MDT (multi-disciplinary team) guidance for managing prostate cancer

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• Hanks et al. (RTOG 92-02) investigated the use of long-term androgen suppression following neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced prostate cancer (T2c to T4 with no extra pelvic lymph node involvement and PSA
Locally Advanced (Non-metastatic) Disease: Relapse after Primary Treatment Figure 3: Treatment algorithm for locally advanced (non-metastatic) disease (cont.) Is this patient suitable for clinical trial? Post-radical prostatectomy MANAGEMENT OPTIONS 2 Failed local Rx with rising PSA and/or local recurrence+ Mo Active surveillance/watchful waiting Active surveillance/watchful waiting Hormone therapy alone Hormone therapy alone External beam radiotherapy (EBRT) +/– concomitant +/– adjuvant hormone therapy Post-radical radiotherapy/ brachytherapy Salvage prostatectomy Novel local salvage therapy Ongoing Support Local patient support network Role of nurse/GP/healthcare professional team Rising PSA levels • The PSA concentration at which to define treatment failure after prostatectomy varies in the literature. Definitions of recurrence • The Phoenix definition of relapse after radiotherapy is nadir plus 2. 97 • Patients whose PSA never falls to an undetectable level in the post-operative period are generally considered to have systemic disease. However, some may have local disease amenable to salvage radiotherapy, and so need to be assessed to determine the best management plan. • A PSA concentration that rises rapidly in the post-operative setting may be indicative of metastatic disease, while a PSA that remains undetectable over a long period then gradually rises may be more likely to indicate local recurrence. 39
Page 1 and 2: MDT (Multi-disciplinary Team) Guida
Page 3 and 4: Integrated Care and the Multi-disci
Page 5 and 6: Figure 2: Treatment algorithm for l
Page 7 and 8: Figure 3: Treatment algorithm for l
Page 9 and 10: Integrated care and clinical govern
Page 11 and 12: Approach to the Patient Key points
Page 13 and 14: Assessment and Diagnosis Screening
Page 15 and 16: Prostate size - a benignly enlarged
Page 17 and 18: Key Questions for the MDT • TNM s
Page 19 and 20: Active surveillance Overview • Ac
Page 21 and 22: Watchful waiting Overview • Watch
Page 23 and 24: o Faced with these figures, some pa
Page 25 and 26: • Dearnaley and colleagues have r
Page 27 and 28: Low dose rate (LDR) brachytherapy O
Page 29 and 30: Novel therapies Cryotherapy/High-in
Page 31 and 32: The term locally advanced prostate
Page 33 and 34: Radiotherapy plus hormone therapy
Page 35 and 36: • Evidence of the benefits of dos
Page 37: Clinical evidence • Adjuvant andr
Page 41 and 42: Clinical evidence • The EORTC 229
Page 43 and 44: Advanced Prostate Cancer (Metastati
Page 45 and 46: Table 6: Effect of immediate versus
Page 47 and 48: Chemotherapy, Strontium and Bisphos
Page 49 and 50: Bisphosphonates • The benefits of
Page 51 and 52: Ongoing Support The MDT team should
Page 53 and 54: 21. Tchetgen MB, Oesterling JE. The
Page 55 and 56: 57. Amer AM, Mott J, Mackay RI, et
Page 57 and 58: 92. Bolla M, Collette L, Van Tienho
Page 59: 126. Marx RE, Sawatari Y, Fortin M,

MDT (multi-disciplinary team) guidance for managing prostate cancer

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