Updates in Prostate Cancer Prepared for GP master class – Sept 2016 Dr. Sai Jonnada Consultant Clinical Oncologist Gloucestershire Oncology Centre Cheltenham General Hospital

Hypofractionated Radiotherapy in Localised prostate cancer Conventional dose fractionation: 7.5 weeks of radiation (74Gy/37#) Following CHHiP trial data (June 2016) 4 weeks of radiation (60Gy/20#) is standard for low and intermediate risk Ca P 74/37# 60/20# 5 yr b-FFR 88.3% 85.9% 5 yr OS 91% 93%   T stage PSA Gleason Low risk T1-2 & PSA <10 & <7 Intermediate low T1-2 PSA 10-15 7(3+4) high PSA 15- 20 7 (4+3) High T3/T4 PSA > 20 8-10

Toxicities from prostate radiotherapy Conventional vs 4 weeks 5 yr % 74/37 60/30 Bladder G2 9.1% 11.7% G3 3% 6% Bowel 13.7% 11.9% 2% No significant difference

Follow up post Radiotherapy Hormone treatment for a total of 3 years in high risk group 2 to 3 months post RT – r/v toxicities, PSA Then 6 monthly for 2 years with 3 monthly PSA Then ? f/u with clinician ?CNS ?primary care PSA 6/12 for 5 yrs and annually thereafter for 10 yrs. PSA relapse = nadir + 2 Refer if PSA > 4; ? >10 (PSA dt using minimum of 3 readings over 6 months)

Metastatic Prostate Cancer

Docetaxel in hormone sensitive setting

Treatment Algorithm in 2016 LHRHa + Docetaxel * 6 Enzalutamide Abiraterone Radium 223 Cabazitaxel MAB

Emerging therapies and their impact More patients living longer More monitoring Busier clinics Higher patient expectations Excellent support and information Nurse led clinics and joint care Rationalising follow up Primary care pathways for discharge and re-referral

Thank you