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

2. 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
7 (4+3)
High
T3/T4
PSA > 20
8-10

3. 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

4. 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)

5. Metastatic Prostate Cancer

17. Docetaxel in hormone sensitive setting

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

21. 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

22. Thank you