Survivorship - Prostate Cancer Algorithm ?· Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis…

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  • Survivorship Prostate Cancer Page 1 of 4

    Prostate cancer 2 or more years from completion of treatment1 and NED

    Department of Clinical Effectiveness V5

    Approved by The Executive Committee of the Medical Staff on 05/29/2018

    Years 2-5:

    History and physical

    exam annually

    DRE4

    PSA every 6 monthsYes

    No

    Return to primary

    treating physicianNew

    primary or

    recurrent

    disease?

    ELIGIBILITY CONCURRENT COMPONENTS OF VISIT

    Continue survivorship

    monitoring

    PSYCHOSOCIAL FUNCTIONING

    SURVEILLANCE

    NED = no evidence of disease DRE = digital rectal exam PSA = prostate specific antigen1 PSA less than 0.1 for status post prostatectomy and less than 1 for status post radiation therapy

    2 Category 1: status-post radical prostatectomy or radiation therapy; pathologic stage pT2, N0, M0, negative margins, or clinical stage cT2, N0, M0; Gleason score less than or equal to 7 and PSA less than 0.1 ng/mL or

    less than 1 ng/mL if treated with radiation therapy3 Category 2: status-post prostatectomy or status-post prostatectomy plus radiation therapy; pathologic stage pT2, N0, M0, positive margins; Gleason score less than or equal to 7 and PSA less than 0.1 ng/mL

    4 As clinically indicated if PSA is undetectable

    5 Category 3: status-post prostatectomy or status-post prostatectomy plus radiation therapy or status-post radiation therapy; pathologic staging pT3, N0, M0; clinical stage, cT3, N0, M0; Gleason score 8-10 and PSA less

    than 0.1 ng/mL or less than 1 ng/mL if treated with radiation therapy only

    This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers.

    DISPOSITION

    Category 12

    and 23

    Years 6 and up:

    History and physical

    exam annually

    DRE4

    PSA annually

    See Page 2

    Years 2-5:

    History and physical

    exam annually

    DRE annually

    PSA every 4 months

    Category 35

    Years 6 and up:

    History and physical

    exam annually

    DRE annually

    PSA annually

    MONITORING FOR LATE EFFECTS

    RISK REDUCTION/EARLY DETECTION

  • ELIGIBILITY CONCURRENT COMPONENTS OF VISIT

    Patient education, counseling, and screening:

    Lifestyle risk assessment2

    Cancer screening3

    HPV vaccination as clinically indicated (see HPV Vaccination Algorithm)

    Screening for Hepatitis B and C as clinically indicated

    (see Hepatitis Screening and Management HBV and HCV Algorithm)

    Cardiovascular risk reduction4

    Assess for:

    Distress management

    (see Distress Screening and Psychosocial Management Algorithm)

    Body image

    Financial stressors

    Social support

    Urinary incontinence

    Erectile dysfunction

    Bowel dysfunction

    Bone health screening as clinically indicated

    PSYCHOSOCIAL FUNCTIONING

    MONITORING FOR LATE EFFECTS

    RISK REDUCTION/EARLY DETECTION

    1 PSA less than 0.1 for status post prostatectomy and less than 1 for status post radiation therapy

    2 See Physical Activity, Nutrition, and Tobacco Cessation algorithms; ongoing reassessment of lifestyle risks should be a part of routine clinical practice

    3 Includes colorectal, liver, lung, pancreatic, and skin cancer screening

    4 Consider use of Vanderbilts ABCDEs approach to cardiovascular health

    Refer or consult

    as indicated

    DISPOSITION

    Survivorship Prostate Cancer Page 2 of 4This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers.

    Prostate cancer 5 or more years from completion of treatment1 and NED

    Department of Clinical Effectiveness V5

    Approved by The Executive Committee of the Medical Staff on 05/29/2018

    https://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/screening/risk-reduction-hpv-vaccination-web-algorithm.pdfhttps://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/clinical-management/clin-management-hepatitis-web-algorithm.pdfhttps://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/clinical-management/clin-management-distress-web-algorithm.pdfhttps://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/screening/risk-reduction-physical-activity-web-algorithm.pdfhttps://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/screening/risk-reduction-nutrition-web-algorithm.pdfhttps://www.mdanderson.org/content/dam/mdanderson/documents/for-physicians/algorithms/screening/risk-reduction-tobacco-cessation-web-algorithm.pdfhttps://www.mdanderson.org/for-physicians/clinical-tools-resources/clinical-practice-algorithms/cancer-screening-algorithms.htmlhttp://cardioonc.org/2017/08/29/know-your-abcs/

  • SUGGESTED READINGS

    Aus, G., Abbou, C. C., Bolla, M., Heidenreich, A., Schmid, H. P., Van Poppel, H., ... & Zattoni, F. (2005). EAU guidelines on prostate cancer. European Urology, 48(4), 546-551.

    Buschemeyer, W. C., & Freedland, S. J. (2007). Obesity and prostate cancer: epidemiology and clinical implications. European Urology, 52(2), 331-343.

    Centers for Disease Control and Prevention. (2018, March 5). Recommended immunization schedule for adults aged 19 years or older, United States 2018.

    Retrieved from https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

    DiBiase, S., & Roach, M. (2017). External beam radiation therapy for localized prostate cancer. UpToDate database. Retrieved from https://www.uptodate.com/contents/external-beam-radiation-

    therapy-for-localized-prostate-cancer/print?source=search_result&search=External%20beam%20radiation%20therapy%20for%20localized%20prostate%20cancer.&selectedTitle=1~150

    Graham, J. (2014). Diagnosis and treatment of prostate cancer: summary of NICE guidance (vol 336, pg 610, 2008). British Medical Journal, 348.

    Kushi, L. H., Byers, T., Doyle, C., Bandera, E. V., McCullough, M., Gansler, T., ... & Thun, M. J. (2006). American Cancer Society Guidelines on Nutrition and Physical Activity for cancer

    prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians, 56(5), 254-281.

    Ma, R. L., & Chapman, K. (2009). A systematic review of the effect of diet in prostate cancer prevention and treatment. Journal of Human Nutrition and Dietetics, 22(3), 187-199.

    National Comprehensive Cancer Network. Prostate Cancer (Version 1.2018). https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed March 7 ,2018.

    National Comprehensive Cancer Network. Prostate Cancer Early Detection (Version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf. Accessed March 7, 2018.

    Obek, C., Neulander, E., Sadek, S., & Soloway, M. S. (1999). Is there a role for digital rectal examination in the followup of patients after radical prostatectomy?. The Journal of Urology, 162(3),

    762-764.

    Pound, C. R., Partin, A. W., Eisenberger, M. A., Chan, D. W., Pearson, J. D., & Walsh, P. C. (1999). Natural history of progression after PSA elevation following radical prostatectomy. Jama,

    281(17), 1591-1597.

    Thompson, I., Thrasher, J. B., Aus, G., Burnett, A. L., Canby-Hagino, E. D., Cookson, M. S., ... & Goldenberg, S. L. (2007). Guideline for the management of clinically localized prostate cancer:

    2007 update. The Journal of Urology, 177(6), 2106-2131.

    Vanderbilt Cardio-Oncology Program. (2017). Know Your ABCDE's. Retrieved from http://www.cardioonc.org/2017/08/29/know-your-abcs/

    Vassilikos, E. J., Yu, H., Trachtenberg, J., Nam, R. K., Narod, S. A., Bromberg, I. L., & Diamandis, E. P. (2000). Relapse and cure rates of prostate cancer patients after radical prostatectomy and 5

    years of follow-up. Clinical Biochemistry, 33(2), 115-123.

    Ward, J. F., Blute, M. L., Slezak, J., Bergstralh, E. J., & Zincke, H. (2003). The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy.

    The Journal of Urology, 170(5), 1872-1876.

    Survivorship Prostate Cancer Page 3 of 4This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers.

    Department of Clinical Effectiveness V5

    Approved by The Executive Committee of the Medical Staff on 05/29/2018

  • DEVELOPMENT CREDITS

    John W. Davis, MD (Urology)

    Wendy Garcia, BS

    Jeri Kim, MD (Genitourinary Medical Oncology)

    Deborah A. Kuban, MD (Radiation Oncology)

    Paula Lewis-Patterson, DNP, RN, NEA-BC (Cancer Survivorship)

    William E. Osai, RN, APN, FNP (Genitourinary Medical Oncology)

    Amy Pai, PharmD

    This survivorship algorithm is based on majority expert opinion of the Genitourinary Survivorship work group at the University of Texas MD Anderson Cancer Center. It was developed using a

    multidisciplinary approach that included input from the following:

    Survivorship Prostate Cancer Page 4 of 4This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers.

    Clinical Effectiveness Development Team

    Department of Clinical Effectiveness V5

    Approved by The Executive Committee of the Medical Staff on 05/29/2018

    Survivorship Prostate WEB Algorithm.vsdPage-1Page-2Page-3Page-4

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