Prostate cancer laser treatment truly transformative

Surgeons have described a new treatment for early stage prostate cancer as “truly transformative”.

Surgeons have described a new treatment for early stage prostate cancer as "truly transformative".

The approach, tested across Europe, uses lasers and a drug made from deep sea bacteria to eliminate tumours, but without causing severe side effects.

Trials on 413 men – published in The Lancet Oncology – showed nearly half of them had no remaining trace of cancer.

Lifelong impotence and incontinence are often the price of treating prostate cancer with surgery or radiotherapy.

Up to nine-in-10 patients develop erectile problems and up to a fifth struggle to control their bladders.

That is why many men with an early stage tumour choose to “wait and see” and have treatment only when it starts growing aggressively.

“This changes everything,” said Prof Mark Emberton, who tested the technique at University College London.

The new treatment uses a drug, made from bacteria that live in the almost total darkness of the seafloor and which become toxic only when exposed to light.

Ten fibre optic lasers are inserted through the perineum – the gap between the anus and the testes – and into the cancerous prostate gland.

When the red laser is switched on, it activates the drug to kill the cancer and leaves the healthy prostate behind.

The trial – at 47 hospitals across Europe – showed 49% of patients went into complete remission.

And during the follow-up, only 6% of patients needed to have the prostate removed, compared with 30% of patients that did not have the new therapy.

Crucially, the impact on sexual activity and urination lasted no more than three months.

No men had significant side effects after two years.

Prof Emberton said the technology could be as significant for men as the move from removing the whole breast to just the lump in women with breast cancer.

He said: “Traditionally the decision to have treatment has always been a balance of benefits and harms. The harms have always been the side effects – urinary incontinence and sexual difficulties in the majority of men.”

“To have a new treatment now that we can administer, to men who are eligible, that is virtually free of those side effects, is truly transformative.”

More than 46,000 men are diagnosed with prostate cancer in the UK each year.

The tumours tend to grow slowly, but still around 11,000 men die from the disease.

However, the new treatment is not yet available for patients. It will be assessed by regulators at the beginning of next year.

Other therapies to kill prostate cancers, such as very focused ultrasound – known as focal Hifu – have a lower risk of side effects.

But these treatments are not universally available.

Dr Matthew Hobbs, from the charity Prostate Cancer UK, said the technology could help men who face the conundrum of whether or not to have treatment.

“Focal therapy treatments like this one have the potential to offer a middle ground option for some men with cancer that has not spread outside the prostate,” he said.

He said the next challenge would be to find out which patients should still wait and see, which ones should have this type of therapy, and which should have more invasive treatments.

“Until we know the answer to this question, it is important that these results do not lead to the over-treatment of men with low risk cancer, or the under treatment of men at higher risk.”

The technology was developed at the Weizmann Institute of Science in Israel alongside Steba Biotech.

Scottish life expectancy still lowest in UK

Life expectancy for Scottish men and women has continued to improve – but they still die younger on average than people anywhere else in the UK.

Life expectancy for Scottish men and women has continued to improve - but they still die younger on average than people anywhere else in the UK.
Statistics from the National Records of Scotland put life expectancy at 77.1 years for baby boys born in the past three years, and 81.1 years for girls.

This was two years lower than the UK average for men, and 1.7 years lower than the female average.

And there were considerable differences between different areas of Scotland.

It showed males in East Dunbartonshire can expect to live for 80.5 years – 7.1 years longer than in Glasgow City, which has the lowest life expectancy in the UK at 73.4 years.

Females in East Dunbartonshire can expect to live for 83.5 years – 4.8 years longer than in West Dunbartonshire, which also has the lowest in the UK at 78.7 years.

In general, male and female life expectancy has tended to increase over time, by 5.8 years for women and by eight years for men since 1980-1982 – meaning the gap between the sexes has also narrowed.

However, the gap between Scottish and English life expectancy for both males and females has widened since 1980-1982 by 0.3 years for males and by 0.2 years for females.

And Scots of both sexes continue to have the lowest life expectancy at birth of any of the four UK countries.

In Scotland, men and women can expect to live shorter lives, by 2.3 years and 1.9 years respectively, than in England, where life expectancy is the highest in the UK.

Among the 28 EU countries, male life expectancy was highest in Cyprus (80.9 years), 3.8 years higher than in Scotland.

Female life expectancy was highest in Spain (86.2 years), 5.1 years higher than in Scotland.

The report also showed that males in Scotland could expect to live for a further 17.3 years at age 65 and females a further 19.7 years.

Despite Scotland’s comparatively low life expectancy, a European survey published last month suggested the country had the highest quality of life of the four UK nations.

The findings considered factors such as health, safety, access to education and personal rights.

Ambulances too slow to reach 999 calls

Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.

Ambulance services are struggling to reach seriously ill and injured patients quickly enough after rising demand has left the system over-stretched.
Patients with life-threatening conditions – like cardiac arrests – are meant to be reached in eight minutes, but only one of the UK’s 13 ambulance trusts is currently meeting its target.

Freedom of information requests by the BBC to ambulance trusts showed over 500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was lost last year waiting for A&E staff to be free to hand over their patients to – a rise of 52% in two years.

This is the equivalent of 286 crews being taken out of the system for a whole year or enough to increase the number of ambulance journeys by 10%.

Senior paramedics said the situation had become so critical that it was not uncommon to run out of ambulances at peak times.

The Welsh ambulance service is the only one that is hitting its targets to respond to life-threatening calls – and that is only after it reduced the number of cases it classed as an emergency from a third to about 5% so it could prioritise the most critical calls.

Last week Scotland adopted a similar system to help it cope, while services in Northern Ireland and England are also looking to follow suit.

It comes after average response times for life-threatening calls topped 10 minutes in Northern Ireland – a rise of nearly three minutes in two years.

Figures provided by two trusts in England also showed average times topping eight minutes for the second highest priority calls, including strokes and fits.

College of Paramedics chair Andrew Newton said the situation was of “great concern”.

“Talking to colleagues around the country, it’s not uncommon to find there are no resources to respond at all at a given time, particularly at nights and weekends. I was talking to one colleague recently who was explaining to me that the nearest ambulances were probably in France.”

Prof Jonathan Benger, the ambulance lead at NHS England, said delays at hospitals were causing “big problems” for ambulance crews as it meant they were taken out of the system and could not answer 999 calls.

But he also said a crucial factor was the increasing number of calls being handled – they hit 9.4m last year, nearly treble the number a decade ago.

“In the face of rising demand it is not surprising we are having difficulty meeting these targets. It is time to look at the system,” he added

Thousands miss out on stroke treatment

About 9,000 stroke patients a year are missing out on a treatment that can prevent disability following a stroke, say UK experts.About 9,000 stroke patients a year are missing out on a treatment that can prevent disability following a stroke, say UK experts.

In the UK, nearly 90,000 people each year are admitted to hospital following a stroke. Clot retrieval can restore blood flow to the brain, preventing some lasting damage, but currently only 600 patients a year get this therapy, they estimate.

A national stroke audit reveals part of the problem is a lack of skilled staff to do the procedure.

During a stroke, the blood supplying vital parts of the brain is interrupted. The most common reason is a clot blocking a major blood vessel in the head, although some strokes are caused by a bleed.

The longer a part of the brain is starved of blood, the more likely lasting damage – such as paralysis and speech problems – will occur.

While many people with a stroke caused by a clot currently get drugs to help dissolve the blockage, this does not always work completely.

Thrombectomy – or clot retrieval – is another method, which aims to remove the clot mechanically. It is a highly skilled operation, and stroke services need to be set up to be able to deliver the treatment.

A thin metal wire housing a mesh is inserted into a major artery in the leg and, under X-ray guidance, it is directed to the site of the problem in the brain.

The mesh is then expanded, like a miniature fishing net, to trap and remove the clot.

Researchers from Newcastle University, Northumbria University, Oxford Academic Health Science Network and the National Institute for Health Research looked at thrombectomy data and stroke statistics in the UK to work out how many patients might benefit from the procedure.

In a presentation given to the UK Stroke Forum national conference, they estimated one in 10 people admitted to a hospital with a stroke could be eligible for thrombectomy.

Investigator Dr Martin James, at the Royal Devon and Exeter Hospital, said: “Delivering the procedure to the 9,000 people who need it will require major changes to the configuration and skill sets of existing acute stroke services.

“We must work quickly to establish what needs to be done so that more people in the UK can benefit from a treatment which can dramatically reduce disability after a stroke as well as cutting associated costs to the NHS and social care.”

Thrombectomy has already been deemed safe and effective by the health watchdog the National Institute of Health and Care Excellence.

NICE says the treatment should be carried out only in places that have trained specialists and the necessary support staff and equipment.
Consultant shortages

The Royal College of Physicians said: “There is a major shortage of appropriately trained staff to undertake thrombectomy, particularly outside of London, and it will take time to train up enough doctors to undertake this skilled procedure.”