british association of urological surgeons metastatic prostate cancer guidelines
TRANSCRIPT
British Association of Urological Surgeons
Metastatic Prostate Cancer Guidelines
Key Recommendations• Multi-faceted disease • Requiring a multi-disciplinary
approach
BAUS MPC Guidelines 2005.
Key Recommendations• MDT review• Best medical practice where
evidence base is lacking• Two-way communication
BAUS MPC Guidelines 2005.
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.
Key Recommendations• Positive approach to HRPC
therapies• Inform and discuss current clinical
trials • Encourage participation
BAUS MPC Guidelines 2005.
Management Algorithms
Assessment
BAUS MPC Guidelines 2005.
First-line Therapy
BAUS MPC Guidelines 2005.
Second-line Therapy
BAUS MPC Guidelines 2005.
Metastatic Bone Disease
BAUS MPC Guidelines 2005.
Obstructive Uropathy
BAUS MPC Guidelines 2005.
Spinal Cord Compression
BAUS MPC Guidelines 2005.
Palliative Care
BAUS MPC Guidelines 2005.
Evidence Chapters
Overview
Scope • Assessment • First-line therapy• Second-line systemic therapies• Management of metastatic bone disease• Radiotherapy• Obstructive uropathy• Spinal cord compression• Palliative care• Patient perspective
Assessment• Indications• Histological diagnosis in most cases• Determine presence of metastatic
disease• Early recognition and accurate
staging
BAUS MPC Guidelines 2005.
Assessment• Initial appraisal
– Biochemical – Imaging
• Patient status determines assessment mode
BAUS MPC Guidelines 2005.
First-line Therapy• Immediate hormone treatment with
an LHRH analogue or orchidectomy• Choice discussed with the patient
BAUS MPC Guidelines 2005.
First-line Therapy• Flare prevention • Liver toxicity
– Liver function monitoring
BAUS MPC Guidelines 2005.
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.
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.
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.
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.
Systemic Management of Metastatic Bone Disease
• For established SREs– Treatment options also include:
• Radiotherapy, surgery and analgesics
BAUS MPC Guidelines 2005.
Radiotherapy• Early referral • External beam and Radionuclide
therapy
BAUS MPC Guidelines 2005.
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.
Spinal Cord Compression• Once confirmed
– immediate action to prevent irreversible effects
BAUS MPC Guidelines 2005.
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.
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.
Patient Perspective• Good communication skills are key• Diagnosis is usually emotionally
devastating• Men’s involvement in their own care
should be assessed on an ongoing basis
BAUS MPC Guidelines 2005.