Prostate cancer is the most frequently diagnosed malignancy among UK men and accounts for 12% of male deaths. Androgen deprivation therapy (ADT) is commonly used as part of the treatment for prostate cancer. It is effective at suppressing prostate-specific antigen, stabilizing disease, alleviating symptoms in advanced disease, and potentially prolonging survival. However ADT, presumably at least in part owing to low testosterone levels is associated with insulin resistance, the development of metabolic syndrome plus increased overall and cardiovascular disease mortality. We have reviewed the relationship between prostate cancer, ADT, metabolic syndrome, type 2 diabetes, and cardiovascular disease. We have not reviewed other potential medical problems such as osteoporosis. We suggest that there should be a baseline assessment of patients' risk for cardiovascular disease before starting ADT. Consideration should be given to starting appropriate therapies including lifestyle advice, antihypertensive and lipid-lowering agents, insulin sensitizer, plus possibly aspirin. Having started ADT, the patients should have a regular (possibly annual) assessment of their cardiovascular risk factors.

From 1999, the NHS Ayrshire and Arran Health Board implemented an innovative nurse-led collaborative care model for the management of patients with prostate cancer (PC). This article describes the model and presents the results of a local evaluation to assess its impact. The evaluation comprised a retrospective audit of the service against national standards for PC management, undertaken in 2012. Seventy-one patients, who were under the care of the service during June 2008, were included. Patient and staff satisfaction were also assessed using questionnaires distributed to 75 patients undergoing outpatient or telephone reviews during April 2012 and 7 one-to-one semi-structured staff interviews. The patient audit showed good compliance with standards relating to selection of appropriate PC treatments according to tumour stage and grade; radiotherapy dosing and referral-to-treatment times. Areas requiring improvement were the documentation of patients' risk and performance status and provision of verbal and written information to patients and carers. Seventy-three per cent of the patient questionnaires were returned, with 96% of respondents rating their overall care as 'excellent' or 'very good'. Staff satisfaction was also high and interviewees described many benefits of the service for patients, hospital staff, GPs and the NHS/health board. Negative responses related mainly to demand/capacity issues. Overall, the evaluation showed good compliance with many national standards and high levels of patient and staff satisfaction. This suggests that with trained and competent nursing staff and collaborative multidisciplinary team working, safe and appropriate care can be achieved for more complex, as well as very stable PC patients.

The urology-oncology service in NHS Ayrshire and Arran (AA) is nurse-led, with a multidisciplinary team (MDT) process at its core. Here, we assess the efficacy of this nurse-led service against similar services and consider it in the context of the new NHS cancer strategy. Materials and methods: Audit data regarding the management of patients with urological malignancies published by the West of Scotland Cancer Network (WoSCAN) were compared against predetermined quality performance indicators. These data were used to assess the efficacy of the NHS AA service against the other WoSCAN centres. Results: All parameters analysed were comparable, except for the following performance indicators for which the NHS AA data appeared to show significant improvement compared with the other WoSCAN centres: the number of patients with bladder cancer with recorded TNM clinical staging (p = 0.012); the proportion of patients with prostate cancer who underwent transrectal ultrasound-guided prostate biopsy for histological diagnosis where a minimum of 10 cores are received by pathology (p = 0.043); and the number of patients with metastatic prostate cancer who underwent immediate hormone therapy (p = 0.031). Conclusion: Our analysis demonstrates that the NHS AA urology-oncology nurse-led MDT-based service is a highly efficient and well-functioning structure.

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167 Background: Prostate cancer is the second most common malignancy in men worldwide with 910,000 cases registered in 2008. The prognosis for low-risk prostate cancer patients remains excellent and arguably the majority may either not require radical treatment or may benefit from deferred radical treatment. Active surveillance involves serial prostate-specific antigen (PSA) monitoring, digital rectal examinations, and periodic trans-rectal ultrasound guided prostate biopsies. Patients for active surveillance are carefully selected, counselled and actively followed-up. Radical treatment is deferred until there is evidence of biochemical, pathological or clinical disease progression. Methods: Retrospective review of prostate cancer patients enrolled on to the active surveillance program within NHS Ayrshire and Arran Hospitals. Clinical examination and PSA monitoring was undertaken 3-monthly in year 1, 4-monthly in year 2 and 6-monthly thereafter. The protocol stipulates repeat TRUS biopsies at years 1, 4, 7 and every 3 years thereafter. Results: 105 patients with low-intermediate risk prostate cancer with a median age of 68yrs (48–78yrs) were followed for a median duration of 30 months (4–152 months). The median PSA at presentation was 7ng/ml (0.5-31). Repeat biopsies were performed in 82 patients and 37% had no histological evidence of cancer. The median time to re-biopsy was 16 months (10–85 months). Of the patients who received radical treatment; 3 underwent radical prostatectomy and 23 received radical radiotherapy. The indications for radical treatment were pathological progression in 73%, PSA progression in 23% and co-existing bladder cancer in 4%. One patient died due to unrelated medical problems and one patient developed metastatic disease. Conclusions: With appropriate counselling, a significant percentage of men with low-moderate risk prostate cancer choose active surveillance. In this study, active surveillance does not appear to compromise outcomes for patients with low-intermediate risk prostate cancer. Less then 25% of patients needed radical treatment and therefore this approach appears cost-effective and avoids treatment-related morbidity.