British Association of Urological Surgeons

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British Association of Urological Surgeons

• Metastatic Prostate Cancer Guidelines

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Key Recommendations

• Multi-faceted disease
• Requiring a multi-disciplinary approach

BAUS MPC Guidelines 2005.
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Key Recommendations

• MDT review
• Best medical practice where evidence base is
  lacking
• Two-way communication

BAUS MPC Guidelines 2005.
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Key Recommendations

• Fully inform patients
• Sensitivity and support
• PSA is a critical measure in most cases
• Disease progression
• Response to therapy

BAUS MPC Guidelines 2005.
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Key Recommendations

• Positive approach to HRPC therapies
• Inform and discuss current clinical trials
• Encourage participation

BAUS MPC Guidelines 2005.
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Management Algorithms
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Assessment
BAUS MPC Guidelines 2005.
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First-line Therapy
BAUS MPC Guidelines 2005.
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Second-line Therapy
BAUS MPC Guidelines 2005.
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Metastatic Bone Disease
BAUS MPC Guidelines 2005.
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Obstructive Uropathy
BAUS MPC Guidelines 2005.
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Spinal Cord Compression
BAUS MPC Guidelines 2005.
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Palliative Care
BAUS MPC Guidelines 2005.
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Evidence Chapters

• Overview

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Scope

• Assessment
• First-line therapy
• Second-line systemic therapies
• Management of metastatic bone disease
• Radiotherapy
• Obstructive uropathy
• Spinal cord compression
• Palliative care
• Patient perspective

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Assessment

• Indications
• Histological diagnosis in most cases
• Determine presence of metastatic disease
• Early recognition and accurate staging

BAUS MPC Guidelines 2005.
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Assessment

• Initial appraisal
• Biochemical
• Imaging
• Patient status determines assessment mode

BAUS MPC Guidelines 2005.
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First-line Therapy

• Immediate hormone treatment with an LHRH analogue
  or orchidectomy
• Choice discussed with the patient

BAUS MPC Guidelines 2005.
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First-line Therapy

• Flare prevention
• Liver toxicity
• Liver function monitoring

BAUS MPC Guidelines 2005.
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First-line Therapy

• Oestrogens are non-standard first-line therapies
• CAB not recommended for routine use
• Intermittent hormone treatment is experimental

BAUS MPC Guidelines 2005.
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Second-line Systemic Therapies

• Chemotherapy - major part of management
• Alternative therapies not recommended
• Use should be discussed openly
• Clinical trials - discuss and consider

BAUS MPC Guidelines 2005.
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Systemic Management of Metastatic Bone Disease

• Metastatic Bone Disease (MBD) is common in
  prostate patients
• Skeletal Related Events
• Bone Pain
• Fracture
• Spinal Cord Compression

BAUS MPC Guidelines 2005.
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Systemic Management of Metastatic Bone Disease

• In HRPC, evidence suggests a role for early
  bisphosphonate therapy to reduce risk and/or
  delay progression to SRE
• Zoledronic acid is the only bisphosphonate proven
  to reduce this risk

BAUS MPC Guidelines 2005.
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Systemic Management of Metastatic Bone Disease

• For established SREs
• Treatment options also include
• Radiotherapy, surgery and analgesics

BAUS MPC Guidelines 2005.
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Radiotherapy

• Early referral
• External beam and Radionuclide therapy

BAUS MPC Guidelines 2005.
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Spinal Cord Compression

• Consider in any prostate cancer patient
  presenting with back pain
• Patient should be asked about
• numbness
• weakness and
• bladder/bowel dysfunction

BAUS MPC Guidelines 2005.
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Spinal Cord Compression

• Once confirmed
• immediate action to prevent irreversible effects

BAUS MPC Guidelines 2005.
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Obstructive Uropathy

• Regular monitoring of serum creatinine
• Urinary tract US or CT to confirm diagnosis
• Urgency of intervention determined by degree of
  renal failure and hyperkalaemia

BAUS MPC Guidelines 2005.
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Palliative Care

• Identify and refer early on
• Needs of the patient and their carers should be
  addressed
• Pain must be assessed and treated
• Access to specialist services

BAUS MPC Guidelines 2005.
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Patient Perspective

• Good communication skills are key
• Diagnosis is usually emotionally devastating
• Mens involvement in their own care should be
  assessed on an ongoing basis

BAUS MPC Guidelines 2005.