Outlining Frontline Strategies in Prostate Cancer Care

In observation of Prostate Cancer Awareness Month in September, Oncology Nursing News hosted a roundtable discussion featuring three advanced practice providers (APPs) from Vanderbilt Health's Department of Urology.

Panelists Maggie O'Block, MSN, APRN-BC; Wendy Nichols, DNP, MSN, APRN, FNP-C; and Meredith Donahue, MSN, APRN-BC, detailed the evolving responsibilities of APPs in urologic oncology. APPs play a central role across the prostate cancer continuum, managing early detection, multidisciplinary coordination, treatment toxicities, and survivorship care.

Refining Early Detection and Screening Workups

Evaluating elevated prostate-specific antigen (PSA) levels requires a structured diagnostic pathway. Per American Urological Association (AUA) guidelines, initial elevated PSA values must be rechecked to confirm persistence before pursuing invasive interventions. To refine risk stratification, APPs integrate secondary assessment tools, including multiparametric MRI and urine biomarkers like MyProstateScore 2.0 (MPS 2.0), prior to ordering a prostate biopsy.

Key screening takeaways for oncology nurses:

• Recheck Elevated PSA: Confirm elevated PSA values with repeat testing before initiating invasive diagnostic workups.
• Obtain Detailed Histories: Evaluate family history across prostate, breast, ovarian, and colon cancers, alongside occupational chemical exposures.
• Incorporate Secondary Diagnostics: Utilize multiparametric MRI and urine biomarker assays (e.g., MPS 2.0) prior to recommending biopsies.
• Communicate Transparently: Provide data-driven counseling for high-risk populations, including Black men and individuals with strong family histories, emphasizing early monitoring over panic.

Optimizing Multidisciplinary Care Coordination

Managing intermediate- to high-risk localized and advanced prostate cancer demands structured interprofessional collaboration. At Vanderbilt Health, dedicated prostate cancer care coordinators assist APPs in streamlining patient referrals, diagnostic imaging, and same-day consultations across urology, medical oncology, and radiation oncology. Weekly multidisciplinary tumor boards provide a collaborative forum to review complex cases. Additionally, specialized Advanced Prostate Cancer Clinics allow APPs to manage patients receiving systemic therapies, novel hormonal agents, or clinical trial options.

Key multidisciplinary takeaways for oncology nurses:

• Leverage Clinical Coordinators: Engage dedicated care coordinators to organize cross-specialty appointments and imaging efficiently.
• Utilize Tumor Boards: Discuss complex or atypical cases in weekly interprofessional tumor board conferences.
• Integrate Advanced Clinics: Establish dedicated clinics to maintain continuity of care for patients with advanced or metastatic disease.

Adverse Event Mitigation and Quality of Life

Long-term systemic therapies, including androgen deprivation therapy (ADT) and novel hormonal agents, cause adverse effects such as fatigue, metabolic changes, bone density loss, and sexual dysfunction. Proactive management is essential to maintain patient adherence and quality of life.

Key quality-of-life takeaways for oncology nurses:

• Protect Cardiac and Bone Health: Coordinate cardio-oncology consultations for patients with cardiovascular risk and obtain baseline DEXA scans every two years.
• Promote Physical Activity: Advise patients to maintain regular physical movement to preserve bone density and combat fatigue.
• Involve Caregivers: Engage family members during visits to uncover unreported functional declines or excessive fatigue.
• Reassess Treatment Goals: Evaluate long-term disease control periodically to consider treatment holidays when clinically appropriate.

Precision Medicine and Scope of Practice

The rapid expansion of targeted therapies and point-of-care genetic testing is broadening the scope of urology oncology APPs. APPs facilitate point-of-care genetic testing to identify actionable mutations for systemic treatment while educating patients on hereditary risk factors for family members.

APPs serve a critical frontline role in correcting widespread public misinformation regarding PSA testing and prostate cancer aggression. For APPs entering urologic oncology, utilizing AUA educational resources and practicing to the full extent of licensure remain vital strategies for delivering evidence-based care.