Primary Care of the Prostate Cancer Survivor

 


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Am Fam Physician. 2016 May 1;93(9):764-771.

  Patient information: See related handout on prostate cancer treatment, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners.

Prostate cancer is commonly recognized and treated. In 2014, there were an estimated 3 million prostate cancer survivors in the United States.1 The number of treated prostate cancer survivors is growing, and this population is aging. These survivors are routinely part of a primary care physician's panel; however, nearly one-half of primary care physicians feel unprepared to manage the long-term effects of prostate cancer treatment.2 In this summary, we review the July 2014 American Cancer Society (ACS) Prostate Cancer Survivorship Care Guidelines, which are based on recommendations from an interdisciplinary expert workgroup.3 Although other guidelines have addressed aspects of follow-up for prostate cancer treatment, this is the first time comprehensive prostate cancer survivorship guidelines have been published. The ACS guidelines were developed to assist primary care physicians in caring for prostate cancer survivors, including monitoring for cancer recurrence, and managing the physical and psychological consequences of treatment.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Digital rectal examination should be performed annually as follow-up after prostate cancer treatment.

C

3, 5

Prostate-specific antigen levels should be checked every six to 12 months for five years and then annually thereafter as follow-up after prostate cancer treatment.

C

3, 5

In patients treated with androgen deprivation therapy, baseline dual energy x-ray absorptiometry should be performed to measure bone mineral density.

C

3, 13, 14

After prostate cancer treatment, health-related quality of life should be assessed annually using tools such as the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP; eFigure A).

C

3, 20


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Digital rectal examination should be performed annually as follow-up after prostate cancer treatment.

C

3, 5

Prostate-specific antigen levels should be checked every six to 12 months for five years and then annually thereafter as follow-up after prostate cancer treatment.

C

3, 5

In patients treated with androgen deprivation therapy, baseline dual energy x-ray absorptiometry should be performed to measure bone mineral density.

C

3, 13, 14

After prostate cancer treatment, health-related quality of life should be assessed annually using tools such as the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP; eFigure A).

C

3, 20


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

The Authors

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ERIKA M. NOONAN, MD, is a geriatrician at Intermountain Healthcare in Provo, Utah. At the time the manuscript was submitted, Dr. Noonan was a geriatric medicine fellow at the University of Utah School of Medicine, Salt Lake City....

TIMOTHY W. FARRELL, MD, AGSF, is an associate professor of medicine in the Division of Geriatrics and adjunct associate professor of family medicine in the Department of Family and Preventive Medicine at the University of Utah School of Medicine. Dr. Farrell is also a physician investigator at the VA Salt Lake City Geriatric Research, Education, and Clinical Center, and serves as interim director of University of Utah Health Sciences Interprofessional Education.

Address correspondence to Erika M. Noonan, MD, 3200 North Canyon Road, Ste. C, Provo, UT 84604. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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