2nd Health Education Day Cancer 18th June 2011 Slainte an Chlar 2nd Health Education Day Cancer 18th June 2011

IRISH RADIOTHERAPY CENTRES 2004: Five centres Dublin(3) Belfast(1) Cork (1) 2008: Eleven Centres Dublin (5) Galway (2) Belfast (1) Limerick (1) Waterford (1) 2

Galway University Radiation Opened 15th March 2005 to end 2010 Patients assessed: 7117 Filmless and paperless work environment Innovative in use of technology Excellence in teaching SpR, therapy, physics, nursing: training accredited nationally Research/protocol based patient care

Number of new patients (First OPD) in Radiotherapy 2005 – 2009 Number of new treatment starts in Radiotherapy Department 2005-2009

Breast Patients New Starts-EBRT 2005-2009 Prostate Patients New Starts- EBRT 2005-2009

Brachytherapy Seeds Prostate Patients Endometrium & Cervix On target for 79 patients in 2010 On target for 56 patients in 2010

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Conventional Radiotherapy Radiation doses Photon IMRT Photon Proton Conventional Radiotherapy IMRT = Intensity Modulated RadioTherapy 8

Radiation doses 100 60 10 PROTONS X-RAYS Low or No Energy Released Here High Energy Released Here PROTONS 100 60 10 X-RAYS 9

BALLOON CATHETER ‘MAMMOSITE’ MammoSite device Inflatable Balloon Placed In Lumpectomy Cavity At Surgery HDR brachytherapy 34 Gy in 10 fractions 40,000 cases treated 10

DELIVERY OF RADIATION (5 DAYS) 11

BRACHYTHERAPY 12

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FLUORO – ALL SOURCES PLACED Perform the cystogram … to provide a learning process / comfort 14

Prostate cancer Very common Over 2500 men diagnosed per year in Ireland Over 500 deaths Very treatable!

Trends in prostate cancer mortality 1995-2005

Trends in prostate cancer incidence 1994-2005

Prostate Cancer Ireland vs USA USA: 186,320 per year, and 28,660 deaths (2008) Crude death rate 15.3 % ---------------------------------------------------------- Ireland: 1687 per year, and 520 deaths (1994-2005 average) Crude death rate 30.8% UK An Irish man diagnosed with CaP is at least twice as likely to die of his disease than his US counterpart… Source: SEER database; Cancer in Ireland 1994-2000

Prostate Cancer in the UK New British Analysis The new British data come from an analysis of 50,066 men diagnosed with prostate cancer between 1997 and 2006 from the Thames Cancer Registry, which covers a population of 12 million in South East England. Subjects were followed to the end of 2007. During that period of time, there was little uptake of PSA testing in asymptomatic men in the United Kingdom. The situation is different in the United States, where there is a high uptake of PSA testing, and has been for some time, lead researcher Simon Chowdhury, MD, consultant oncologist at Guy's and St Thomas' NHS Foundation Trust in London, United Kingdom, told Medscape Medical News. Dr. Chowdhury presented the findings at the 2011 Meeting of United Kingdom Association of Cancer Registries and National Cancer Intelligence Network (NCIN), held in London. The analysis found that prostate cancer was the cause of death in 49.7% of the men who had been diagnosed with the disease. The other causes of death were cardiovascular disease (17.8%), other cancers (11.8%), pneumonia (7.5%), and other causes (13.25%).

Prostate cancer incidence 2004-2006 by County

What is your prostate and why should you care? Secondary sex organ (see breasts) Produces seminal fluid Commonest male cancer DRE PSA Evaluation Treatment options

Are we looking for prostate cancer?

Annual number of PSA tests

Percentage of men over 50 having a first PSA test

New and suspected prostate cancer cases seen by hospital Ireland 2006 - 2007 Hospital New prostate cancer cases diagnosed in 2006 New prostate cancer cases diagnosed in 2007 Suspected prostate cancer cases seen in 2006 Suspected prostate cancer cases seen in 2007 Benign: malignant ratio 2007 AMNCH 327 273 797 676 2.5:1 Beaumont 151 179 530 453 CUH 186 210 340 382 2:1 Limerick Regional 112 104 301 311 3:1 Mater 220 240 1000 (estimate) 1200(est) 5:1 (est) MUH 145 171 304 274 1.6:1 St James’ 101 105 Unknown 280 2.6:1 St Vincent’s 180 335 UCHG 272 365 820 1100 Waterford 107 150 1.4:1

Testing for the spread of the cancer An MRI Machine…and image A Bone scan Machine… and image                                                                                  

Treatments for Prostate Cancer Radical surgery Open prostatectomy (retropubic/transperineal) Laparascopic prostatectomy Robotic laparascopic prostatectomy (“DaVinci”) External Beam Radiation Therapy (EBRT) Conventional 3D conformal IMRT Image guided hypofractionated IMRT Brachytherapy Permanent low dose Temporary HDR Combinations Hormone treatment Novel drugs for hormone resistant prostate Cancer badly needed

Take home message Prostate cancer very common and very treatable Early warning devises are available Report any symptoms Check with your doctor Multiple treatment options…one size definitely does not fit all! Be aware….

Update since last year Clare Cancer Support – Congratulations! Prostate Rapid Access Clinics GUH 1000 men, 50% cancers Prostate Cancer Institute - operational National Cancer Control Program National Cancer Screening Service Standard setting committees Diagnostic/treatment recommendations

PCI Inauguration 1st April 2011