The landscape of curative treatment has evolved significantly, particularly over the past five years. In addition to established modalities such as Intensity-Modulated Radiotherapy (IMRT) and hormonal therapy, modern approaches may include Stereotactic Ablative Body Radiotherapy (SABR), occasionally delivered via MR-guided linear accelerators, extended nodal irradiation, treatment of oligometastatic disease, chemotherapy, and novel hormonal agents. These may be delivered before, during, or after radiotherapy depending on clinical need.

For cases of advanced prostate cancer that are no longer curable, there is now a broad array of therapeutic options. These include hormonal agents, molecularly targeted therapies, radiopharmaceuticals, and chemotherapy. The optimal sequencing and combination of these treatments continue to evolve in response to new clinical evidence.

Colorectal and Anal Cancer

I have nearly two decades of experience managing colorectal and anal cancers, with a particular subspecialist interest in rectal and early-stage rectal cancers. While surgery remains the cornerstone of treatment for most colorectal cancers, chemotherapy and radiotherapy — either alone or in combination — are often used pre- or post-operatively to optimise outcomes for patients with localised disease.

Early Rectal Cancer

With the increasing adoption of bowel cancer screening (including the use of faecal immunochemical tests sent by post) and an ageing population, we are diagnosing more cases at an earlier stage. In select early rectal cancers, (chemo)radiotherapy may serve as the sole curative modality, thus avoiding the need for major surgery.
I have led the development of Contact X-ray Brachytherapy (also known as Papillon treatment) in Nottingham and have been an integral member of the team delivering this specialised therapy for over 10 years at Nottingham City Hospital as part of my NHS practice.