LA Urological ancers linical Guidelines

1 LCA Urological Cancers Clinical Guidelines October 2014 (updated December 2014). Contents Introduction .. 5. Executive 6. 1 Overview and background .. 8. 8. Early diagnosis .. 8. Multidisciplinary team working in the LCA .. 9. Coordination between teams ..12. Key worker ..12. Communication and support ..12. Survivorship ..13. Specialist palliative care ..16. Data requirements and metrics ..16. Treatment of children, teenagers and young adults (TYA) ..18. 2 Penile Introduction ..19. Clinical Guidelines on the diagnosis of penile cancer ..21. Guidelines on treatment of penile cancer ..22. Management of the regional nodes ..23. Pathology protocols for penile and urethral cancer (supra-network)..25. Follow-up Specialist palliative care ..30. Annex : Members of the Supra-network Penile Cancer Team ..31. Annex : Penile chemotherapy regimens and indications.

2 32. Annex : Penile radiotherapy cancer guidance (The Royal Marsden NHS Foundation Trust) ..34. Annex : Request for histopathological material from other hospitals (St George's Healthcare NHS. Trust) ..35. Annex : LCA penile imaging Guidelines ..36. 3 Testicular Cancer ..37. Introduction ..37. 2. CONTENTS. Diagnosis ..38. Primary surgical management ..38. Pathological assessment ..39. Referral to the supra-network Organ-sparing surgery ..41. Testicular stromal Retroperitoneal node dissection ..42. Chemotherapy ..42. Follow-up ..42. Research and Annex : Testicular Guidelines for systemic therapy ..43. Annex : South East London testicular cancer follow-up management protocols ..46. Annex : North West London testicular cancer follow-up management Annex : South West London testicular cancer follow-up management 4 Bladder Cancer.

3 63. Introduction ..63. Management of non-muscle invasive bladder Management of non-invasive disease (pTa, pT1a/b CIS) ..65. Upper tract monitoring ..68. Muscle-invasive bladder cancer ..68. Bladder cancers other than urothelial carcinoma ..73. Upper tract tumours ..74. Advanced urothelial cancer ..74. Pathology ..76. Research and Annex : Bladder chemotherapy regimens ..79. 5 Renal Cancer ..82. Introduction ..82. Pathology ..82. Systemic therapy ..84. Research and 6 Prostate Cancer ..87. 3. LCA Urological CANCERS CLINICAL Guidelines . Introduction ..87. The LCA Urological cancer network ..88. Referral Guidelines ..88. Investigation and management of prostate cancer ..89. Pathological assessment ..94. Staging ..96. Management of prostate cancer ..97. Spinal cord compression ..112. Specialist palliative care ..112. Annex : Prostate systemic therapy regimens: indications and doses.

4 114. Annex : Radiotherapy treatment protocol for prostate cancer ..116. Appendix 1: Urgent Suspected Urological Cancers Referral Forms ..122. Appendix 2: LCA Key Worker Policy ..125. Appendix 3: LCA Specialist Palliative Care Referral Appendix 4: LCA Holistic Needs Assessment Tool ..130. Appendix 5: Treatment of Children ..131. Appendix 6: Treatment of Teenagers and Young Appendix 7: List of contributors ..134. 4. INTRODUCTION. Introduction These Guidelines cover the five tumour sites that make up the vast majority of Urological cancers, namely the prostate, bladder, kidneys, testicles and penis. The guidance represents the clinical consensus of the members of the London Cancer Alliance (LCA) Urology Pathway Group in their capacity as expert clinical representatives from across LCA providers. It is not intended to be the definitive position on the treatment of patients with a particular cancer type but a best practice guide; this is particularly relevant in prostate cancer and renal cancer where a range of treatment options may be appropriate and the final decision is at the discretion of the treating clinician in consultation with the patient.

5 In producing these Guidelines , the Pathway Group has drawn on multiple sources of best practice guidance, which includes National Institute for Health and Care Excellence (NICE) guidance, Improving Outcomes Guidance (IOG), the National Cancer Action Team (NCAT) Manual for Cancer Services Urological Measures and the Guidelines of the European Association of Urology (EAU). The latter are regarded as a gold standard for all European departments and often further afield. They are extensively referenced, including levels of evidence to support key recommendations, and updated annually. All the LCA Guidelines are compliant with the EAU Guidelines , and in the case of kidney and bladder we have not attempted to rewrite the Guidelines but have merely drawn attention to local policy and areas where practice may differ from the Guidelines , and the rationale for any such differences.

6 The LCA Guidelines are designed to be used by all healthcare professionals in Trusts within the LCA who are involved in the care of the Urological cancer patient. They have been developed to take into account the wide range of clinical experience of the user and the different clinical settings in which they work. The Guidelines are intended to assist in the initial assessment, investigation and management of patients. Adoption of the LCA Guidelines will allow widespread implementation of up-to-date and evidence-based management of Urological cancer patients, and will assist in the provision of a consistently high standard of care across the LCA. I hope these Guidelines are helpful. Many specialists both within the LCA Urology Pathway Group and the stakeholder group have contributed. There has been extensive opportunity for individuals to review the Guidelines , and their comments have been taken into consideration.

7 I would like to thank them for their contributions. Justin Vale Chair of the LCA Urology Pathway Group 5. LCA Urological CANCERS CLINICAL Guidelines . Executive summary These Guidelines cover the five tumour sites that make up the vast majority of Urological cancers, namely the prostate, bladder, kidneys, testicles and penis. The guidance represents the clinical consensus of the members of the LCA Urology Pathway Group in their capacity as expert clinical representatives from across LCA providers. Chapter 1 provides some guidance which is applicable to all tumour types and covers the following areas: prevention, early diagnosis, multidisciplinary team (MDT) working, survivorship, palliative care, communication and protocols for the treatment of children, teenagers and young adults with Urological cancer. The following sets out where each of the Guidelines for the five Urological cancer tumour types can be found within this document.

8 Supporting documentation and relevant annexes for each guideline can be found at the end of each chapter. Chapters 2 and 3 provide the penile and testicular cancer Guidelines respectively. They describe the recommended referral pathway from general practice, through local cancer teams and onwards to the appropriate supra-network centre. They summarise the treatment options available at the centre and also the pathway back to specialist centres for chemo/radiotherapy for selected patient groups and, in the case of testicular cancer, the pathway back to specialist centres for salvage surgery. The principal references for the penile and testicular Guidelines are the European Association of Urology (EAU) Guidelines (Penile, 2009;. Testicular, 2011) with modifications approved by the Urology Pathway Group to reflect the centralisation of specialist services and UK practice.

9 Chapter 4 provides the bladder Guidelines . These Guidelines are designed as a reference for local urology departments and specialist cancer centres, and to inform purchasers of what to expect from their local service. Suggestions for local audits to continually improve the service and knowledge outcomes are included. The Guidelines are closely based on the EAU guideline (2013). They also amalgamate the South and West London cancer network Guidelines from the previous cancer networks. Areas of difference from the EAU Guidelines are highlighted. Chapter 5 provides the renal cancer Guidelines . These Guidelines are comprised of three complementary documents. The first is an operational policy which sets out the new arrangements for specialist renal MDTs in the LCA a reduction in the number of specialist MDTs to improve access to new treatments and trials.

10 The two MDTs are now fully operational. The operational policy has been developed by the Urology Pathway Group which can be found on the LCA website. All new patients will be discussed at the specialist MDT which goes beyond the requirements of the 2002 Improving Outcomes Guidance (IOG). The second LCA renal cancer guidance document is the LCA dataset for pathology reporting of renal cancer to include the requirements of the Royal College of Pathologists, while the third document is a summary of local arrangements for chemotherapy taking into account national guidance and the availability of agents via the Cancer Drugs Fund. As far as the surgical management of renal cancer is concerned, all the individuals involved in the care of renal cancer patients are signed up to the EAU Guidelines on renal cancer available at 6.