This document discusses innovations in prostate disease management, including focal therapy options for prostate cancer and the UroLift procedure for treating benign prostatic hyperplasia (BPH). It summarizes guidelines for investigating hematuria and evaluating prostate cancer risk. It also compares treatment options for localized prostate cancer and BPH, noting UroLift offers symptom relief while preserving sexual function unlike other BPH treatments. Clinical data shows UroLift improves urinary symptoms and quality of life compared to TURP, with faster recovery and no effect on ejaculation.

1. Urological Cancer Indicators &
Innovations in Prostate
Disease Management
Marc Laniado MD FEBU FRCS(Urol)
Consultant Urological Surgeon
Specialising in prostate cancer and BPH
Nuada Medical
ml@nuadamedical.com

2. Three main areas of interest

3. Visible haematuria:
suspected cancer referrals
• >45 years
• unexplained visible
haematuria without UTI or
• visible haematuria that recurs
after UTI treatment

4. Non-visible haematuria (NVH) is + or more
blood on urinalysis
Non-visible Haematuria
(3 urine dipstick over 2 to 3 weeks)
Symptomatic
“s-NVH”
Significant if ≥1 of 3 samples
dipstick +, ++, +++
Asymptomatic
“a-NVH”
Significant if ≥ 2 of 3 urine samples
dipstick +, ++, +++

5. > 60 years old
• non-visible haematuria AND
• dysuria
OR
• WBC elevated [NEW CG27, 2015]
Bladder cancer:
suspected cancer referral

6. Non-urgent referral for NVH if < 60 years old
<40 years 40-60 years >60 years
Asymptomatic:
risk factors for
significant disease !
refer to haematuria
clinic, otherwise
monitor
Routine referral to
haematuria clinic
Urgent Referral under
2 week wait
Symptomatic: Routine
referral to haematuria
clinic

7. Non-urgent referral for haematuria/
bladder cancer clinic
Recurrent UTI & > 60 y old

8. Prostate cancer testing?
Symptomatic men Asymptomatic men

9. • Consider PSA & do prostate examination for
[1.6.2]

10. Symptoms of concern -
urological evaluation
• unexplained weight
loss [1.13.2]
• Carry out evaluation
symptoms/signs/
findings to clarify
which cancer

11. • Suspected cancer referral [new 2015]
• PSA > age specific reference range PSA [1.6.3]
• Abnormal DRE [1.6.1]

12. PSA thresholds vary…
Age
Range
Public Health
England &
PCRMP*
BAUS
Prostate
Cancer UK
45 to 49 2.7
2.5 + risk
factors
50 to 59 3 3.9
60 to 69 3 5.0
70 to 79 7.2
≧ 80
❋Prostate Cancer Risk Management Programme 2016,
Consensus Statement

13. Prostate cancer testing?
Symptomatic men Asymptomatic men

14. PCRMP guidance states that
"The PSA test is available free to any
man aged 50 or over who requests
it, after careful consideration of the
implications".

15. Don’t test PSA if recent UTI, ejaculation,
cycling, prostate stimulation

16. Always repeat the PSA
2 to 4 weeks later
PSA
Frequency
50% of abnormal PSA values ARE NORMAL on retest

17. PSA testing in asymptomatic men
Prostate Cancer Risk Management Programme,
Public Health England 2016

18. If risk factors for PCa, refer with PSA
below threshold in some situations
Pan
Pr
Pr PanBr
Br
PrPr
O
C
Family History
Black men
Obesity

19. Old pathway for investigation
Cancer
Many flaws….

20. Treatment Options are Broad & Unclear
?

22. 10 y Prostate Ca mortality same when
compared by original treatment allocation
NEJM 2016
Ave age 62, (life expectancy 17 y)

23. 20% progressed if randomised
to active monitoring
NEJM 2016
Surgery/RT
Active
monitoring

24. Over 50% of monitoring group eventually
needed treatment as misclassified
NEJM 2016

25. Prebiopsy MRI & MRI-targeted transperineal
biopsies correctly stratify patients (& no infections)
Cancer
Monitor PSA & no
biopsy if normal MRI

26. Radical prostatectomy
Conventional whole prostate treatments
cannot assure good functional outcomes
Radical radiotherapy
Active monitoring

27. Solution is to treat only that part of the prostate
with significant cancer - Focal Therapy
Prostate cancer on right side
Half the prostate
scheduled for treatment
∴ fewer side-effects

28. MRI-targeted HIFU @ PMH

29. Post HIFU MRI shows ablation
Ablated
area
Unaffected
Prostate

30. Prostatic Urethral Lifts -
symptom relief & normal
ejaculation
Marc Laniado MD FEBU FRCS(Urol)
Consultant Urologist

31. BPH affects all older men
30 40 50 60 70 80
100%
50%
0%
Age
Percentageofmenaffected

32. Here today to learn about for BPH -
your patients have read it in the Daily Mail!

33. Current treatments for BPH cause
sexual dysfunction
Surgery:
HOLEP
Drugs:
𝝰 blocker

34. ….men don’t want sexual side-effects

35. Functional anatomy of the
male genitourinary tract

36. Normal ejaculation requires
an intact bladder neck

37. UroLift implant designed to
compress prostate lobes
Implant
Delivery
Device

38. UroLift retract prostate lobes
without affecting bladder neck

39. Urinary symptoms score drops
by 11 points after UroLift
UroLift
TURP
Sonksen 2015 Eur Urol

40. UroLifts relieve symptoms by 4
weeks, last at least 4 years
IPSSPoints
4 years
Storage
symptoms
Voiding
symptoms
14
12
10
8
6
4
2
0
Roehrborn 2015 Can J Urol

41. Faster quality of life recovery
after UroLift compared to TURP
TURP
UroLift
Sonksen 2015 Eur Urol

42. Antegrade wet ejaculation & better
sex after UroLift compared to TURP
UroLift
TURP
Ejaculatory&SexualFunction
Sonksen 2015 Eur Urol

43. Side effects are transient (2
weeks) & well tolerated
UroLift Controls
Dysuria 34% 17%
Hematuria 26% 5%
Pelvic pain 18% 5%
Urge Incontinence 4% 2%
UTI 3% 2%

45. UroLift fits well into the
existing pathway
Man with
persistent
LUTS due
to BPH
Ejaculation
important
?
Tamsulosin
Alfuzosin
80 g
No Median lobe
PVR < 150 ml
N
Y
still bothered
still bothered
Y
N
UroLift
HoLEP