New Guidelines Address Long-Term Needs of Prostate Cancer Survivors

Recommendations to support primary care of men with history of prostate cancer

New American Cancer Society (ACS) prostate cancer survivorship care guidelines released on 10 June, 2014 outline post-treatment clinical follow-up care for the myriad of long-term and late effects prostate cancer survivors in the United States may face. The guidelines report is published early online in the ACS journal CA: A Cancer Journal for Clinicians.

The guidelines are designed to promote optimal health and quality of life for the post-treatment prostate cancer survivor by facilitating the delivery of comprehensive post-treatment care by primary care clinicians. They are based on recommendations set forth by an expert panel convened as part of the work of the National Cancer Survivorship Resource Center, a collaboration between the American Cancer Society and The George Washington University Cancer Institute, funded by a 5-year cooperative agreement from the Centers for Disease Control and Prevention.

Prostate cancer survivors represent more than four in ten male cancer survivors and one in five of all cancer survivors in the United States. While guidelines exist for treatment and surveillance for recurrent disease, availability of guidelines for long-term post-treatment care is limited.

The ACS prostate cancer survivorship care guidelines were developed using a combined approach of evidence synthesis and expert consensus. They address health promotion, surveillance for recurrence and screening for second primary cancers, and the assessment and management of physical and psychosocial long-term and late effects resulting from prostate cancer and its treatment. A key challenge to the development of the guidelines was the limited availability of published evidence informing the clinical management of prostate cancer survivors after treatment.

Among the recommendations

Since information needs evolve as patients transition from treatment through various stages of survivorship, survivor and caregiver information needs should be assessed regularly, with information and support services provided or referred to as necessary.

Primary care clinicians should provide regular evaluations of survivors to determine appropriate levels of participation in health promotion and lifestyle modification programmes.

Primary care clinicians should conduct routine assessments of body mass index among survivors across the prostate cancer survivorship continuum, with recommendations for limiting consumption of high-calorie foods and beverages for survivors who are overweight or obese.

Primary care clinicians should educate survivors regarding the association between physical activity and lower overall and prostate cancer-specific mortality and improved quality of life.

Since smoking after treatment of prostate cancer increases the risk of cancer recurrence and second cancers, primary care clinicians should assess for tobacco use and offer or refer survivors to cessation counselling and resources.

While existing evidence is not definitive with regard to frequency of monitoring for recurrence using PSA testing, the NCCN guidelines for prostate cancer treatment recommend measuring serum PSA levels every 6 to 12 months for the first 5 years after definitive treatment, and then to recheck annually.

Clinicians should be aware of a small increased risk of second primary cancers after radiation therapy compared with men receiving surgery. While evidence does not support increased frequency or intensity of screening, adherence to routine ACS screening guidelines for the early detection of any new cancers is recommended.

Survivors should be assessed for physical (e.g. urinary, sexual, bowel) and psychosocial effects of prostate cancer and its treatment; the focus of assessment should be tailored to the type of cancer treatment received and current disease state to trigger appropriate self-management and clinical management strategies for support and therapy.

Estimates indicate that as many as 30% of patients with prostate cancer experience clinically relevant general distress, 25% have increased anxiety, and nearly 10% experience major depressive disorder. These guidelines affirm early identification, treatment, and ongoing assessment for psychological distress as important aspects of prostate cancer survivorship care.

Reference

Skolarus T, Wolf A, Erb N, et al. American Cancer Society prostate cancer survivorship care guidelines. CA: A Cancer Journal for Clinicians 2014; June 10. doi: 10.3322/caac.21234. [Epub ahead of print]