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Survivorship Prostate Cancer Page 1 of 4 Prostate cancer 2 or more years from completion of treatment 1 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 DRE 4 PSA every 6 months Yes No Return to primary treating physician New 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 antigen 1 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 therapy 3 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 Anderson’s specific patient population; MD Anderson’s services and structure ; and MD Anderson’s 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 1 2 and 2 3 Years 6 and up: History and physical exam annually DRE 4 PSA annually See Page 2 Years 2-5: History and physical exam annually DRE annually PSA every 4 months Category 3 5 Years 6 and up: History and physical exam annually DRE annually PSA annually MONITORING FOR LATE EFFECTS RISK REDUCTION/EARLY DETECTION

Survivorship - Prostate Cancer Algorithm · Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis Screening and Management ... American Cancer Society Guidelines on Nutrition

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Page 1: Survivorship - Prostate Cancer Algorithm · Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis Screening and Management ... American Cancer Society Guidelines on Nutrition

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 Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s 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

Page 2: Survivorship - Prostate Cancer Algorithm · Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis Screening and Management ... American Cancer Society Guidelines on Nutrition

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 Vanderbilt’s ABCDE’s 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 Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s 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

Page 3: Survivorship - Prostate Cancer Algorithm · Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis Screening and Management ... American Cancer Society Guidelines on Nutrition

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 Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s 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

Page 4: Survivorship - Prostate Cancer Algorithm · Survivorship – Prostate Cancer Page 1 of 4 ... (see Hepatitis Screening and Management ... American Cancer Society Guidelines on Nutrition

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 Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s 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