This updated guideline from Nice on prostate cancer has a couple of useful elements for us. The first is that they have standardised the protocol for 'active surveillance' and GPs are expected to be involved in the PSA monitoring aspect - so that is worth having a look at. The second aspect is about managing some of the side-effects of treatments.
Patients with 'low-risk' cancers (ie those that are less likely to go on to cause further problems) and those with 'intermediate-risk' cancers who opt for it, can choose active surveillance. They are monitored with regular PSA, DRE (digital rectal exam) and biopsy. NICE encourages the use of GPs in the PSA monitoring aspect. They found that different centers around the country were doing very different things, so they have attempted to standardise what is done. This is based on expert consensus as trial evidence is lacking. 'PSA kinetics' means the speed of change (which we don't need to worry about).
Side-effects of treatments
There is quite a lot in the guideline about treatment of various side-effects, which may be useful to us, but the updated bits are:
· Enteropathy – radiation induced enteropathy can occur, but people should be assessed by a specialist to exclude alternative diagnoses (eg cancer / IBD)
- Hot flushes secondary to hormone therapy
1st line - Medroxyprogesterone 20mg OD for 10/52
2nd line - Cyproterone acetate or megestrol acetate 20mg BD for 4/52