23/09/2010 urology network meeting prostate and bladder cancer rlu/bgh joint clinic presented by: dr...
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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