Are you living with Prostate Cancer?

Transcription

1 People in Partnership Meeting (PIP) Are you living with Prostate Cancer? And want to know how to manage it? Mr Alvan Pope, Consultant Urologist at Hillingdon and Mount Vernon Hospitals speaking to patients and members of the public on: Tuesday 4 March 2014, pm Committee Room 5, Civic Centre Uxbridge, UB8 1UW

2 Incidence Prostate cancer is the most commonly diagnosed cancer in men in the UK New diagnoses of cancer annually in males Prostate Lung Large Bowel Bladder Stomach

3 Prostate Cancer Facts >10,000 deaths a year in UK - 34,000 new cases Commonest male cancer death in non-smokers Can only reliably cure localised disease No agreed screening programme A lot of low-risk disease Risk of over-treatment is substantial

4 How do you know?

5 PSA Protein produced by prostate cells Raised by: Cancer Benign enlargement Inflammation Not very good for screening Much better for follow-up

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8 Diagnostic Tests Prostate Specific Antigen Digital Rectal Exam TRUS guided biopsy Role of MRI

9 How do you know? Most patients will need a prostate biopsy to diagnose and grade, followed by an MRI and sometimes a bone scan to stage their disease

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11 Clinical presentation Three stages of prostate cancer Localised disease (65%) Locally advanced disease (25%) Advanced (metastatic spread) (10%)

12 Treatment of Prostate Cancer Early, localised tumours Low risk monitoring (delay treatment) High risk - radiotherapy or surgery Locally advanced tumours Hormones +/- radiotherapy Advanced tumours Hormones, then chemotherapy

13 What s important to Patients Treatment Choices Consequences of Treatment PSA and PSA relapse What s new?

14 Prostate cancer low risk Men with low-risk localised prostate cancer who are considered suitable for radical treatment should first be offered active surveillance. NICE Feb 2008

15 Active surveillance Regular blood tests (PSA) Multi-parametric MRI at entry Regular examinations to feel the prostate Repeat biopsies and/or MRI scans to check nothing changed Avoid the side effects of treatment Plan treatment for when it suits you

16 IMRT intensity modulated Fiducial markers

17 Brachytherapy LDR (seed)

18 Da Vinci Robotic Prostatectomy

19 CyberKnife at Mount Vernon

20 CyberKnife Multiple beams from many directions

21 Consequences of radical treatments Bladder control issues (esp. with surgery) Bowel problems (esp. with radiotherapy) Sexual dysfunction (with both) Long-term effects (eg: second cancers)

22 Prostate Cancer (advanced) Metastatic Disease to bones

23 Dr Charles Huggins ( ) Described the use of oestrogens to control prostate cancer Nobel Prize 1966

24 Hormone treatment Block either the production or action of testosterone required for prostate growth Prostate cancer cells are starved Cancer shrinks into remission Standard care for metastatic cancer Improves efficacy of radiotherapy Commonly given as a 3-monthly implant Decapeptyl, Prostap or Zoladex

25 Side effects of hormones Lethargy, sweats, hot flushes Lack of sexual interest/loss of erections Loss of muscle mass/gain fat Loss of physical capacity Gynaecomastia (mild/mod) Osteoporosis/fractures-long term/elderly Subtle memory impairment long-term

26 Intermittent Hormones

27 Diet and Prostate Cancer

28 Diet and Prostate Cancer Lycopenes (processed tomato products & selenium supplements) help reduce risk of prostate cancer by up to 20% Red meat and fat not conclusive Inconsistent findings for green tea, fruit & vegetables, soya products may protect

29 Can diet reduce the risk of my cancer coming back? Lots of research! No clear or precise recommendations Combination of lifestyle factors Physical Activity HEALTH Weight Diet YOU CONTROL THESE

30 What happens when my PSA starts to rise again? This will happen to many men after radical treatment (eg. surgery or radiotherapy) only to a minority of men on monitoring and to all men treated by hormones alone What is the definition of PSA recurrence? After radiotherapy nadir (lowest value) +2 After surgery 3 progressive increases above 0.2

31 After surgery Salvage Treatments Radiotherapy for PSA relapse (3 rises) Observation & hormones for clinical relapse After radiotherapy Observation & hormones for clinical relapse Cryotherapy and possibly HiFU After hormones Chemotherapy & clinical trials

32 What s new? Low risk Surveillance with MRI Localised - New treatments reducing trauma Surgery Robotics, focal HiFU, Cryotherapy Radiotherapy Cyberknife Advanced - New drugs Chemotherapy (eg: Docetaxel, Carbazitaxel) Hormonal - Abiraterone, Enzalutamide Intermittent Hormone Therapy

33 Priorities for Prostate Cancer Care at Hillingdon Improved information and support Rehabilitation - the first year after treatment Supported self-management

34 Prostate cancer in Hillingdon prevalence around 920 patients Diagnosis and treatment 120 Monitoring 600 Rehabilitation 50 Progressive care 118 End of life care 35 Monitoring could potentially be for 10 years 35% no treatment; 45% after radical treatment; 20% hormones Rehabilitation: year after radical treatment includes recovery from or management of acute effects of treatment Progressive care: metastatic disease, anticipate palliative care needs End of life includes all those in the last year of life

35 Why is information important? Empowers Patients Enables Patients to make informed decisions May reduce anxieties Promotes confidence in the service May reduce unnecessary GP/ Hospital visits

36 Cancer Information Centre Hillingdon Hospital

37 Ongoing work to develop rehabilitation packages Cancer Information Centre Return to work models Exercise models Self-management models Health & Wellbeing/education days 37

38 Supported self-management Realisation that many men have routine hospital follow-up for prolonged time Stable patients don t need to come to hospital GP s were anxious about taking back (survey) Remote monitoring of PSA Holistic needs assessment Clear point of contact (CNS) for concerns Rapid access back into service without seeing GP

39 Risk Stratification and models of care Moving towards self-directed follow-up

40 Concerned? Come and talk afterwards Patient support groups National Macmillan helped fund the new cancer information centre at Hillingdon Hospital Prostate Cancer UK Local Community Cancer Centre, Yiewsley Lynda Jackson Centre (MVH)

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