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

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Second- or third-line hormone therapy • Some patients will respond to second-line hormone therapy (CAB with the addition of an antiandrogen, anti-androgen withdrawal, diethylstilboestrol [DES]). Anti-androgen withdrawal responses are seen in approximately 25% of cases who have been treated with first-line CAB or have had substantial (>1 year response) to second-line CAB. • A common second-line treatment is the addition of an anti-androgen. A retrospective analysis of 122 patients who received the addition of bicalutamide 50 mg to goserelin for PSA and clinical progression showed a >50% decrease in PSA concentration in 30% of patients (responders) and a reduction in PSA concentration in 75% of all patients. The median duration of response from start of bicalutamide 50 mg was 291 days for responders and 193 days for the population as a whole. Those patients with a short duration of response to goserelin monotherapy (
Chemotherapy, Strontium and Bisphosphonates Those patients who do not respond to hormone therapy are considered to have hormone-refractory prostate cancer (HRPC; i.e. unresponsive to all hormone therapies) or castrate-refractory prostate cancer (unresponsive to treatment with LHRH agonists) and are candidates for chemotherapy, novel therapies and/or symptomatic local treatments. Chemotherapy • A prospective study by Tannock in 1996 compared the benefits of mitoxantrone 12 mg/m² every 3 weeks plus prednisone 5 mg twice-daily with prednisone alone in 161 men with symptomatic HRPC. 116 o The primary endpoint was palliative response defined as a 2-point decrease in pain as assessed by a 6-point pain scale. o There was a significant advantage to the chemotherapy combination with a 29% pain response compared to 12% with steroids alone. o The duration of palliation was 43 weeks versus 18 weeks (p
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 and 38: Clinical evidence • Adjuvant andr
Page 39 and 40: Locally Advanced (Non-metastatic) D
Page 41 and 42: Clinical evidence • The EORTC 229
Page 43 and 44: Advanced Prostate Cancer (Metastati
Page 45: Table 6: Effect of immediate versus
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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