Health Measures
1. Collect information on prostate cancer and its treatment, side effects, other health problems and care services, and provide or refer prostate cancer survivors to relevant information and resources.
2. Advise prostate cancer patients to control their high-calorie diet and beverage intake and to increase appropriate physical activity to maintain a normal weight.
3. Advise prostate cancer patients to exercise for at least 150 minutes per week; this includes weight loss exercises.
4. Advise prostate cancer patients to develop good eating habits and eat more cereals, fruits and vegetables and whole grains.
a Eat more micronutrient-rich vegetables and fruits, less foods containing unsaturated fats, at least 600 IU of vitamin D daily, and the right amount of calcium (not more than 1200 mg/d).
bPatients with prostate cancer who have poor nutrient absorption (e.g., intestinal problems that may affect nutrient absorption) are advised to consult a registered dietitian.
5. Prostate cancer patients are advised to avoid or consume alcoholic beverages in small amounts, no more than twice a day.
6. Advise prostate cancer patients not to smoke cigarettes or similar tobacco products.
Monitoring of Prostate Cancer Recurrence
7.For the first five years after treatment, serum PSA (prostate-specific antigen) levels should be measured every 6-12 months in prostate cancer patients. After that, it will be reviewed annually.
ASCO specifically states that prostate cancer specialists may recommend high frequency PSA testing in the early post-treatment period for survivors with a higher risk of recurrence or a higher likelihood of salvage therapy. The exact PSA testing regimen for prostate cancer patients requires a combination of recommendations from prostate cancer specialists and primary care physicians.
8. Primary care physicians should evaluate prostate cancer survivors with elevated PSA levels to determine further follow-up and treatment options.
9. It is recommended that prostate cancer survivors confer with their oncologist for an annual DRE (rectal exam).
ASCO specifically states that primary care physicians should consult with a prostate cancer specialist regarding the need for a rectal exam as it relates to tumor recurrence detection in prostate cancer survivors.
Screening for secondary tumors
10. According to the ACSO guidelines for screening and early diagnosis, prostate cancer survivors who have received prior radiation therapy may be at risk for developing bladder and colorectal cancer, and screening and early diagnosis are recommended for high-risk groups if conditions warrant.
ASCO specifically states that patients and physicians should be aware of the possible increased risk of bladder and colorectal cancer after the completion of pelvic radiation therapy. Prostate cancer survivors should be routinely screened for colorectal cancer according to previous care guidelines and evaluated for any signs or symptoms of bladder or colorectal cancer development.
11. If a prostate cancer survivor presents with symptoms of blood in the urine, cytology and an upper branch urinary tract examination are recommended to determine the cause and to rule out the possibility of bladder cancer.
12. If a prostate cancer survivor presents with rectal bleeding, pain, or other symptoms, consultation with a relevant specialist or a participating radiation oncologist and examination is recommended to determine the cause and rule out the possibility of colorectal cancer.
Assessment, control and treatment of the physiological and psychological effects of prostate cancer
Anemia: a specific risk factor for men receiving ADT (androgen deprivation therapy, also known as depot treatment)
13. It is recommended (ASCO replaced “performed” with “recommended” in the ASC version) that prostate cancer survivors with signs of anemia have an annual CBC (complete blood count) to monitor their hemoglobin levels.
Bowel Dysfunction
14. Inform prostate cancer survivors of bowel function and related conditions (e.g., rectal bleeding).
15. If a prostate cancer survivor has a negative colorectal cancer test result, it is recommended that patients with rectal bleeding be given prescription medications such as stool softeners, topical corticosteroids, or anti-inflammatory drugs.
ASCO specifically states that if a survivor develops rectal bleeding after radiation therapy, colorectal cancer can be ruled out and the treatment plan should be developed in discussion with a radiation oncologist who has been involved in the treatment. Treatment options include the use of corticosteroid suppositories to reduce the level of inflammatory response, the use of stool softeners, or dietary changes.
16. If a prostate cancer survivor develops persistent rectal disease (e.g., bleeding, abnormal sphincter function, rectal irritability, etc.), the patient is advised to consult with a specialist.
Fine vessel disease and metabolic disease: specific risk factors for men undergoing ADT (depot treatment)
17. Determine the patient’s blood pressure, lipid and glucose levels according to the USPSTF (United States Preventive Services Task Force) guidelines for cardiovascular risk factor assessment and screening.
Grief/depression/PSA anxiety
18. Assess grief/depression/PSA anxiety status in prostate cancer survivors at the first follow-up visit or other appropriate time according to clinical guidelines (ASCO removes “periodically, at least annually” and “simple screening tools such as a grief thermometer” from the ASC version of the guideline recommendations). “).
ASCO specifically states that physicians should refer to the ASCO guidelines for screening, assessment, and care of anxiety and depression in adult cancer patients when addressing this area.
19. Control sadness/depression in prostate survivors with the help of counseling services or medication.
20. If counseling services and medications are not effective, it is recommended that sad/depressed survivors receive expert evaluation or further treatment.
Fracture risk/osteoporosis: specific risk factors for men undergoing ADT (depot treatment)
21. Risk assessment of prostate cancer survivors who undergo ADT (debulking therapy), undergo baseline DEXA (dual-line X-ray absorptiometry) scans, and have poor FRAX (WHO fracture risk assessment) scores.
22. For prostate cancer survivors at high risk of fracture, weekly bisphosphonate therapy (oral alendronate at a dose of 70 mg once) or annual treatment with zoledronic acid administered intravenously (at a dose of 5 mg once) is recommended to increase the patient’s bone mineral density. In addition, patients at high risk for osteoporosis can also use Didanosemide (Denosumab), which is approved by the U.S. Food and Drug Administration.
ASCO Special Announcement: To improve bone health in prostate cancer survivors at risk for osteoporosis, primary care physicians should consult with a prostate cancer specialist and design a treatment plan. This treatment plan should be based on the results of their discussion of the pros and cons of skeletal-targeted drugs.
Sexual dysfunction/body image
23. Discuss with prostate cancer survivors about their sexual function.
24. Monitor erectile function in prostate survivors by medical means.
25, ED (erectile dysfunction) can be treated in a variety of ways, such as penile prosthetics, type 5 phosphodiesterase inhibitor drugs (e.g., sildenafil sildenafil, vardenafil hydrochloride, tadalafil tadalafil).
26. Prostate survivors with chronic abnormal sexual function are advised to consult a urologist, sexual health specialist, or pharmacist to determine the cause and take appropriate treatment measures.
Sexual intimacy
27. Encourage prostate cancer survivors to discuss topics related to sexual intimacy with their partners and to consult a specialist or related service if necessary.
28.Treat erectile dysfunction with the help of the prescribed medications mentioned above.
29. Suggest the use of sex toys for homosexual or heterosexual prostate cancer survivors to improve erectile dysfunction. During sexual treatment, you can refer to the advice of experts in the field of mental health.
Abnormal urinary function
30. Discuss urinary function abnormalities (e.g., urinary line, bladder emptying difficulties) and urinary incontinence with prostate cancer survivors.
31. Consider regular urination and suggest that prostate cancer survivors address nocturia, frequency, and urgency by taking anticholinergic medications (e.g., oxybutynin). Survivors with slow urinary flow are advised to take alpha-inhibitors (e.g., tamsulosin tamsulosin).
32. Survivors who develop urinary incontinence after prostatectomy are advised to consult with a health professional about pelvic recovery. At a minimum, such prostate cancer survivors should be instructed to perform Kegel exercises (perineal contraction exercises).
33. Prostate cancer survivors with chronic incontinence or associated urologic disease should be advised to visit a urologist for further investigations (e.g., urodynamic testing, cytology) and to discuss further treatment options (e.g., surgical implantation of a urethral suspensory band or artificial ureter for patients with incontinence).
Vasomotor symptoms (e.g., hot flashes): specific risk factors for men undergoing ADT (detumescent therapy)
34. Although this entry is not currently approved by the U.S. Food and Drug Administration, selective 5-hydroxytryptamine, adrenergic-activated reuptake inhibitors, and gabapentin (gabapentin) are all available for patients with vasomotor symptoms.
ASCO Special Note: ASCO believes that further clinical investigation is necessary to validate the recommendation. At that time, physicians should be aware of the development of vasomotor symptoms in ADT (deconditioning) and also discuss with patients the potential risks, benefits, and costs of vasomotor symptom treatment options.
Care Coordination and Rehabilitation Exercises
35. Before a prostate cancer survivor is referred to a primary care provider (PCC), it is recommended that the primary care specialist provide the primary care provider with an overview of treatment and a plan of care. The primary care provider and the oncologist involved in treatment should consult on the details of the care plan and define their responsibilities and roles.
36 The primary care provider acts as the primary medical care coordinator during prostate cancer screening, treatment, and post-treatment care, focusing on preventive care and management of complications in patients with prostate cancer and addressing physical and psychological issues of survivors on a regular basis. These care operations require the assistance of participating treating clinicians.
37. Conduct an annual assessment of the long-term or late effects of prostate cancer and its treatment, which includes urinary, bowel function, sexual function, and hormonal disorders.
38. Encourage the involvement of caregivers, spouses, and peers in the daily care of prostate cancer survivors.
39. Recommend that prostate survivors take full advantage of the care resources available in the community or from other survivors.