ASCO Supports ACS Guidelines for Prostate Cancer Survivor Care

Matthew J. Resnick, MD

ASCO has endorsed new prostate cancer survivorship care guidelines from the American Cancer Society (ACS) that provide a structure to help prostate cancer specialists and primary care physicians deliver high quality of care to patients with localized disease.

For clinicians, the guidelines should serve “as a platform to guide discussions with patients, as well as to encourage seamless transitions between prostate cancer specialists, such as urologists, radiation oncologists, and primary care physicians,” said Matthew J. Resnick, MD, a member of the ASCO Endorsement Panel.

The guidelines are “geared toward men who have been treated for localized prostate cancer and who have no evidence of disease,” said Resnick, an assistant professor of Urologic Surgery at Vanderbilt University Medical Center. They apply to patients “who have achieved a steady state [in their disease] and who may elect for various reasons to have their ongoing care provided by a primary care physician,” he added.

Key clinical care areas in prostate cancer survivorship include urinary function, sexual function, bowel function, and psychological health.

“Certainly, the issues surrounding mental health, depression screening, and appropriate level of physical activity, diet care issues, and smoking cessation are all essential, as are screening for second primary cancers,” said Resnick.

The ACS guidelines focus on these issues by addressing health promotion, detection of disease recurrence, screening and early detection of second primary cancers, assessment and management of physical and psychosocial long-term and late effects, and care coordination and practice implications.

In its endorsement statement, ASCO acknowledged “the effort put forth by the ACS to produce a combination of evidence and expert clinical practice-based management recommendations to guide prostate cancer survivorship care across care delivery settings.”

ASCO also added a number of qualifying statements to the original recommendations for clarification, expansion, and transference of care into a collaborative clinical setting.

Specifically, ASCO recommended measuring PSA levels every 6 to 12 months for the first 5 years, then an annual check thereafter; ensuring that survivors with elevated or rising PSA levels are evaluated by their primary care physician for further follow-up and treatment; adhering to ACS guidelines for screening and early detection; assessing and managing physical and psychosocial effects of prostate cancer and its treatment; and monitoring annually the long-term or late effects of prostate cancer and its treatment.

Resnick also noted the continually increasing part of the urologist across the entire prostate cancer continuum of care. He said that the role of the urologist in treating patients with castration-resistant prostate cancer (CRPC) has been evolving; however, that role has not been clearly defined.

According to Resnick, urologists now have the ability to “care for patients much longer before they go on to receive chemotherapy, before progression to castrate resistance and metastatic disease. A lot is driven by local practice patterns, relationships with medical oncologists, and personal preference given the lack of high quality comparative effectiveness evidence surrounding the optimal sequence of available treatments.”

“There is still a lot of work to be done in this space that is going to help define the roles of each individual specialist in order to optimize the delivery of care to patients with advanced disease,” said Resnick.

The endorsement of the ACS survivorship guidelines is included among ASCO’s clinical practice guidelines, which the organization states are intended to “serve as a guide for doctors and outline appropriate methods of treatment and care.”

Beyond these survivorship recommendations, ASCO has several guidelines for the diagnosis and treatment of prostate cancer, including PSA screening, systemic therapy in metastatic CRPC (mCRPC), non-hormonal therapy for men with mCRPC, adjuvant and salvage radiotherapy after prostatectomy, use of 5-alpha reductase inhibitors for prostate cancer chemoprevention, and initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer.