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Prostate Cancer - Coggle Diagram
Prostate Cancer
Assessment
Consider referring a person with possible symptoms of prostate cancer using a suspected cancer pathway referral (for an appointment within 2 weeks) if their PSA level is above the threshold for their age in Table 3. Take into account the person's preferences and any comorbidities when making the decision.
Secondary care assessment for people with suspected prostate cancer may include: a prostate biopsy or imaging.
Refer the person using a suspected cancer pathway referral (for an appointment within 2 weeks) if their prostate feels malignant on DRE.
PSA thresholds are age specific.
Consider prostate-specific antigen (PSA) testing - provide information and advice to enable to make an informed choice, if appropriate arrange testing. PSA testing should not be offered to asymptomatic people.
The aim of PSA testing is to detect localized prostate cancer when treatment can be offered that may cure cancer or extend life.
Offer a digital rectal examination (DRE).
Testing has benefits such as early detection and treatment, but also has limitations such a false negatives and false positives leading to unnecessary investigation and treatment.
Suspect prostate cancer in men who have any of the following symptoms that are unexplained: lower back or bone pain, lethargy, erectile dysfunction, visible haematuria, anorexia/weight loss, LUTS or lower back pain, bone pain, weight loss.
Management
Radical treatment: PSA levels should be measured no earlier than 6 weeks after treatment, then at least every 6 months for 2 years, and once a year thereafter. After at least 6 months' initial follow up, consider a remote 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. Do not routinely offer DRE.
For all: review and manage disease complications, adverse effects from treatment and impact on quality of life.
Active surveillance: Year 1 PSA 3-4 monthly, PSA kinetics, at 12 months perform DRE, 12-18 months multiparametric MRI. Year 2 PSA 6 monthly, monitor PSA kinetics, perform DRE every 12 months.
Follow up and monitoring for watchful waiting: PSA level once per year, DRE is not recommended on a routine basis, if evidence of significant disease progression review should be undertaken by urological cancer specialist, follow up should take place if there is a local agreement in place.
If biochemical relapse (rising PSA level) occurs, calculate an estimate of PSA doubling time based on a minimum of three measurements over at least 6 months.
Offer advice on where to assess advice and support such as Cancer Research, Prostate cancer Uk etc.
Refer men with evidence of significant disease progression (rapidly rising PSA level or bone pain) to a urological cancer specialist.
Management options in secondary care depend on the man's prognostic risk. Options include watchful waiting, active surveillance, radical treatments and adjunctive/palliative treatments.
Treatment for prostate cancer will be initiated and managed in secondary care.
Risk factors
Body weight and body mass index (BMI)
Family history of prostate cancer and genetics
Black ethnicity
Increasing age
Definition: Prostate cancer is a malignant tumour of the prostate. Localized prostate cancer is confined within the capsule and seldom causes symptoms. Locally advanced prostate cancer extends beyond the capsule of the prostate and is often asymptomatic when diagnosed. Metastatic prostate cancer most frequently affects the bones, where it causes pain and fragility fractures. The aetiology of prostate cancer is unknown.