Shared Care Agreement for Gonadorelin Analogues in Prostate Cancer (buserelin, goserelin, histrelin, leuprorelin& triptorelin) Version 1.0

Specialist responsibilities Confirm diagnosis and assess patient’s appropriateness for treatment with gonadorelin analogues Discuss benefits and side effects of treatment with the patient. Initiate treatment with anti-androgens to cover for potential ‘tumour flare’ up and request GP to prescribe a gonadorelin analogue. Send GP a copy of the shared care agreement and hormonal therapy template letter. Regularly review the patient’s condition and communicate promptly with the GP when treatment is changed. Monitor clinical response to treatment, e.g bone pain and performance status Advise the GP of interval of administration - whether it be one monthly, three monthly or six monthly, when to stop treatment, or when to consult with the specialist. Continue regular review of patient Radiology and radioisotopes (MRI scan of the pelvis and bone scan may be performed) (These tests will be performed at diagnosis if appropriate and subsequently if indicated by specialists). Baseline FBC & U&Es, including LFTs & prostate-specific antigen (PSA). Ensure clear back-up arrangements exist for GPs, including direct telephone numbers for advice and support. Report adverse events to the MHRA and GP. www.mhra.gov.uk/Safetyinformation/Reportingsafetyproblems/index.htm

Primary care prescriber responsibilities If unwilling to share care for clinical reasons, the consultant should be notified as soon as practicable so as not to delay treatment. Save the shared care agreement into the patient’s medical record. Prescribe the specified gonadorelin analogue at the dose recommended and for the time specified. Report to and seek advice from the specialist on any aspect of patient care that is of concern to the GP and may affect treatment Monitor PSA only if specifically requested by secondary care (this is usually done by secondary care). Refer to secondary care if the patient has symptoms to suggest local, regional or metastatic progression or if there has been a rise in the PSA. The absolute level and or rate of rise (doubling time) as specified by secondary will indicate when to refer back to secondary care. Contact the hospital specialist if potassium or serum creatinine (unless known to have chronic renal failure) are significantly raised and unrelated to diuretic/antihypertensive treatment. Refer back to specialist in the event of deteriorating clinical condition or intolerance occurs. Report adverse events to specialist and MHRA. www.mhra.gov.uk/Safetyinformation/Reportingsafetyproblems/index.htm

Patient's role Report any adverse effects to the specialist or GP. Share any concerns in relation to treatment Report to the specialist or GP if he does not have a clear understanding of their treatment.

For up to date information on doses, administration, cautions, side effects, contraindications please refer to the individual drug summary of product characteristics www.medicines.org.uk or current BNF www.bnf.org Contact details Telephone No. Contact details Telephone No. Urologists Specialist nurse Mr. Robert Brierly 01473 703799 (for general advice around side effects) 01473 702773 Mr. Gautam Banerjee 01473 703799 Uro-oncology Mr Peter Donaldson 01473 703799 Charlotte Etheridge(Macmillan Urology Mr George Yardy 01473 703799 CNS) Oncologists Amanda Ford (Macmillan Radiotherapy 01473 704361 Dr. Scrase 01473 704908 Specialist) Dr. R. Venkitaraman 01473 704908

Produced by Ipswich and East Suffolk Clinical Commissioning Group in conjunction with Ipswich Hospital, last updated April 2014. Due for review April 2016.