problem in my family. I am now much healthier – in many respects, my cancer diagnosis was a blessing.
“I was visiting The Royal Marsden for quarterly checkups, but now I only need to go every six months.”