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 Protocols currently being altered due to MRI More stratified follow-up Initially PSA 3 monthly and DRE annually

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 vs bicalutamide vs LHRH Antagonist

Ca P : Post treatment NICE Surgery Radiotherapy 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 PSA yearly and refer back if >10

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

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

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

6 week follow up consultant appointment with histology Surgery for RCC 6 week follow up consultant appointment with histology Nurse appointment for hollistic needs between 6 weeks and 3 months post op Follow-up programme initiated Not suitable for telephone follow up Standard outpatient review Suitable for telephone follow-up Scan organised as per protocol with U and E beforehand Result of scan to consultant or Nurse Abnormal- outpatient appointment No recurrence: nurse telephone follow-up: Next scan organised and U and E 1 month before CT

Questions?