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.