Men with prostate cancer often are followed-up by oncologists, primary care providers (e.g. urologists, internists), or both. An expert panel and focus groups in Michigan created Guidelines for the Primary Care Management of Prostate Cancer Post-Treatment Sequelae in 2009 and published an update in July 2014. The Michigan Cancer Consortium modified the earlier guidelines, which now include the following elements: (1) patient-reported symptom assessment, (2) distinctions between medical and self-management strategies for prostate cancer treatment-related side effects, (3) recommendations for involving partners in survivorship care, and (4) care coordination strategies for primary and specialty care providers.
The updated recommendations are consistent with recommendations from the American Urological Association and NCCN and include PSA testing every 6 to 12 months following treatment for 5 years, then annually. Annual digital rectal examination should be coordinated among the different providers, and may be omitted in cases of undetectable PSA. Because androgen deprivation is typically administered in 3-month depot injections, PSA testing every 3 months is recommended for these individuals; however, if there is an undetectable PSA (<0.1 ng/mL) during androgen deprivation, PSA testing every 6 months may be considered.
The management recommendations for urinary and bowel symptoms after prostate cancer treatment include assessment of symptoms, pharmacologic therapy, self-management techniques, device use, and referral for specialized care. Men experiencing urinary symptoms may benefit from pyridium, alpha-adrenergic blockers (e.g., tamsulosin), and anticholinergic therapy (e.g., oxybutynin). Those with frequent or liquid bowel movements may find antidiarrheals beneficial. Fiber supplements can help patients who have either loose stools or constipation. Rectal pain, itching, and hemorrhoidal flares are treated symptomatically with over-the-counter wipes, creams, and suppositories.
Skolarus TA, Wittmann D, Northouse D, et al. Recommendations for Prostate Cancer Survivorship Care: An Update to the 2009 Michigan Cancer Consortium Guidelines for the Primary Care Management of Prostate Cancer Post-Treatment Sequelae 2014; Journal of Men's Health, doi:10.1089/jomh.2014.0026, published online 15 July 2014.