Urology - Patients starting Abiraterone, Apalutamide, Enzalutamide, and Daralutamide

This leaflet has been designed to support you through your treatment on novel hormones prescribed for treatment of your prostate cancer.

You will have had a discussion with either an Oncologist or Urology Surgeon about starting one of the above drugs and this means you will attend for follow up regularly in a nurse led clinic.

Follow up will usually be face to face, however patients on Enzalutamide, Apalutamide and Daralutamide may have their first appointments by telephone: 4 weeks after starting their treatment.

Patients on abiraterone will usually have a face-to-face appointment 2 weeks after starting treatment when their bloods will be checked in secondary care (hospital).

Following this, reviews will be carried out between 4-12 weekly.

After you are stabilised on treatment your follow up will likely move to telephone reviews carried out by the Christie Team and this will be discussed with you as necessary.

These treatments are only available to be prescribed by the urology team and are collected from Rowlands pharmacy in the Hope Building of Salford Royal Hospital.

Your GP and pharmacist will not be able to prescribe or dispense these drugs.

While on these treatments it is important to remember that your standard hormone injection (Zoladex, Prostap, Decapeptyl or Degarelix) will still be administered by your GP/Practice nurse either monthly, 3 monthly or 6 monthly depending on which treatment you are on.

These appointments are just as important, and it is vital you ensure you arrange these treatments in a timely fashion.

Before your appointments in urology, you should ensure that you have the blood tests below done every time.

FBC: This is a test to check the types and numbers of cells in your blood, including red blood cells, white blood cells and platelets. This can help give an indication of your general health, as well as provide important clues about certain health problems you may have.

An FBC may detect signs of:

• Iron deficiency anaemia or vitamin B12 deficiency anaemia
• Infection or inflammation
• Bleeding or clotting disorders

Bone Profile and Liver Blood tests: The bone profile test measures and analyses the enzymes, proteins, and minerals that are present in your bones. It is a crucial test for monitoring the health of your bones – and for ensuring that they are developing and repairing themselves properly.

Liver Blood tests look at how the liver is functioning and can indicate whether there is any damage or inflammation inside the liver. Sometimes these new drugs can affect the liver, and it is an important test that aids in our assessment.
 
Prostate Specific Antigen (PSA): The PSA test is a blood test that measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells.

U&E: The U&E profile includes sodium, potassium, urea, and creatinine. These tests are completed to evaluate your Kidney function.

Options: In order to have the results of blood tests available for your appointment

1: If you have a Salford based GP you can arrange an appointment at the community diagnostic hub.
0161 206 4100 option 1 (Monday - Friday 9am - 4.45pm)

Addresses of diagnostic hubs

Swinton Gateway, 100 Chorley Road, Swinton M27 6BP

Irlam Medical Centre, MacDonald Rd, Irlam M44 5LH

Pendleton Gateway, 1 Broadwalk, Salford M6 5FX

Newbury Place Health Centre, 55 Rigby Street, Salford, M7 4NX

Ordsall Health Surgery, 118 Phoebe Street, Salford, M5 3PH

The nurses at Urology will need to pre book your blood tests and you will arrange an appointment to have your bloods taken before your appointment.

These results will then be available on the Salford Royal Hospital electronic patient records.
 
2: You can arrange with your GP/Practice nurse to have your bloods taken at the local practice. (If you are out of area for Salford, the results will need to be brought with you to clinic either on paper, or emailed directly to the nursing team on urologycns@nca.nhs.uk).

Please discuss any issues regarding your blood tests been available as this may hold up your prescription been issued on the day of your appointment and may mean another trip back to collect your prescription later.

What should I expect from my appointment?

You will have your blood pressure and weight checked at every follow up and we may assess your ankle/lower legs for signs of any leg swelling.

Your bloods will be reviewed and discussed with you.

You will have the opportunity to discuss any concerns or worries you may be experiencing and may be asked to discuss any urinary symptoms/bowel problems/pain/appetite issues or changes to your general health.

If you are started on any new medication, it is important that we are informed about this as some drugs may interact with your cancer treatment and adjustments may need to be made.

You should have been provided with written information about your new treatment, and these will explain how to take your tablets, how often and what side effects you may experience.

Please ask us if you have not had this.

Red flags

Should you experience any of these symptoms you should gain medical advice from your GP in hours (or us) or your local Emergency Department out of hours (if it is urgent).

Blood in your urine - This could mean you have an infection. If you are able to still pass urine then take a sample to your GP and drink plenty of fluids to flush your system though, please do this gently – you may be prescribed antibiotics but please let us know so we can discuss whether any further tests/ investigations are required.

Back Pain: What is malignant spinal cord compression (MSCC)?

MSCC can happen when cancer grows in the bones of the spine or in the tissues around the spinal cord. The cancer can press on the spinal cord (compression).

MSCC is a rare condition, but it can be extremely serious.

About 3 to 5 in 100 people with cancer (3 to 5%) develop MSCC. Any type of cancer can lead to malignant spinal cord compression. It is more common in people with breast cancer, lung cancer and prostate cancer, lymphoma, and myeloma.

Below, you will find a list of the most common signs and symptoms which patients diagnosed with MSCC have reported (PCUK 02/22).

Finding MSCC early can improve patients’ quality of life. To help diagnose MSCC, patients need to report any of these symptoms to their team urgently.

Please remember, having some of these symptoms does not necessarily mean that you will have MSCC, but your team will want to know so that they can investigate.

The diagram shows two cross-sections of the spine. The first view shows the normal spine. It shows the bones of the spine (vertebrae) with the spinal cord running inside them. The second view shows a tumour in one of the vertebrae pressing on the spinal cord.
www.macmillan.org.uk/cancer-information-and-support/impacts- of-cancer/malignant-spinal-cord-compression

Symptoms of spinal cord compression:

• New and persistent localised back or neck pain, chest wall pain or other unexplained pain that is unusual for you
• Severe pain in the lower back that gets worse or doesn’t go away
• Pain in the back which is worse when coughing, sneezing, or straining
• Back pain which is worse at night
• Numbness, heaviness, weakness, or difficulty using arms or legs
• A band of pain around the chest or abdomen or pain down an arm or leg
• Changes in sensation, for example pins and needles or electric shock sensations
• Numbness in the area around the back passage (the saddle area)
• Not being able to empty the bowel or bladder
• Problems with controlling the bowel or bladder

If you are concerned about symptoms suggesting Metastatic Spinal Cord Compression, examples of healthcare professionals that you can speak to include: your GP, oncologist, specialist nurse or physiotherapist.
www.christie.nhs.uk/patients-and-visitors/services/metastatic-spinal-cord-compression-mscc/information-for-mscc-patients

Below is a link to an animated video from the Musculoskeletal Association of Chartered Physiotherapists:
https://www.macpweb.org/News/when-should-you-seek- urgent-help-for-your-backpain/227074

Blood Clots

Thank you for taking the time to read this information, we hope it will guide you and answer any questions you may have.
In between your clinic appointments please ring 0161 206 5380 if you have any questions for the specialist nurses (Monday - Friday 9am - 5pm).

Sister Margaret Russell (Urology Advanced Nurse practitioner)
Sister Laura Jones (Clinical Nurse Specialist)