23/09/2010

Urology Network Meeting

Prostate and Bladder Cancer RLU/BGH Joint Clinic

Presented by: Dr Z Malik

• Clinic began 9th January 2009

•187 patients seen by Dr Malik, Dr Eswar & Dr Robson (as at 04/09/10)

•159 patients with Prostate cancer, 28 patients with Bladder cancer

Joint Urology Clinic

Prostate Cancer ~ Staging n=159TNM Staging at Presentation to CCO No. Patients % Patients

T1 – 1c 30 18.9

T2 – 2c 84 52.8

T3 – 3b 26 16.4

T4 1 0.6

T? M0 2 1.3

M1 10 6.3

Not Recorded 1 0.6

Recurrence 3 1.9

Progressive 2 1.3

Total 159 100

Prostate Cancer ~ Treatment for Tumour n=154

Treatment (including planned) No. Patients % Patients

Surgery 16 10.4

Surgery, hormones, radical radiotherapy 3 1.9

Surgery, radical radiotherapy 1 0.6

Surgery, palliative radiotherapy 1 0.6

Hormones, radical radiotherapy 43 27.9

Radical radiotherapy 8 5.1

Brachytherapy 12 7.8

Chemotherapy 1 0.6

Stampede Trial 6 3.9

Hormones 24 15.6

Surveillance 23 14.9

Bisphosphonate 1 0.6

Patient deciding 15 9.7

Total 154 100

Relevant PSA Before Treatment

• Recorded for 133 out of 154 patients with new tumour status

Minimum: 0.03

Maximum: 121

Median: 8.2

Prostate Cancer ~ Treatment for Recurrence & Progressive Tumours n=5

Recurrence No. Patients

Observation 1

Radical radiotherapy 1

Hormones, prophylactic radiotherapy

1

Total 3

Progressive No. Patients

Trial (another hospital) 1

Palliative radiotherapy 1

Total 2

Bladder Cancer ~ StagingTNM Staging at

Presentation to CCONo. Patients % Patients

T2 – 2a 7 25

T3 – 3b 10 35.7

T4 3 10.7

T? M0 1 3.6

M1 5 17.9

Not Recorded 1 3.6

Progressive 1 3.6

Total 28 100

Bladder Cancer ~ Treatment

Treatment (including planned) No. Patients % Patients

Surgery 5 17.9

Surgery, radical radiotherapy 1 3.6

Surgery, chemotherapy, radical radiotherapy 1 3.6

Surgery, palliative radiotherapy 4 14.3

Neoadjuvant chemotherapy 9 32.1

Neoadjuvant chemotherapy, concurrent chemoradiation 1 3.6

Neoadjuvant chemotherapy, palliative radiotherapy 1 3.6

Palliative chemotherapy 3 10.7

Radical radiotherapy 1 3.6

None (1 pt other tumour) 2 7.1

Total 28 100

7 patients underwent TURBT between December 2008 and January 2010

23/09/2010

Urology Network Meeting

Prostate and Bladder Cancers ~ New Referrals to CCO

Presented by: Dr Z Malik

Referred between 1st August 2009 and 31st July 2010 with new tumour:

• 712 prostate

• 134 bladder

Prostate andBladder Cancer

Prostate Cancer

Referring Hospitals ~ 1st August 2009 to 31st July 2010

North

Royal Liverpool & Broadgreen 114 33.7

Walton 3 0.9

Aintree 58 17.2

Southport & Ormskirk 56 17.6

St Helens & Knowsley 61 18.0

Nobles 46 13.6

Total 338 100

South

Countess of Chester 39 10.9

North Cheshire 99 27.6

Wirral 221 61.6

Total 359 100

Prognostic Groups (UICC 2009)Group Features

1 T1/T2a N0 M0 PSA<10 Gleason 6

2A T1/T2a/b N0 M0 PSA<20 Gleason 6/7

2B T2c N0 M0 any PSA any Gleason or

T1/2 N0 M0 PSA20+ and/orGleason8+

3 T3a/b N0 M0 any PSA, any Gleason

4 T4 N0 M0 any PSA any Gleason or

Tx N1 M0 or Tx Nx M1

Prognostic Groups

• Group1; Good Prognosis• Group2a; Intermediate Prognosis• Group2b; mainly poor prognosis but

includes T2c Gleason 6/low PSA• Group3; T3s, poor prognosis• Group4; T4 and metastatic

South ~ Prognostic Group vs Treatment at CCO (excludes patients who had a prostatectomy)

1 2A 2B 3 4 Total

Hormones 0 1 1 17 13 32

Hormones+XRT 4 57 39 64 5 169

XRT alone 2 3 1 0 0 6

Brachy* 5 19 0 0 0 24

Monitoring 5 27 13 16 17 78

Palliative XRT 0 1 0 5 23 29

1 2A 2B 3 4 NR Total

Hormones 2 29 9 1 41

Hormones+XRT

3 43 25 75 5 3 154

XRT alone 5 13 7 4 29

Brachy*

Monitoring 19 27 14 12 22 6 100

Palliative XRT 1 1 12 14

North ~ Prognostic Group vs Treatment at CCO

(excludes patients who had a prostatectomy)

Patients who had a Prostatectomy

Prognostic Grouping

South Group I Group IIA Group IIB Group III Group IV Other

Hormones, radical xrt 1

Radical xrt 1 1 2

None 3 1 2

Prognostic Grouping North Group I Group IIA Group IIB Group III Group IV Other

Hormones, radical xrt

Radical xrt 1 1 1

None 1

North + South ~ Relevant PSA Before Treatment

• Recorded 666 out of 712 patients

Minimum: 0.13

Maximum: 7960

Median: 11.6