Treatments provided by Marc Laniado

A prostate biopsy involves using thin needles to take small samples of tissue from the prostate. There are two main types of prostate biopsy – – a TRUS (trans-rectal ultrasound) guided or transrectal biopsy, and a template (transperineal) biopsy. The transrectal biopsy is the most common type of biopsy in the UK. The doctor or nurse uses a thin needle to take small samples of tissue from the prostate. You’ll lie on your side on an examination table, with your knees brought up towards your chest. The doctor or nurse will put an ultrasound probe into your back passage (rectum), using a gel to make it more comfortable. The ultrasound probe scans the prostate and an image appears on a screen. The doctor or nurse uses this image to guide where they take the cells from. You will have an injection of local anaesthetic to numb the area around your prostate and reduce any discomfort. The doctor or nurse then puts a needle next to the probe in your back passage and inserts it through the wall of the back passage into the prostate. They take 10 to 12 small pieces of tissue from different areas of the prostate. This procedure usually takes about 10 to 15 minutes. During a trans-perineal biopsy a biopsy needle is inserted between the testicles and the back passage (perineum). The needle is inserted through a grid. It takes more tissue samples from more areas of the prostate than a TRUS biopsy. The number of samples taken will vary but can be around 30 to 50 from different areas of the prostate. This could mean that there is more chance of finding prostate cancer cells, if any are present. An ultrasound probe will be inserted into your back passage, using a gel to make this easier. An image of the prostate will appear on a screen which will help the doctor to guide the biopsy needle. A grid (template) will then be placed over the area of skin between the testicles and the back passage. The needles will be inserted through the holes in the grid, into the prostate. The trans-perineal template biopsy will take about 20 to 40 minutes. You will need to wait a few hours to recover from the general anaesthetic before going home. A third prostate biopsy methodology is an MRI guided trans-perineal approach targeting lesions using MRI fusion. This procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate. The live ultrasound images of the prostate are “fused” with the multiparametric (“enhanced”) MRI of the prostate taken earlier (usually no more than 6 months before the biopsy). . Biopsies are taken through the skin between the testicles and the back passage (the perineum) as described above for the in trans-perineal biopsy. The sampling is targeted to the suspicious areas seen on the MRI. Additional samples may be taken from the rest of the prostate, even if normal on the MRI, depending on the reason for why the biopsies are being taken. The number of samples taken depends on the size and number of abnormalities, as well as the size of the prostate, usually ranging from 4 to 24 biopsies. After the biopsies have been completed, a firm dressing will be applied to the perineum and held in place with a pair of disposable pants.

There are two types of minimally invasive prostate laser surgery to treat a benign enlarged prostate gland. The more established Laser prostatectomy uses focused light to destroy the tissue blocking the urethral opening, a fast and simple procedure that generally takes about one hour. Holmium laser prostate enucleation (HoLEP) is a newer procedure, which utilises the holmium laser as a precise cutting instrument to resect large pieces of prostate. The main advantage of HoLEP over other laser prostatectomy techniques is that it can rapidly create a large 'TURP-like' cavity, making it suitable for large prostate glands.

Transurethral Resection of the Prostate is a procedure to alleviate a enlarged prostate gland. An endoscope is inserted into the urethra to localise the blockage, a resectoscope is used to cut out the centre of the enlarged prostate, and finally a catheter is used to drain the bladder. The procedure will take about one hour and is usually performed as a outpatient procedure.

Prostatectomy is the surgical removal of all or part of the prostate gland. This operation can be performed for a variety of reasons, but often as a response to urinary retention or certain cancers, and the amount removed can be from trivial quantities of tissue to total/radical excision. A number of different surgical techniques, such as open or robotic-assisted surgery are possible, depending on the needs of the surgery.

During a conventional radical prostatectomy, the cave of Retzius has to be removed in order to gain access to the prostate. The fat and connective tissue that lie within it are removed, the puboprostatic ligaments are cut and a certain amount of the arterial inflow of blood into the penis is interrupted. These steps contribute significantly to post-prostatectomy incontinence and impotence.

However, Retzius-sparing radical prostatectomy is a technique that approaches the prostate from below, rather than from above the bladder. The technique of re-joining the bladder and urethra after the prostate has been removed is also different from conventional prostatectomy, in that the front aspect of the join has to be completed before the back wall, which is the reverse of the conventional procedure.

The UroLift® system is a relatively new surgical procedure for the treatment of lower urinary tract symptoms due to an enlarged prostate due to benign prostate hyperplasia. A number of tiny implants are inserted to lift and hold the enlarged prostate tissue out of the way so that it no longer blocks the urethra, resulting in improved urine flow. This procedure does not destroy the prostate tissue, meaning that it does not cause erectile dysfunction or permanent urinary incontinence. It is a minimally invasive procedure which that allows patients to return home and to normal daily activities soon after treatment.