Download Speaker key - Camden GP Website

John Hines
Speaker key
JH
IV
John Hines
Interviewer
JH
My name is John Hines, and I’m a consultant urological surgeon at University
College Hospital, but also I’m the urology pathway director for London Cancer.
Today it was a roundtable discussion with GPs from the Camden area, mostly
focusing on the recent changes in guidance about urology cancers.
IV
What are the urological cancers that GPs might see?
JH
There are five urological cancers and two of them are relatively common;
that’s prostate cancer and bladder cancer. Renal cancer is also one of the tumours we
deal with which is slightly less common, and then there are two rare tumours which
are testicular cancer and penile cancer.
IV
How common are they and which age groups do they affect?
JH
Prostate cancer is a very common tumour and becomes increasingly common
as men get older. If you live to a very old age, there’s an extremely high chance you
will have prostate cancer. However, very many prostate cancers aren’t a threat to life.
But in middle-aged men, men in their 50s and 60s, it can be a very dangerous cancer.
Bladder cancer is the seventh or eighth most common cancer found in the UK at the
moment, and renal cancer is probably about tenth. The other cancers, testicular cancer
is rare, but this affects young men. Usually the age at most risk is between 15 and 40.
Penile cancer is very rare and is a skin cancer essentially that affects older men. So
there is a very wide range in terms of age that men and women might present with a
urological cancer.
IV
How do these tumours present?
JH
Most men with prostate cancer don’t really have any symptoms directly
related to the tumour. They only have symptoms, in fact, if the tumour is very widely
spread and metastatic. So in this day and age with the PSA, prostate specific antigen
blood test, most men will present with a high PSA. With regard to bladder cancer, the
cardinal sign of bladder cancer is passing blood in the urine and usually there is no
pain associated with that. That’s true for men and women.
With regard to renal tumours, many of them are now detected incidentally on some
kind of imaging which would typically be an ultrasound scan done for a completely
unrelated reason, possibly related to the investigation of gall stones or something like
that. Some people with tumours in the kidney will pass blood in their urine and often
they will be seen in a clinic. This is probably thought to be dedicated to patients with
bladder cancer, but in fact the blood that they’re passing can be related to their kidney
1
tumour. But the imaging that we do in either eventuality would detect that very
rapidly.
With regard to testicular cancer, the most common presentation of that is the patient
finds a hard lump in their testicle; that is how nearly all of those present. And penile
cancer, which is very rare, is usually a change on the skin, so it’s a spot or a red area
that doesn’t get better.
IV
Are there any common pitfalls, either in diagnosis or treatment, to try and
avoid?
JH
With regard to prostate cancer, I think the biggest pitfall is for GPs not to
perform a rectal examination, because if the prostate gland feels abnormal, then
there’s a very high chance there is a significant tumour and that man should be sent in
urgently. With regard to bladder cancer, a lot of these tumours can present with
infections that just don’t respond to treatment and so in that situation trying to treat
the patient in a prolonged way with many courses of antibiotics that don’t work, it
will be better, far better in fact, to refer that patient in sooner.
IV
Where is the specialist service that GPs refer to?
JH
GPs, in fact, should send their patients to their local hospital if they think their
patient has a urological cancer. All of our local hospitals have special two-week wait
rapid access clinics for all of our tumours, and the diagnosis of all of these tumours is
made very well in the local hospitals. Having said that, there are some very
specialised treatments which now have been centralised. An example would be radical
prostatectomies are now all performed at University College Hospital on a robot, and
all the surgery for renal cancer is now undertaken at the Royal Free Hospital. But
certainly GPs shouldn’t refer patients directly to University College Hospital or the
Royal Free unless that’s their local hospital. All referrals should be made in the
standard fashion to local hospitals using the two-week wait system.
IV
What can a GP do to improve the prognosis?
JH
Well, in urology we do have a wide variety of different tumours, but the same
is true for all of them that early diagnosis is extremely helpful. So early, appropriate
referral from a GP is very, very important, and in particular organ confined prostate
cancer should now be regarded as a treatable cancer so it’s very important these
patients are referred appropriately. And, even more importantly, bladder cancer can
spread very rapidly so early referral of a patient who may have bladder cancer is very
important indeed.
IV
Are there going to be any advances in diagnosis and treatment in the future?
JH
Currently we are seeing much better treatment of prostate cancer treated
surgically because of the use of robotic surgery, which men recover from more
rapidly than open surgery and have fewer side-effects. With regard to bladder cancer,
there is the chance we will soon have some biomarkers; in other words, some
chemical tests we can do that will make the diagnosis much easier.
2
With regard to renal tumours, new surgical techniques using a robot at the Royal Free
Hospital, such as partial nephrectomy where only part of the kidney is removed, is a
much better option for the patient than losing a whole kidney for a tumour that only
affects part of the kidney.
And the techniques of treating just the affected part of the kidney which are being
developed now, such as cryotherapy and radiofrequency ablation which are less
invasive, are certainly to the patient’s advantage and I think will become more
common, particularly as we will be tending to diagnose tumours when they’re
smaller.
IV
Where can GPs find out more?
JH
So all the best sources of information are online now, so there’s NICE
guidance on the NICE website which is national. A very good one for prostate disease
is Prostate Cancer UK. There’s another good one for men’s tumours, urology
tumours, which is the Orchid website, and then of course there is the London Cancer
website which is particularly relevant to GPs in this area. And I’m very happy to be
contacted by GPs at [email protected] if they have any individual enquiries that
they wish to discuss with me.
3