PROSTATE CANCER STRATIFIED FOLLOW UP. Hilary Baker Lead CNS for Uro-oncology MSc, BSc, RGN.

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1 PROSTATE CANCER STRATIFIED FOLLOW UP Hilary Baker Lead CNS for Uro-oncology MSc, BSc, RGN.

2 LEARNING OBJECTIVES To refresh your knowledge about prostate cancer. To discuss the purpose and patient benefits of the prostate cancer stratified follow-up. To discuss the agreed management for patients along the stratified follow-up pathway.

3 WHAT IS CANCER Cancer starts when a gene changes and begins to grow and multiply in an uncontrolled manner to create a tumour. A primary tumour is where cancer starts. Secondary tumour or a metastasis is spread of the disease to other parts of the body. There are more than 200 different types of cancer. 1 in 2 people in the UK will get cancer in their lifetime. CRUK 3

4 PROSTATE CANCER The prostate is usually the size and shape of a walnut and grows bigger as men get older. Sits underneath the bladder and is surrounded by the urethra Main function is to make semen to carry sperm and act as a sphincter for continence 1 in 8 men will get prostate cancer in UK. Over 47,000 men are diagnosed with prostate cancer every year (129 men every day) Prostate cancer often grows slowly to start with and may never cause any problems. 83.8% 10 year survival CRUK 4

5 PROSTATE CANCER Signs and symptoms LUTS Elevated PSA (BAUS guidelines) Pain Haematuria/haemospermia Weight loss ED Causes Age Family history Ethnicity Body weight 5

6 DIAGNOSIS 2 Week Wait referral One-stop clinic Multi-parametric MRI Clinical Assessment Biopsy Histology discussed at MDT OPA - diagnosis & treatment plan 6

7 TREATMENTS Treatments all depend on the stage and grade of cancer: Surgery RALP Radiotherapy and hormones Brachytherapy Focal therapy Trials Active surveillance Hormones LHRH & GnRH Chemotherapy - Docetaxel Radium-223 Orchiectomy 7

8 PROSTATE PATHWAY AT UCLH Post surgery Monitored for outcome effects Repatriated Referred to oncology Stratified follow-up Post RT & Hs Monitored for outcome effects Additional treatments Stratified follow up Focal therapy Monitored for outcome effects Repatriated Referred to oncology Stratified follow-up 8

9 STRATIFIED FOLLOW UP 9

10 WHY STRATIFIED FOLLOW UP PATHWAY? Men living with CaP will continue to increase as the population ages. Research from NCSI Recovery Package Interventions shows men favor primary care followup closer to home Taylors personalised care and embeds selfsupportive management within a safe framework Provides coordinated care between primary and secondary care. All cases discussed at Urology MDT. Trained HCP will review results using an agreed protocol Rapid re-entry in to specialist cancer service if required via urgent referral. Provide local cost effective-service 10

11 DEFINITIONS OF STABLE CaP Are as follows: Localised Prostate Cancer Watchful Waiting: considered for self-management. Curative radical prostatectomy: All patients 1 year after treatment and PSA is <0.1 ng/ml above nadir. Radical radiotherapy aim PSA <0.1: All patients 2 years after treatment and PSA is <2 ng/ml above nadir and no complications. Hormonal treatment only for locally advanced disease with or without metastases: All patients 1 year after treatment whose PSA is less than 4 ng/ml. Focal treatment: All patients 1 year after treatment and no complications. Consultant will set individualised ceiling for PSA at this time 11

12 TREATMENT SUMMARY Patient referred back to primary care will have had: Discussion of future care management & patient agreement GP is notified of the decision regarding transfer. Outcomes post treatment addressed. ehna Attended a Health & Wellbeing event Treatment summary outlining; diagnosis, treatment, follow-up requirements, any consequences of treatment, red flags and re-referral criteria 12

13 TRIGGERS FOR CONCERN Raised PSA beyond agreed guidelines Urinary urgency or trouble urinating Pain or stiffness in the bones of the hips, back or chest Loss of sensation or muscle strength in the legs Bladder and bowel incontinence Cough that doesn t go away or shortness of breath Haematuria Rectal bleeding Anaemia Depression and anxiety ***********SEEK PROFESSIONAL HELP************ 13

14 PROFESIONAL HELP Make a thorough assessment of condition then: Discuss with GP make 2WW referral Additionally contact patient s CNS or Contact Urology Registrar on call or Contact patient s consultant directly 14

15 IN CONCLUSION Different modalities for CaP all have different side effects Prostate stratified follow-up care is excellent way of furthering collaborative relationships between primary and secondary care. Clinical governance responsibility for patients on the personalised clinical follow up and supported selfmanagement pathways lie with the Urology MDT and CCG. Currently there is a review of LC and NCL guidelines 15

16 Thank you and any questions? 16

17 REFERENCES Prostate Cancer UK Cancer Research UK London Cancer Prostate Cancer Stratified Follow Up Implementation-Resource-Pack_March-2016_FINAL.pdf NICE Prostate Cancer Guidelines European Association of Urology Guidelines for Prostate Cancer BAUS Raised PSA Guidelines a 17