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 vs bicalutamide vs LHRH Antagonist

5. 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

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
Transperineal vs 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. 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

10. Questions?