Prostate cancer

• Initial 6 month visit at Beatson
• Follow up schedule
• 6 monthly prostate-specific antigen (PSA) check for 5 years then annual to 10 years telephone/letter review.

Patient has access to CNS team via direct telephone number.

All cases will be reviewed in MDT and agreed if Active Surveillance is an appropriate option.

The CNS will discuss treatment options with patients, ensuring the patient has a good understanding of the principles of Active Surveillance. The nurse will provide written information +/- signpost to validate online support (Prostate Cancer UK). This information can be accessed by the patient and their family. All patients will be provided with contact details for the specialist nursing team.

*Assess if active surveillance remains appropriate - consider radical treatment/watchful waiting.

If MRI confirms disease progression +/- a continual rise in PSA. The CNS would request radiology staging investigation as per the local protocol. Following the completion of required investigation the nurse specialist will request for the case to be discussed in the local Urology MDT. A consensus will be sought regarding appropriate further management options. The nurse specialist will update the patient regularly.

All patients will have direct contact details for CNS team should they have any concerns between visits.

Review patient in clinic/telephone at time of developing relapsed disease. Discuss disease status and further treatment options. Consider rescanning and discussion in MDT if the patient has a good performance status and wishing to consider salvage treatment. 

If not suitable or the patient does not wish to be considered for salvage treatment the following follow up schedule is advised.

Follow up schedule for Watchful Waiting

• 6 monthly PSA check – telephone/letter review*
• If PSA stable at 5 years - Discharge to GP - no routine PSA testing advised.
• Consider hormone therapy +/- reimaging (CT + Bonescan) if PSA doubling time <6months or patient develops symptoms suggestive of advancing disease.

*Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks.  Example: increased comorbidities where it is evident that hormone therapy would only be considered if the patient is symptomatic - Discharge to GP with advice that hormone therapy could be commenced on basis of symptom progression.

All patients will have direct contact details for CNS team should they have any concerns between visits.

Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular review. Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression. Provide details for Patient Initiated Review.

All patients will have direct contact details for CNS team should they develop symptoms of concern – Patient Initiated Review.

Follow up schedule

• 3 monthly PSA check – face to face (F2F) clinic review, if PSA response
• 6 monthly PSA checks – telephone or letter review.

Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks.  Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression. Provide details for Patient Initiated Review

If PSA progression (PSA doubling time <6months) or symptom progression consider CT + Bonescan and arrange discussion in local MDT.

All patient will have direct contact details for CNS team should they have any concerns between visits.

Follow up schedule

• 3 monthly PSA check – face to face (F2F) clinic review, if PSA response
• 6 monthly PSA checks – telephone or letter review.

Consider Discharge if it becomes evident that the patient is unlikely to benefit from regular PSA checks.  Example: increased comorbidities where it is evident that systemic treatment/palliative radiotherapy would only be considered if the patient is symptomatic - Discharge to GP with advice that further treatment could be considered on basis of symptom progression.  Provide details for Patient Initiated Review

If PSA progression (PSA doubling time <6 months) or symptom progression consider CT + Bonescan and arrange discussion in local MDT.

Review in Consultant Oncology clinic / Non Medical Prescribing clinic.

All patients will have direct contact details for CNS team should they have any concerns between visits.

IHC system: follow-up model for men who have completed radical treatment for prostate cancer