43 Early Stage Prostate Cancer Survivorship Challenges
Prostate cancer is the second most common cancer in men, and long-term survival is common. It is important that patients continue to receive comprehensive care after completion of active therapy for their early stage prostate cancer. Care for cancer survivors is most effective when conducted in coordination between cancer specialists and primary care physicians. Studies have indicated that primary physicians are nine times more likely to counsel patients and actively participate in survivorship care when they have received a written care plan for the treating specialist. Effective survivorship care is focused in three areas: overall or general health, screening for recurrence or secondary cancers, and identification and management of treatment related side effects.
As men with early stage prostate cancer move from active treatment to surveillance and survivorship, it is important for physicians to talk with them about general health and the components of a healthy lifestyle. This counseling should focus on maintaining a healthy diet, weight management, continuing physical exercise, limiting alcohol intake, and avoiding or eliminating tobacco use. Additional topics of discussion should include optimal management of comorbid medical conditions and health maintenance including routine cancer screenings. Prostate cancer survivors, particularly those who have received androgen deprivation therapy (ADT), are at higher risk of developing hypertension, osteoporosis, dyslipidemia, and diabetes and should be screened by their primary care physicians for these conditions annually. Additionally, anemia is common in men during and after ADT.
Cancer survivors are often concerned about recurrence, and screening for recurrence is an essential part of survivorship care. 44The American Cancer Society, American Society of Clinical Oncology, and National Comprehensive Cancer Network all recommend screening for prostate cancer recurrence with serum prostate-specific antigen (PSA) every 6 to 12 months during the first 5 years after treatment. After that time, annual serum PSA levels should be continued indefinitely. In addition to screening for prostate cancer recurrence, patients should also receive routine screening for secondary cancers, which may be related to treatment. It should be noted that men with prostate cancer treated with radiotherapy have a slightly increased risk for bladder and colorectal cancers, and thus particular attention should be given to early signs or symptoms of these cancers (1).
As a result of improving effectiveness of prostate cancer treatments, men may live for many years after treatment. Side effects of cancer treatment can be long-lived or even delayed in onset. Ongoing screening and management of bowel, urinary, bone, and sexual side effects are important. Additionally, evaluation of psychosocial effects of cancer and cancer treatment is important. Anxiety and depression are common among cancer patients, and these conditions can be effectively treated with medications and counseling. Many men report that the psychosocial effects of cancer treatment have a significant impact on their quality of life. Screening for and management of these conditions is an essential part of survivorship care.