Guidelines for Care of Prostate
Cancer Survivors Published by Cancer Society
Targeted to health care professionals
involved in treatment of thousands of survivors, mostly senior men
14, 2014 The bad news about prostate cancer is that it strikes about
240,000 men mostly older men - in the U.S. every year. The good news
is most men survive and are more likely to die of something other than
prostate cancer. This high rate of survival is one reason the American
Cancer Society has issued survivorship guidelines this week to help
health care professionals address issues that occur in men after
The American Cancer Society
Prostate Cancer Survivorship Care guidelines released this week outline
post-treatment clinical follow-up care for the myriad of long-term and
late effects of prostate cancer survivors.
The advice from the American Cancer
Society is to help doctors, nurses, and other professionals take care of
cancer survivors who have finished their cancer treatments.
Starting at diagnosis and until the
end of treatment, men with prostate cancer receive most of their health
care from specialists such as a urologists and oncologists. Once
treatment is finished, however, most of the medical care for these men
will be given by their primary care clinician.
A major reason guidelines are
needed is that prostate
cancer occurs mainly in older men who often have other health issues
that are treated by primary care clinicians.
The guidelines are based on
recommendations set forth by an expert panel convened as part of the
work of the National Cancer Survivorship Resource Center, a
collaboration between the American Cancer Society and The George
Washington University Cancer Institute, funded by a 5-year cooperative
agreement from the Centers for Disease Control and Prevention (CDC).
Prostate cancer survivors represent
more than four in ten male cancer survivors and one in five of all
cancer survivors in the United States.
While guidelines exist for
treatment and surveillance for recurrent disease, availability of
guidelines for long-term post-treatment care is limited. The American
Cancer Society Prostate Cancer Survivorship Care guidelines were
developed using a combined approach of evidence synthesis and expert
They address health promotion,
surveillance for recurrence and screening for second primary cancers,
and the assessment and management of physical and psychosocial long-term
and late effects resulting from prostate cancer and its treatment. A key
challenge to the development of the guidelines was the limited
availability of published evidence informing the clinical management of
prostate cancer survivors after treatment.
information needs evolve as patients transition from
treatment through various stages of survivorship, survivor
and caregiver information needs should be assessed
regularly, with information and support services provided or
referred to as necessary.
care clinicians should provide regular evaluations of
survivors to determine appropriate levels of participation
in health promotion and lifestyle modification programs.
care clinicians should conduct routine assessments of body
mass index among survivors across the prostate cancer
survivorship continuum, with recommendations for limiting
consumption of high-calorie foods and beverages for
survivors who are overweight or obese.
care clinicians should educate survivors regarding the
association between physical activity and lower overall and
prostate cancer-specific mortality and improved quality of
smoking after treatment of prostate cancer increases the
risk of cancer recurrence and second cancers, primary care
clinicians should assess for tobacco use and offer or refer
survivors to cessation counseling and resources.
existing evidence is not definitive with regard to frequency
of monitoring for recurrence using PSA testing, a leading
clinical practice guideline, The NCCN guidelines for
prostate cancer treatment recommend measuring serum PSA
levels every 6 to 12 months for the first 5 years after
definitive treatment, and then to recheck annually.
Clinicians should be aware of a small increased risk of
second primary cancers after radiation therapy compared with
men receiving surgery. While evidence does not support
increased frequency or intensity of screening, adherence to
routine ACS screening guidelines for the early detection of
any new cancers is recommended.
Survivors should be assessed for physical (e.g.: urinary,
sexual, bowel) and psychosocial effects of prostate cancer
and its treatment; the focus of assessment should be
tailored to the type of cancer treatment received and
current disease state to trigger appropriate self-management
and clinical management strategies for support and therapy.
Estimates indicate that as many as 30% of patients with
prostate cancer experience clinically relevant general
distress, 25% have increased anxiety, and nearly 10%
experience major depressive disorder. These guidelines
affirm early identification, treatment, and ongoing
assessment for psychological distress as important aspects
of prostate cancer survivorship care.
We are hopeful that the hard work
that went into the development of these much-needed guidelines will pay
off in improved care for the approximately 240,000 men diagnosed with
prostate cancer every year, said Rebecca Cowens-Alvarado, MPH,
principal investigator for the National Cancer Survivorship Resource
Center, director of Cancer Control Mission Strategy at the American
Cancer Society and co-author of the report.
The adoption of these guidelines
will be a critical step forward to improve the delivery of prostate
cancer survivorship care.
About The National Cancer Survivorship Resource
The National Cancer
Survivorship Resource Center (The Survivorship Center) is a
collaboration between the American Cancer Society and The George
Washington University Cancer Institute funded through a 5-year
cooperative agreement with the Centers for Disease Control and
Prevention. Its goal is to shape the future of cancer survivorship care
and improve the quality of life of cancer survivors as they transition
from treatment to recovery.
For more information about The
Survivorship Center, visit cancer.org/survivorshipcenter. The guidelines
are supported in part by Cooperative Agreement #5U55DP003054 from the
Centers for Disease Control and Prevention. The contents of the
guidelines article are solely the responsibility of the authors and do
not necessarily represent the official views of the Centers for Disease
Control and Prevention.