How do I prepare for treatment? What happens afterwards? Where can I get more information? Cancerbackup The Prostate Cancer Charity

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1 How do I prepare for treatment? Do not drink fluids for at least two hours before treatment so that your bladder will be empty. Tell your doctor or nurse about any medicines you take regularly and any allergies you may have. What happens afterwards? Empty your bladder frequently to help prevent bladder problems For the first six hours after treatment, be sure to sit down when passing urine. This will lessen the chance of urine splashing on the skin and causing irritation or contamination. For the first six hours after treatment, household bleach should be poured around and down the toilet bowl each time you pass urine. This should be left for 15 minutes before flushing. Wash your hands with soap and water every time you finish urinating. Where can I get more information? Cancerbackup Telephone: Website: The Prostate Cancer Charity Telephone: Website: UCL Hospitals cannot accept responsibility for information provided by external organisations.

2 Contact details Richard Weston, Nurse Practitioner Switchboard: ext Mobile: Rachel Leaver, NurseLecturer/Practitioner Switchboard: ext PA for Mr Feneley, Urology Consultant Telephone: Please use the contact numbers above if your symptoms remain severe after two to three days or you have any questions or concerns. If you need a large print, audio or translated copy of this document, please contact us on or , ext We will try our best to meet your needs. First published: March 2008 Last review date: September 2013 Next review date: September 2015 Leaflet code: UCLH/S&C/SURG/UROL/EMDA/1 University College London Hospitals NHS Foundation Trust Created by Medical Illustration RNTNEH Unique Code: 29046

3 University College Hospital at Westmoreland Street Intravesical installations for bladder cancer using electromotive drug administration (EMDA) Urology Directorate

4 Introduction You will have recently had a cystoscopy and/or biopsy of your bladder or removal of a bladder tumour surgically. This is called a TURBT (transurethral resection of a bladder tumour). Your diagnosis has shown that your tumour does not invade deeply into the bladder wall. Unfortunately bladder tumours will grow back in between five to seven out of every ten people (50 to 70 per cent) and most of these can be shaved off the bladder lining by surgery. In some people additional treatment may be recommended to delay the tumour recurrence, depending on the extent and type of cancer. These treatments are given directly into the bladder and are known as intravesical chemotherapy. They work only in the bladder either by killing cancerous cells (chemotherapy) or by boosting the immune system (immunotherapy). The chemotherapy drug used is mitomycin C and the immunotherapy vaccine is called Bacillius Calmette-Guérin (BCG) (see separate leaflets). In some cases your doctor may advise the use of EMDA (electromotive drug administration) with mitomycin C. Mitomycin C given in this way can either be used on its own or in combination with BCG depending on the type of tumour. Using EMDA has been shown to increase the effectiveness of intravesical treatment.

5 What does having mitomycin C treatment using EMDA involve? Intravesical therapy is given through a catheter (small narrow tube) which is inserted through your water pipe (urethra) and into your bladder. Local anaethetic gel is used to minimise discomfort when passing the tube. Each treatment takes half an hour while you are lying on a couch in the outpatient department. When using the EMDA system, the catheter inserted into your bladder contains a wire which is attached to a small machine. Two pads placed on your abdomen are also connencted to the machine.the EMDA machine generates a very safe, low and adjustable electrical current which increases the penetration of mitomycin C into the bladder wall. Some people experience a tingling sensation, or occasionally bladder spasms during treatment. When treatment is finished, the catheter and pads are removed and you will be asked to empty your bladder. What are the possible side effects of mitomycin C using EMDA? Inflammation of the bladder lining; Soreness or pain in bladder; Passing urine more often then normal; Urinary tract infection; Passing blood in the urine; Skin rash (rare) from the drug; Redness and irritation on the skin from the electrode pads.

6 How often will I have treatment? Mitomycin C alone Induction course: Treatments are given once each week for six weeks in total. This will be followed by a check cystoscopy six to eight weeks after finishing the course to check your bladder for tumour recurrence. Maintenance courses (provided there is no cancer on check cystoscopy): Treatments are given once a week for three weeks in total; This is begun six months after the induction course and is repeated every six months for a total of six courses (over three years). A flexible cystoscopy is performed after each three week course to check the bladder for tumour recurrence. Mitomycin C combined with BCG induction course: Treatment is given once each week for nine weeks in total. This comprises of two instillations of BCG followed by one instillation of mitomycin C, repeated three times. A cystoscopy will be carried out six to eight weeks after finishing the course. Maintenance course: (provided there is no cancer on check cystoscopy): Treatment is given once each month for nine months in total; two instillations of mitomycin C at a one month interval are followed by one instillation of BCG. This sequence is repeated three times. A cystoscopy may be performed after every three instillations to check your bladder for tumour reoccurence.