PROSTATE CANCER FOUNDATION ADVANCED PROSTATE CANCER
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1 PROSTATE CANCER FOUNDATION ADVANCED PROSTATE CANCER Liam Wilson, Urologist
2 WHAT AM I TALKING ABOUT OVERVIEW OF TONIGHT What is advanced prostate cancer When to start treatment What is initial treatment? New treatments available Specific Problems and other Specialties
3 INTRODUCTION WHAT IM NOT GOING TO TALK ABOUT PSA testing/screening Curative Treatment for Early Prostate Cancer Robotic surgery, Radical prostatectomy Brachytherapy, Radiotherapy
4 IF I TALK TOO MUCH/TOO FAST RESOURCES/READING/QUESTIONS Please ask questions - during/afterwards This presentation - Prostate cancer foundation
5 PROSTATE CANCER Many men have/get prostate cancer Many men never know that they have it Many do not die of it Avoid treating those who don't need treatment Aggressively treat those who do (at the right time)
6 WHAT IS ADVANCED PROSTATE CANCER? Cancer that cannot be cured Cancer outside the prostate Spread to lymph nodes Bones
7 ADVANCED PROSTATE CANCER STAGING OF PROSTATE CANCER
8 PROSTATE CANCER TIMELINE Curable Early Stage (Curable) Recurrent Cancer Surgery Radiotherapy Brachytherapy Years
9 PROSTATE CANCER TIMELINE Curable Advanced Early Stage (Curable) Recurrent Cancer Hormone Sensitive Castrate Resistant End Stage Surgery Radiotherapy Brachytherapy Years
10 DEFINITION-CANCER THAT CANT BE CURED MEN WITH ADVANCED PROSTATE CANCER Who are they? Recurrent Cancer after Radical Treatment Men on watchful waiting Men who have an elevated PSA Men who present with symptoms of advanced disease Can be diagnosed at any point on the timeline,
11 PROSTATE CANCER CAN BE A HUMBLING CONDITION TO TREAT EVERY MAN IS DIFFERENT NOT ALL MEN ARE AVERAGE
12 EXAMPLES OF ADVANCED PROSTATE CANCER CASE 1 - LAST FRIDAY 81 yr old man Rib pain - nothing else PSA =?
13 EVERY MAN IS DIFFERENT CASE 1
14 EXAMPLES OF ADVANCED PROSTATE CANCER CASE 2 70yr old man Admitted to hospital Never been sick Diagnosed with advanced prostate cancer PSA - Normal
15 PSA REDUCES RISK OF ADVANCED PROSTATE CANCER PSA TESTING
16 TREATMENT OF ADVANCED PROSTATE CANCER
17 TIMING OF TREATMENT IS IMPORTANT-DELAY IF POSSIBLE PROSTATE CANCER TREATMENT Preserve quality of life Early treatment does not affect survival Avoid long term side effects of treatment But Need to prevent complications of advanced prostate cancer
18 LONGEVITY-WHICH ONE OF THESE GUYS NEEDS TREATMENT? ITS NOT YOUR DATE OF BIRTH THATS IMPORTANT
19 NZ MEN ARE LIVING LONGER Prostate cancer is a slow growing disease, but Men are living longer
20 INCREASED LONGEVITY A 65 YEAR OLD NZ MAN In 1970; Lived another 12 years -to 77 In 2014 Lives another 19 years - to 84 Prostate cancer becomes a factor
21 PROSTATE CANCER TIMELINE Cured Cured by Salvage treatment Early Stage (Curable) Recurrent Cancer Years
22 NEED INFORMATION TO MAKE AN INFORMED DECISION STAGING - RADIOLOGY Bone scan MRI CT REGULAR PSA IS VITAL
23 PSMA SCAN - IS NEW, LOOKS GREAT, BUT THE JURY IS STILL OUT.. BRIGHT LIGHT = CANCER. NO BRIGHT LIGHT = NO CANCER? PSMA
24 TEXT WHEN TO START TREATMENT - ASSESS RISK Look at Man - health, medications, etc Prostate Features PSA Grade of cancer - Gleason Score 6,7,8-10 Stage of Cancer - does radiology show spread?
25 PROSTATE CANCER TIMELINE Cured Cured by Salvage treatment Early Stage (Curable) Recurrent Cancer Hormone Sensitive Castrate Resistant Androgen Ablation Gleason 6 Gleason 8-10 Years
26 TEXT HIGH RISK Young man High grade Advanced Stage Start Treatment Rapidly rising PSA
27 PROSTATE CANCER IS FUELLED BY TESTOSTERONE TREATMENT - ANDROGEN ABLATION In the old days Now we have - Lucrin/Zoladex/Eligard Injections
28 CUT THE FUEL SUPPLY, SHRINK THE CANCER ANDROGEN ABLATION Safe Effective Durable But Side Effects Hot Flushes Weight Gain Blood sugar Bone density In the old days-started straight away Now- can safely delay starting injections until PSA or even higher
29 ANDROGEN ABLATION - EXTRAS Pills can be helpful in combination with injections Bicalutamide/Flutamide/Cyproterone But additional benefit minimal Additional Side effects usually not worth it
30 THE END
31 THE END WAIT THERE S MORE
32 CASTRATE RESISTANT PROSTATE CANCER EVENTUALLY INJECTIONS WILL STOP WORKING Historically very few (good) options after this Managing symptoms was the only option
33 PROSTATE CANCER TIMELINE -2 NEW TREATMENTS AVAILABLE Abiraterone Docetaxel Chemotherapy Castrate Resistant End Stage Enzalutamide
34 NEW AGENTS = NEW OPTIONS NEW AGENTS Well studied Comprehensive benefits/effects Symptoms,complications,PSA, survival Studies stopped early due to obvious benefit
35 BEST OPTION FOR CASTRATE RESISTANT PROSTATE CANCER ABIRATERONE - ZYTIGA Works by stopping production of testosterone Safe Effective Practical - oral tablet Expensive, but
36 WHEN HORMONES FAIL ABIRATERONE - ZYTIGA - NOW FUNDED IN NZ
37 ABIRATERONE - ZYTIGA NEEDS MONITORING Blood pressure Electrolytes Liver Function tests Fluid retention, weight
38 OTHER OPTIONS FOR CASTRATE RESISTANT PROSTATE CANCER ENZALUTAMIDE Proven to be effective, safe Few side effects - high blood pressure,seizures, fatigue High cost - not funded
39 CHEMOTHERAPY FOR ADVANCED PROSTATE CANCER DOCETAXEL FOR PROSTATE CANCER Historically toxic - significant side effects questionable benefit, particularly in elderly men But,
40 CHEMOTHERAPY - ROLES IN ADVANCED CANCER NEW EVIDENCE Can use it early (When start Injection Treatment) 57vs44m Can use it late After Injections stop working (possibly) After Abiraterone stops working (possibly)
41 PROSTATE CANCER TIMELINE - EARLY CHEMO Cured Cured by Salvage treatment Early Stage (Curable) Recurrent Cancer Hormone Sensitive Castrate Resistant Androgen Ablation +Chemotherapy?
42 PROSTATE CANCER TIMELINE -LATE CHEMO Abiraterone Docetaxel Chemotherapy Castrate Resistant End Stage Enzalutamide
43 PROSTATE CANCER TIMELINE -LATE CHEMO Docetaxel Chemotherapy Abiraterone Favourite Case Castrate Resistant End Stage Enzalutamide
44 DIET/LIFESTYLE/EXERCISE THROUGHOUT THE JOURNEY IS IMPORTANT THIS IS VERY IMPORTANT Support Groups Exercise Groups Prostate Cancer Foundation reading resources Books
45 SPECIFIC MANAGEMENT
46 BONE HEALTH PREVENT OSTEOPOROSIS + COMPLICATIONS OF CANCER Calcium and Vitamin D Bisphosphonates - protect against osteoporosis/fracture/?pain? survival benefit
47 RADIOTHERAPY FOR ADVANCED PROSTATE CANCER VITAL ROLE Spinal Cord Compression Bone Pain Blood in the urine
48 SPECIFIC COMPLICATIONS OF ADVANCED PROSTATE CANCER UROLOGISTS Obstructed kidneys - Unblock - stent/nephrostomy Bone Pain - Pain management, Radiotherapy Blood in urine - laser surgery
49 END STAGE HOSPICE/PALLIATIVE CARE Early referral to hospice found to be beneficial They are experts in managing advanced prostate cancer Advance Care Planning Panel Discussion
50 IN CONCLUSION ITS ALL ABOUT THE MAN Preserve quality of life Minimise side-effects Prevent complications of advanced cancer Encourage healthy lifestyle
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