However, ASCO has added a qualifying statement that colorectal cancer should be ruled out in survivors experiencing rectal bleeding after radiation therapy. The guidelines suggest measuring prostate-specific antigen (PSA) levels every 6 to 12 months for the first 5 years and re-checking annually thereafter.

ASCO has added a qualifying statement that prostate cancer specialists may recommend more frequent PSA monitoring during early survivorship, particularly in men with higher risk of prostate cancer recurrence and men who may be candidates for salvage therapy.


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The guidelines state that the exact schedule for PSA measurement should be determined by both the prostate cancer specialist and primary care physician in collaboration.

“I think the guidelines and the endorsement are absolutely perfect and just what we need. There are more prostate cancer survivors than ever before and the numbers are going to be increasing. The number of the men being cured exacts a price in terms of physical limitations and emotional limitations,” said Gerald Andriole, MD, who is the head of urologic surgery at Washington University School of Medicine in St. Louis, MO.

“Anything that can be done to bring guidelines onto the same page for doctors as this does is welcomed. It will help eliminate confusion.”

Dr. Andriole told Cancer Therapy Advisor that there is controversy right now about the use of PSA screening and these guidelines with the new endorsement will help give clinicians a much needed tool. Yair Lotan, MD, who is a professor of urology at the University of Texas in Dallas, TX, said PSA monitoring is important in the first 5 years following successful therapy.

However, he said PSA levels are one of several issues that have to be addressed. In addition, he noted that there is a benefit in having only one set of guidelines.

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“It is good to endorse and not make up your own guidelines. It is efficient,” said Dr. Lotan in an interview with Cancer Therapy Advisor. “Care now involves much more than just saying we have cured [a patient] by looking at [their] PSA levels but you also have to look at psychosocial issues.”

The guidelines call for counseling survivors to achieve and maintain a healthy weight through a healthful diet and increased physical activity (at least 150 minutes per week of physical activity). It recommends consuming a diet intake of at least 600 IU of vitamin D per day and consuming adequate calcium (not to exceed 1,200 mg a day). 

The guidelines state that prostate cancer survivors should be counseled to avoid or limit alcohol consumption to no more than two drinks per day. In addition, clinicians should assess for tobacco use and offer cessation counseling and resources.

References

  1. Resnick MJ, Lacchetti C, Bergman J, et al. Prostate Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. February 9, 2015. [Epub ahead of print] pii: JCO.2014.60.2557.
  2. DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252-271.