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Standardised follow-up

Standardised follow-up. Steve Bromage. Urological cancer follow-up. Prostate Active surveillance Watchful waiting Post treatment Raised PSA Renal Telephone follow-up Bladder Secondary care ( cystoscopic ). Prostate cancer: Active Surveillance. Follow-up secondary care

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Standardised follow-up

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  1. Standardised follow-up Steve Bromage

  2. Urological cancer follow-up • Prostate • Active surveillance • Watchful waiting • Post treatment • Raised PSA • Renal • Telephone follow-up • Bladder • Secondary care (cystoscopic)

  3. Prostate cancer: Active Surveillance • Follow-up secondary care • Protocols currently being altered due to MRI • More stratified follow-up • Initially PSA 3 monthly and DRE annually

  4. Watchful waiting • Often discharged to primary care • PSA 6 monthly- yearly • Individual thresholds set • Hormone treatment indicated: • PSA rising over 50 without significant symptoms • Fast doubling time • Consider side effects of hormone treatment • LHRH agonist vsbicalutamidevs LHRH Antagonist

  5. Ca P : Post treatment • NICE • Check PSA levels …….at least every 6 months for the first 2 years, and then at least once a year after that. [2019 consultation] • After at least 6 months’ initial follow-up, consider a non-hospital based follow-up strategy for people with a stable PSA who have had no significant treatment complications, unless they are taking part in a clinical trial that needs formal clinic-based follow-up [2019 consultation] • Estimate PSA doubling time if biochemical relapse occurs. Base this on a minimum of 3 measurements over at least a 6-month period. [2008] • Surgery • Discharge at 2 years • PSA yearly and refer back if >0.1 • Radiotherapy • Discharge at 2 years • PSA yearly and refer back if >10

  6. Hormone treated Ca P • Often discharged on established hormone treatment • PSA yearly basis • Re-refer • if >10 • Symptomatic (worsening LUTS, bony pain) • Patient led PSA monitoring • Technology • EG. MyPSA app • Infoflex • My Medical Record • Somerset Cancer Register

  7. Raised PSA and negative investigations • Individualised PSA threshold based • MRI • PSA • PSA density • Biopsy Y/N • Transperinealvs TRUS • Age • Risk Factors • 2 PSA minimum to generate re-referral

  8. Renal cancer Follow-up • Assign risk on histology (low/intermediate/high) • Holistic needs assessment • Normally CT follow-up for 5-10 years • Little requirement for face-face appointments

  9. Questions?

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