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Genitourinary Cancer

Guidelines in this section:

Refer a patient

The GU Tumour Group is a multi-disciplinary committee charged with the development of management policy for genitourinary tumour sites. This policy results from the deliberations of site subcommittees that include literature review, and experience with prior policy with outcome analysis where possible. It is recognized that management of the individual patient must take into consideration such additional factors as ability to withstand the proposed therapy.

The implementation of policy must necessarily be left to the discretion of the individual consulting physician. In some instances, the low frequency of cases or recommended procedures will require referral to a sub-specialist or to a major cancer centre for an opinion. It is the declared policy of the group to encourage referral of cases where the best course of action is unclear; every effort will be made to inform the referring and family physicians of any recommendations and as far as practicable to refer the patient back to their community for procedures and follow up.
 

A multi-disciplinary case conference is held weekly at BC Cancer's Vancouver Centre, with the participation of an attending urologist from the tumour group, on a two month rotation. Patients are referred to the conference chairman by their attending oncologist. Referring urologists will be notified when their patient is to be presented and then participation is welcomed. The conference is particularly useful for review of physical findings, pathology, and radiology, and where an interdisciplinary opinion is needed.


Case conferences are also held at the Vancouver Island Centre, the Fraser Valley Centre, and the Centre for the Southern Interior.

 

Published 25 August 2009

Clinical trials: Open

Systemic Program

Prostate

HRPC Pre-Chemo

  1. Phase II: GW786084 +/- Casodex for HRPC (open now - VC)
  2. Phase II: ZD6474 vs. Casodex in HRPC (open now - VC, CSI)

HRPC First-Line Chemo/ Docetaxel-Based

  1. Phase III: Docetaxel +/- VEGF Trap (open - VC)
  2. Phase I: Docetaxel + LBH first line or after prior docetaxel (open - VC)

HRPC After First-Line Chemo

  1. Phase II: Panobinostat (HDAC inhibitor) after 2 lines of previous chemotherapy (open - VC, CSI)

Neoadjuvant

  1. Phase II: CP-751,871 (IGF1-R monoclonal antibody) neoadjuvant prior to prostatectomy (open)
  2. Phase III: NCIC.CTG.PR12 – Neoadjuvant hormone therapy +/- docetaxel prior to radiation (open)

Kidney

Adjuvant

  1. Phase III Adjuvant Sunitinib/Sorefenib (open at VGH)

First Line

  1. Phase III: Pazopanib vs. Sunitinib (open)

Second Line

  1. CCI-779 vs. Sorafenib after Sunitinib (open) + Biomarker study (investigator initiated)

Testes

Phase II of sunitinib in chemo-resistant disease (open)


Bladder

Phase II of sunitinib for urothelial cancer (open - VC)


Radiation Oncology
  1. ASCEND RT- primary therapy for intermediate, and lower tier high risk prostate cancer. All patients receive a year of androgen ablation, with eight months neoadjuvant, pelvic irradiation, randomized to dose escalation with external beam vs brachy boost. Generally meeting accrual targets
  2. Prias - active surveillance low risk prostate cancer. International registration protocol for low risk prostate cancer patients managed with curative intent (i.e. not passive watchful waiting). Involves specific monitoring protocol including repeat biopsy, dre and psa follow-up
  3. IMVRT - primary therapy for low risk prostate cancer. Randomized trial monotherapy with brachytherapy vs hypofractionated dose escalated prostate irradiation with IMRT
  4. DART - NCIC PR 12- primary therapy for high risk prostate cancer. Randomized trial. All patients receive neoadjuvant ablation then prostate irradiation followed by adjuvant androgen ablation (total AA three years). Patients randomized to receive taxotere chemo vs no chemo during neoadjuvant therapy
  5. Radicals - NCIC pr 13. MRC sponsored trial. Adjuvant and salvage therapy for prostatectomy. Factorial design with multiple randomizations. Patients at definite risk of relapse receive adjuvant RT and randomized to no androgen ablation, short AA, or long AA. Patients at an uncertain risk are randomized to same second randomization as definitive risk, vs observation. Patients at a low risk of relapse have their RT deferred and are followed and then at relapse receive salvage RT and are randomized to no androgen ablation, short AA, or long AA
  6. RTOG 0526: Salvage Brachytherapy for locally recurrent prostate cancer after external beam irradiation, Phase 2 study. Eligibility: Initial Stages T1-T2c, Gleason scores 2-6, and PSA ≤ 20 ng/mL, or Stages T1-T2c, Gleason score 7, and PSA ≤ 10. No mets. IPSS < 15. PSA value < 10 ng/mL. No prior EBRT to the prostate that exceeded 72 Gy (2 Gy fractions) or equivalent
  7. RTOG 0415: A phase III randomized study of hypofractionated 3D-CRT/IMRT versus conventionally fractionated 3D-CRT/IMRT in patients with favourable-risk prostate cancer. Study size: 1067. Eligibility: Histologically confirmed prostate adenocarcinoma within 180 days of randomization. Clinical stage T1-2c (AJCC 6th edition). PSA < 10 ng/mL within 180 days prior to registration. Treatment: Arm 1 (Minimum PTV prescription) 3D-CRT or IMRT: 73.8 Gy in 41 fractions. Arm 2 (Minimum PTV prescription) 3D-CRT or IMRT: 70 Gy in 28 fractions
  8. IMAX: (Phase I) IMAX study (Intraprostatic MAXimal simultaneous boost): A dose-escalation study using a maximal simultaneous intraprostatic boost with RapidArc intensity modulated radiotherapy in intermediate risk prostate cancer. Eligibility: Intermediate risk prostate cancer. No hormone therapy. This dose-escalation study will deliver 73.7 Gy in 28 #s (although this dose is specified differently, it is exactly equivalent to the 70 Gy in 28#s used without complications in IMVI-RT and as specified by RTOG 0415) to the PTV concurrent with three dose levels of simultaneous intraprostatic boost (SIB)

Access to clinical trials for patients with GU cancer are also available at other programs, in particular at the Prostate Centre. Trials open at the Prostate Centre.

 

Revised August 2014

 

Updated 30 January 2012

When first seen at a BC Cancer facility, patients expect that the relevant reports will be available to the oncologist so that an appropriate disposition can be made without unnecessary delay. 


New patient referral


To facilitate this, the nurse or clerk in the Admitting Department taking the initial referral will establish available information from a checklist (see Referral Information: Reports required by the Admitting Department: Genitourinary) developed by the tumour group for each site. It is recognized that this information may already have been sent to BC Cancer (attention Admitting Department), or that individual tests may not be appropriate in specific instances.


Referral of urgent cases such as testis cancer or muscle-invasive bladder cancer should not be delayed whilst staging is done. A telephone call to an oncologist may assist with rapid patient disposition. This list is provided for the assistance of referring physicians and their office staff.


All recent consultations and operative, pathology, imaging and relevant lab reports, and similar reports related to previous episodes of cancer for patients referred at relapse or with a second malignancy, are required. Information regarding previous non-surgical cancer therapy is also very valuable and difficult to obtain. For more complex cases, a referring letter would be greatly appreciated.


Patients who have been returned to their community and are no longer followed at BC Cancer may be referred back by contacting the patient's BC Cancer oncologist, who can usually be identified from prior correspondence (also each chart indicates a "doctor-in-charge" by tumour site). Second genitourinary primaries may be handled similarly. New primaries of non-GU sites are usually managed as for new referrals.

Patients may also be referred to traveling clinics under the Communities Oncology Program. However it should be appreciated that this may lead to delay where a subspecialty opinion or treatment at a cancer centre is required.

 

A mechanism is in place at all cancer centres for a triage oncologist to review referrals for urgency and to balance distribution between specialties. The referral clerk can facilitate identification of the appropriate oncologist if discussion with the referring physician is required. If required, multi-disciplinary review will be arranged by the initial oncologist.


In cases where it is unclear or unlikely that the patient will benefit from being seen in consultation, the triage oncologist may choose to contact the referring physician. If the patient is not to be seen, any advice should be documented and copied to the referring and family physicians.

 

Updated 28 July 2011

Chair

Dr. Kim Chi, Medical Oncology, VC

Members

Dr. A.   Agranovich   Radiation Oncology   FVC
Dr. A.   Alexander   Radiation Oncology   VIC
Dr. C.   Andreou   Urology   Surrey
Dr. S.   Aparicio   Pathology   VC
Dr. A.   Attwell   Medical Oncology   VIC
Dr. F.   Bachand   Radiation Oncology   CSI
Dr. T.   Bainbridge   Pathology   CSI
Dr. P.   Black   Urology   VGH Prostate Center
Dr. P.   Blood   Radiation Oncology   VIC
Dr. D.   Bowes   Clinical Fellow Rad Onc   CSI
Dr. M.   Carter   Urology   Kelowna
Dr. B.   Caskey   Clinical Associate   CSI
Dr. A.   Cheung   Radiation Oncology   AC
Dr. A.   Coldman   Population & Preventive Oncology   BCCRC
Dr. J.   Crook   Radiation Oncology   CSI
Dr. W.   Cyr   Urology   Abbotsford
Dr. J.   Davison   Nurse Research Scientist   VGH Prostate Center
Dr. A.   DeLuca   Pathology   VC
Dr. H.   Docherty   Clinical Associate   CSI
Dr. G.   Duncan   Radiation Oncology   VC
Dr. S.   Ellard   Medical Oncology   CSI
Dr. D.   Finch   Medical Oncology   CSI
Dr. M.   Gleave   Prostate Centre   VGH
Dr. L.   Goldenberg   Urology   VGH
Dr. S.   Goodman   Urology   Chilliwack
Dr. J.   Goulart   Radiation Oncology   VIC
Dr. R.   Halperin   Radiation Oncology   CSI
Dr. E.   Hardy   Medical Oncology   CSI
Dr. C.   Holloway   Radiation Oncology   VIC
Dr. P.   Ingledew   Radiation Oncology   FVC
Dr. A.   Karvat   Radiation Oncology   FVC
Dr.   Keith   Medical Oncology   AC
Dr. M.   Keyes   Radiation Oncology   VC
Dr. D.   Kim   Radiation Oncology   CSI
Dr. C.   Kim-Sing   Radiation Oncology   VC
Dr. C.   Kollmannsberger   Medical Oncology   VC
Dr. C.   Krahn   Urology   Vancouver
Dr. W.   Kwan   Radiation Oncology   FVC
Ms. V.   Kyritsis   Pharmacy   VC
Dr. L.   Le   Medical Oncology   FVC
Dr. J.   Lim   Radiation Oncology   VIC
Dr. M.   Liu   Radiation Oncology   FVC
Dr. K.   Lowden   Clinical Associate   CSI
Dr. M.   Manji   Radiation Oncology   CSI
Dr. H.   Martins   Medical Oncology   VIC
Dr. J.   McCracken   Urology   Victoria
Dr. M.   McKenzie   Radiation Oncology   VC
Dr. M.   McLoughlin   Urology   Vancouver
Dr. J.   Michels   Medical Oncology   VIC
Dr. D.   Mirchandani   Medical Oncology   CSI, Penticton
Dr. J.   Morris   Radiation Oncology   VC
Dr. K.   Murphy   Medical Oncology   FVC
Dr. N.   Murray   Medical Oncology   VC
Dr. C.   Oja   Medical Oncology   FVC
Dr. H.   Pai   Radiation Oncology   VIC
Dr. D.   Palma   Resident Rad Onc/Med Onc   VC
Dr. D.   Panjwani   Radiation Oncology   VC
Dr. N.   Patanjali   Fellow, Rad Onc   VC
Dr. D.   Petrik   Radiation Oncology   CSI
Dr. T.   Pickles   Radiation Oncology   VC
Dr. M.   Po   Radiation Oncology   FVC
Dr. M.   Reed   Radiation Oncology   CSI
Dr. M.   Sadar   Research Scientist   BCCRC
Dr. D.   Sauciuc   Medical Oncology   CSI
Ms. W.   Sim   Health Info Services   VC
Dr. A.   So   Research Scientist   VGH
Dr. G.   Steinhoff   Urology   Victoria
Dr. J.   Sutherland   Medical Oncology   CSI
Dr. T.   Thomson   Pathology   VC
Dr. A.   Tinker   Medical Oncology   VC
Dr. S.   Tyldesley   Radiation Oncology   VC
Ms. C.   Van Patten   Nutrition   VC
Dr. M.   Vlachaki   Radiation Oncology   VIC
Dr. T.   Walia   Medical Oncology   AC
Dr. J.   Warner   Urology   Burnaby
Dr. J.   Wilson   Radiation Oncology   CSI
Dr. R.   Winston   Medical Oncology   AC
Dr. J.   Wright   Urology   Vancouver
Dr. J.   Wu   Radiation Oncology   VC
Dr. R.   Yong   Urology   Surrey
Dr. M.   Zulfiqar   Medical Oncology   AC

 

 

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