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

• Nutritional Information
• Osteoporosis Screening Guidelines
• Prostatic Neoplasms - The Pros and Cons of PSA Screening for Prostate Cancer: BC Cancer Recommendations
• Patient Information Document: Screening for Prostate Cancer with PSA
• Patient and Family Counselling Services offers a number of support programs and services to patients and their families. For more information please contact 604.877.6000, local 2194 or toll free (in B.C.) at 1.800.663.3333 local 2194
• The Library at 604.675.8001 or toll free (in B.C.): 1.888.675.8001 ext. 8001 is a valuable resource
• Recommended Websites on cancer and health are compiled and evaluated by BC Cancer librarians and experts
• Types of Cancer
  • prostate
  • bladder
  • kidney
  • testis
  • penis
  • renal pelvis & ureter
  • urethra
• Coping with cancer

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

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