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Recommendations for urological cancers issued by NICE.

Over 30 000 people in England develop new urological cancers each year, and traditionally, their management has been coordinated by urologists. Experience from other tumours has demonstrated the importance of a multi-disciplinary approach to ensure the highest quality standards of care, but few such groups have so far been established in urological departments. This Guidance Document was issued on the 19th of September and outlines the changes in services for patients with urological cancers to be implemented by Cancer Networks [1]. The recommendations were underpinned by a systematic review carried out by Malcolm Mason under the auspices of the York Group and there was a large ‘proposal generating event’, attended by key health professional and patient groups. The document notes that recommendations may take some time to implement because of the significant changes in configuration of services required across Trusts. Will these proposed changes result in improved services and outcomes for patients with urological cancers? The document contains the following key recommendations: (1) All patients with urological cancers should be managed by multi-disciplinary urological cancer teams. (2) Major improvements in information and support services are required. Nurse specialists should be trained to take key roles in providing these services. (3) Within each network, multi-disciplinary teams should be formed in local hospitals (cancer units); at cancer centres, with the possibility in larger networks of additional specialist teams serving populations of at least one million; and at supra-network level to provide specialist management for some male genital cancers. (4) Radical surgery for prostate and bladder cancer should be provided by teams typically serving populations of a million or more and carrying out a cumulative total of at least 50 such operations per annum. Whilst these teams are being established, surgeons carrying out small numbers (less that five per annum) of either operation should make arrangements within their network to pass this work on to more specialized colleagues. (5) There are many areas of uncertainty about the optimum form of treatment for patients with urological cancers. It is important that high-quality research studies should be supported and that patients should be encouraged to participate in appropriate trials. Most of these recommendations are aimed at the construction of effective MDTs at the Cancer Unit, and though they will cost money, such recommendations are sensible, non-controversial and will undoubtedly result in improved management for patients with urological cancer. The input of pathology, imaging and oncology may be difficult currently because of staff and equipment shortages, but is clearly important and will become increasingly so with the advent of effective novel treatments for urological cancers. The proof of principle has been established with Herceptin for breast cancer and Imatinib (Glivec) for chronic myeloid leukaemia. The place of combinations of surgery, chemotherapy, radiotherapy and hormonal treatments remains uncertain in many urological cancers, but MDTs should at least