1. 23/09/2010 Urology Network Meeting Prostate and Bladder Cancer RLU/BGH Joint Clinic Presented by: Dr Z Malik

2. Clinic began 9 th 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

3. Prostate Cancer ~ Staging n=159 TNM Staging at Presentation to CCONo. Patients% Patients T1 – 1c3018.9 T2 – 2c8452.8 T3 – 3b2616.4 T410.6 T? M021.3 M1106.3 Not Recorded10.6 Recurrence31.9 Progressive21.3 Total159100

4. Prostate Cancer ~ Treatment for Tumour n=154 Treatment (including planned)No. Patients% Patients Surgery1610.4 Surgery, hormones, radical radiotherapy31.9 Surgery, radical radiotherapy10.6 Surgery, palliative radiotherapy10.6 Hormones, radical radiotherapy4327.9 Radical radiotherapy85.1 Brachytherapy127.8 Chemotherapy10.6 Stampede Trial63.9 Hormones2415.6 Surveillance2314.9 Bisphosphonate10.6 Patient deciding159.7 Total154100

5. Relevant PSA Before Treatment Recorded for 133 out of 154 patients with new tumour status Minimum: 0.03 Maximum: 121 Median: 8.2

6. Prostate Cancer ~ Treatment for Recurrence & Progressive Tumours n=5 RecurrenceNo. Patients Observation1 Radical radiotherapy1 Hormones, prophylactic radiotherapy 1 Total3 ProgressiveNo. Patients Trial (another hospital)1 Palliative radiotherapy1 Total2

7. Bladder Cancer ~ Staging TNM Staging at Presentation to CCO No. Patients% Patients T2 – 2a725 T3 – 3b1035.7 T4310.7 T? M013.6 M1517.9 Not Recorded13.6 Progressive13.6 Total28100

8. Bladder Cancer ~ Treatment Treatment (including planned)No. Patients% Patients Surgery517.9 Surgery, radical radiotherapy13.6 Surgery, chemotherapy, radical radiotherapy13.6 Surgery, palliative radiotherapy414.3 Neoadjuvant chemotherapy932.1 Neoadjuvant chemotherapy, concurrent chemoradiation13.6 Neoadjuvant chemotherapy, palliative radiotherapy13.6 Palliative chemotherapy310.7 Radical radiotherapy13.6 None (1 pt other tumour)27.1 Total28100 7 patients underwent TURBT between December 2008 and January 2010

9. 23/09/2010 Urology Network Meeting Prostate and Bladder Cancers ~ New Referrals to CCO Presented by: Dr Z Malik

10. Referred between 1 st August 2009 and 31 st July 2010 with new tumour: 712 prostate 134 bladder Prostate and Bladder Cancer

11. Prostate Cancer

12. Referring Hospitals ~ 1 st August 2009 to 31 st July 2010 North Royal Liverpool & Broadgreen11433.7 Walton30.9 Aintree5817.2 Southport & Ormskirk5617.6 St Helens & Knowsley6118.0 Nobles4613.6 Total338100 South Countess of Chester3910.9 North Cheshire9927.6 Wirral22161.6 Total359100

13. Prognostic Groups (UICC 2009) GroupFeatures 1T1/T2a N0 M0 PSA<10 Gleason 6 2AT1/T2a/b N0 M0 PSA<20 Gleason 6/7 2BT2c N0 M0 any PSA any Gleason or T1/2 N0 M0 PSA20+ and/orGleason8+ 3T3a/b N0 M0 any PSA, any Gleason 4T4 N0 M0 any PSA any Gleason or Tx N1 M0 or Tx Nx M1

14. 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

15. South ~ Prognostic Group vs Treatment at CCO (excludes patients who had a prostatectomy) 12A2B34Total Hormones011171332 Hormones+XRT45739645169 XRT alone231006 Brachy*51900024 Monitoring52713161778 Palliative XRT01052329

16. 12A2B34NRTotal Hormones2299141 Hormones+X RT 343257553154 XRT alone5137429 Brachy* Monitoring19271412226100 Palliative XRT111214 North ~ Prognostic Group vs Treatment at CCO (excludes patients who had a prostatectomy)

17. Patients who had a Prostatectomy Prognostic Grouping SouthGroup IGroup IIAGroup IIBGroup IIIGroup IV Other Hormones, radical xrt1 Radical xrt112 None312 Prognostic Grouping NorthGroup IGroup IIAGroup IIBGroup IIIGroup IV Other Hormones, radical xrt Radical xrt111 None1

18. North + South ~ Relevant PSA Before Treatment Recorded 666 out of 712 patients Minimum: 0.13 Maximum: 7960 Median: 11.6