Urological cancer
The Oncology Online Quality System (OOQS) provides up-to-date quality-controlled Edinburgh Cancer Centre documentation, including Clinical Management Guidelines by tumour group, SACT lists and procedures. OOQS includes guidelines for managing conditions associated with malignancy and treatment related side-effects.
The SCAN Urology Tumour Specific Group is a multi-disciplinary group made of health professionals from the South East of Scotland and meets 4 times a year.
A list of all formulary decisions relating to Urological Cancer medicines can be viewed on the Formulary Decisions section of the website. Formulary decisions are agreed through SCAN and across all three Boards.
OOQS: Tumour Site (intranet) SCAN: Tumour Specific Groups – Urology
The position of specialist treatment in this condition pathway is not intended to guide on place in therapy. The place in therapy is directed by a consultant oncologist experienced in the management of prostate cancer, use is in line with relevant local or national guidance. Refer to urological cancer formulary decisions and clinical management guidelines for more details. See prescribing notes on duration of therapy.
3.75mg every month.
11.25mg every three months.
Anti-androgen for testosterone flare (off-label) - 50mg daily for 3 weeks starting 2 weeks before the gonadorelin analogue.
Treatment of advanced or metastatic disease in combination with gonadorelin analogue therapy – 50mg daily, starting at least 3 days before the gonadorelin analogue.
Locally advanced prostate cancer unsuitable for local therapy or prostate cancer (metastatic) with the aim of retaining sexual function.
Anti-androgen alone in younger men who wish to retain sexual potency – 150mg daily.
Initially 240mg, to be administered as 2 injections of 120mg, then 80mg every 28 days, dose to be administered into the abdominal region.
Initially 240mg, to be administered as 2 injections of 120mg, then 80mg every 28 days, dose to be administered into the abdominal region.
Loading dose 360mg for 1 dose, then maintenance 120mg once daily.
Prescribing Notes:
General notes
- The position of specialist treatment in this condition pathway is not intended to guide on place in therapy. The place in therapy is directed by a consultant oncologist experienced in the management of prostate cancer, use in line with relevant local or national guidance. Refer to urological cancer formulary decisions and prostate caner clinical management guidelines for more details.
- Duration of therapy will be communicated in letters from the specialist.
Gonadorelin analogues
- Gonadorelin analogues cause side-effects similar to orchidectomy. Both anti-androgens and gonadorelin analogues may cause gynecomastia, reduced libido, hot flushes, mood changes and sweats.
- Gonadorelin analogues may cause 'tumour-flare' in the first weeks of treatment with a transient worsening of pain or uretic obstruction. This can be prevented be pre-treatment with an anti-androgen.
- Durations of therapy for Leuprorelin:
- Neo-adjuvant endocrine therapy - may be given for up to 3 months to down-stage locally advanced tumours before definitive local treatment with radiotherapy. The product with 3 monthly administration should be used, if the patient is to also get adjuvant treatment.
- Adjuvant endocrine therapy - for 2 years.
- There are 2 other gonadorelin analogues approved for use as alternatives; goserilin and triptorelin.
- There are differences in the licensing of individual agents; please refer to the Summary of Product Characteristics.
- Androgen suppression with gonadorelin analogues can cause hot flushes, please refer for more information to treatment of hot flushes caused by androgen suppression for malignant disease.
- For prescribing Gonadotrophin-releasing hormone (GnRH) analogue (any medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin), please refer to Scottish Drug Tariff part 12 Schedule 2 ‘Drugs to be prescribed in certain circumstances under the NHS Pharmaceutical services’ for items that must be endorsed ‘SLS’.
Bicalutamide
- Bicalutamide is the first choice of anti-androgen because of its once daily administration schedule.
- Bicalutamide is used off-label as an anti-androgen for testosterone flare with gonadorelin analogues in the treatment of prostate cancer
- Bicalutamide should not be used as monotherapy for the treatment of localised prostate cancer, but it is licensed for monotherapy of locally advanced prostate cancer.
- Bicalutamide may be used as an anti-androgen alone in younger men with metastatic prostate cancer who wish to retain sexual potency.
Degarelix
- Degarelix is a gonadotrophin-releasing hormone (GnRH) antagonist approved for Specialist Initiation for the treatment of adult patients with advanced hormone-dependent prostate cancer.
Relugolix
- Relugolix is a gonadotrophin releasing hormone (GnRH) antagonist approved: for the treatment of adult patients with advanced hormone-sensitive prostate cancer; for the treatment of high-risk localised and locally advanced hormone dependent prostate cancer in combination with radiotherapy; as neo-adjuvant treatment prior to radiotherapy in patients with high-risk localised or locally advanced hormone dependent prostate cancer.
History Notes
27/02/2025
Addition of Relugolix (SMC2678), ERFC Feb 25.
06/02/2025
Updated prescribing information gonadorelin analogues, ERWG Jan 2025
16/11/2023
Revised simplified formulary recommendations, ERWG May 23.