In an editorial in Eur Urol (2014), the concluding statement sums up the advantages of Robotic surgery.

“Robotics is like driving a limousine instead of a compact car. you can go the same distance in both, but the limousine, although more expensive, is safer, smoother, and more comfortable.”

In an article by Eylert et al published in JCU (2014) the authors report a continuous fall in the incidence of bladder cancer (not including early pTa disease or carcinoma-in-situ. They looked at National Cancer Data Repository data for years 1990-2009. Overall the incidence of bladder cancer fell from 10,742 to 8,775 during this time period. Mortality has also fallen (from 4546 to 4135) but not proportionately, suggesting poorer survival.

In an article published by Porpiglia et al in Eur Urol, the authors studied outcomes in a group of men randomised to either laparoscopic or robotic prostatectomy. Surgery was carried out by a single surgeon with large experience of both approaches. Robotic surgery was associated with better continence at various time points up to 12 months, better erectile function and similar margin rates.

Both laparoscopic and robotic radical prostatectomies have undoubted advantages over the open approach, but there is continued debate whether the extra cost of robotic surgery can be justified compared to laparoscopic surgery. This study, although small and easily criticised for being the experience of a single surgeon will add to the debate.

There is a lack of high quality evidence to help decision making whilst choosing treatment for localised prostate cancer. In a study by Sooriakumaran et al published in BMJ (2014) the authors study 34515 Swedish men treated for prostate cancer with either surgery (n=21533) or radiotherapy (n=12982). Median follow up was over 5 years for both modalities. Mortality from prostate cancer was higher in the radiotherapy arm for patients with non-metastatic disease (subdistribution hazards ratio=1.76). Younger, fitter men with fewer comorbitities and with intermediate or high risk disease had the greatest differential benefit from surgery.

There are a number of limitations of this study, and a randomised trial comparing these two treatments is still awaited, but this probably gives the best current evidence.

In an article by Heidenrreich et al, published in Eur Urol (2013) the authors review the EAU gudielines for early detection of prostate cancer. One of the statements argues that a baseline PSA at 45 yrs old of >1ng/ml and a baseline above 2ng/ml at age 60 are significantly associated with prostate cancer mortality even up to 25 years after diagnosis.

Of survey of 95 men with chronic prostatitis, published in the journal Urology (2013), found that about 50% reported worse symptoms after tea, hot peppers, alcoholic drinks and chilli. About 20% improved by drinking only water and herbal teas, and taking laxatives decusate and polycarbophil.

In an article by Thompson et al published in N Eng J M (2013) the authors discuss the 18 year results of the prostate cancer prevention trial.

Among 18,880 eligible men who underwent randomization, prostate cancer was diagnosed in 989 of 9423 (10.5%) in the finasteride group and 1412 of 9457 (14.9%) in the placebo group (relative risk in the finasteride group, 0.70; 95% confidence interval [CI], 0.65 to 0.76; P<0.001). Of the men who were evaluated, 333 (3.5%) in the finasteride group and 286 (3.0%) in the placebo group had high-grade cancer (Gleason score, 7 to 10) (relative risk, 1.17; 95% CI, 1.00 to 1.37; P=0.05). Of the men who died, 2538 were in the finasteride group and 2496 were in the placebo group, for 15-year survival rates of 78.0% and 78.2%, respectively. The unadjusted hazard ratio for death in the finasteride group was 1.02 (95% CI, 0.97 to 1.08; P=0.46). Ten-year survival rates were 83.0% in the finasteride group and 80.9% in the placebo group for men with low-grade prostate cancer and 73.0% and 73.6%, respectively, for those with high-grade prostate cancer. Finasteride reduced the risk of prostate cancer by about one third. High-grade prostate cancer was more common in the finasteride group than in the placebo group, but after 18 years of follow-up, there was no significant between-group difference in the rates of overall survival or survival after the diagnosis of prostate cancer.

In an article by Carter in BJUI (2013) the rationale and evidence for prostate cancer screening using PSA is reviewed. The author argues against a growing trend to abandon PSA to detect early prostate cancer, but suggests that not all age groups of men benefit. The age group of patients that benefit most from PSA testing is the 55-69 year old group. Below this age group (and certain,y below age 40) testing is not recommended unless there are high risk factors. Men in the target age group should be fully counselled about the risks of over diagnosis and after a normal test probably only need repeat testing every 2 years.

In an article in BMJ (2013) by Robinson et al the authors studied 1499 cases and 6316 controls. There was a decrease in risk in prostate cancer with an increasing duration of 5ARI. This decrease affected cancers with and Gleason score of 2-6 and 7. Cancers with Gleason scores of 8-10 were neither increased or decreased.

Gender inequalities in the promptness of bladder and renal cancer after symptomatic presentation: evidence from secondary analysis of an English primary care audit survey. BMJ Open June 2013

Women with bladder and renal cancer are more likely than men to require three or more consultations with their general practitioner before they are referred to a hospital specialist. They also experience longer time intervals between presentation and hospital referral. These include gender differences for patients both with and without blood in the urine (haematuria), suggesting that doctors often interpret the clinical importance of haematuria differently in men and women. This is thought to be due to the higher risk of urinary infections in women than men. Blood in the urine is a key symptom in the diagnosis of these serious but treatable diseases. If you experience blood in the urine you should see your doctor immediately and they will decide if you need referring on to a specialist. At the Staffordshire Urology Clinic we offer state of the art investigation of blood in the urine and highly specialist management of both kidney and bladder cancer including key hole (laparoscopic surgery).