Prostate cancer (PCa) is the 3rd most prevalent cancer for men in Hong Kong, with >60% increase in the number of new cases in the past decade (1369 cases in 2008 vs 2204 cases in 2018). Traditionally, diagnosis pathway of PCa begins with an abnormal serum prostate-specific antigen (PSA) and/ or an abnormal digital rectal examination (DRE), both of which are known to have low specificity. Patients are then subjected to a transrectal ultrasound-guided prostate biopsy (TRUS bx), which is indeed a “blind” procedure (with chance of missing clinically significant cancer and over-diagnosing some indolent cancers) and not without risks (notably septicaemia of 1.5-3%). All these down sides are now overcome with a new diagnostic pathway being implemented, incorporating the serum Prostate Health Index (PHI), and multiparametric magnetic resonance imaging (mpMRI), which provides risk-stratification for men before decision to prostate biopsy. The biopsy modality has also evolved from TRUS bx to transperineal (TP) biopsy to reduce infective risks, and the MRI-TRUS fusion biopsy technique has allowed a very precise targeted biopsy on suspicious lesion(s) on the mpMRI. With the service implemented in PMH since October 2020, we have proved its superiority in diagnosing PCa (sensitivity for all PCa: 88.9%; clinically significant PCa: 85.2%). Regarding surgical treatment advancement, the peri-operative and functional outcomes of radical prostatectomy have been greatly improved since the employment of robotic minimally invasive technique more than a decade ago. The surgical technique is further refined with the adoption of various robotic surgical techniques such as maximal nerve-sparing, urethral length-preserving and Reztius-sparing on appropriate settings to achieve early urinary continence and better erectile function preservation after the procedure. Hospital stay after the procedure can be as short as two days and no blood transfusion is required. A dedicated PCa diagnostic and surgical treatment service has provided hope for men battling with this common cancer.
