By Dr. Anoop Meraney
Approximately 240,000 men are diagnosed with prostate cancer each year. As a result of PSA testing, 90 percent of patients diagnosed with prostate cancer have localized or locally advanced prostate cancer, which is a potentially curable stage of the disease.
The five-year survival for these patients is close to 100 percent. Several new developments and drugs have also resulted in improved survival for patients with advanced prostate cancer. Because of these advances, there are now approximately 2.8 million prostate cancer survivors in the United States. One in five cancer survivors are prostate cancer survivors.
Treatment of prostate cancer can involve surgery (prostatectomy), radiation therapy, hormone therapy or chemotherapy. Patients with prostate cancer could have received one or more of these treatment options to cure or control the disease. Although the value of PSA testing as an initial screening tool for diagnosing is debatable, PSA as a post-treatment biomarker is a sensitive tool to assess for recurrence and treatment response.
All survivors need long-term cancer surveillance with post-treatment PSA monitoring. The Hartford Healthcare Cancer Institute offers a survivorship visit to all patients who have completed active treatment. Survivors meet with a nurse practitioner who specializes in cancer survivorship. The visit, designed to address prostate cancer care and overall health and wellness, provides a treatment-related summary to survivors.
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Cancer-related follow-up as specified by national guidelines, based upon the individual’s stage and treatment, is also reviewed during the visit. Survivors are provided with educational materials, links to resources, and information about support programs. While advances have resulted in improved survival, prostate cancer survivors face unique challenges related to side effects and other health concerns as a result of their treatment.
Side effects can vary based on the treatment, and a patient’s pre-existing risk factors and comorbidities. Patients undergoing prostatectomy, radiation therapy and hormone therapy can develop sexual dysfunction, urinary and bowel toxicity and adverse psychological effects. Patients undergoing hormone therapy and chemotherapy are at risk of developing bone-related complications, cardiovascular risks and metabolic effects of treatment. The survivorship visit is also designed to assess and address treatment-related side effects. Various risk assessment tools, including questionnaires, detect and assess severity of side effects.
Many prostate cancer survivors have other underlying medical conditions and regularly need to see several specialists in addition to a team of prostate cancer specialists. Survivorship visits facilitate care coordination between all health care providers responsible for the care of a survivor. Visits are also designed to address the individual’s global health including nutrition counseling, suggestions related to physical activity, smoking cessation and screening for secondary and other malignancies.
Our hope is that every prostate cancer survivor avails this opportunity, which is geared to help all survivors take control of their overall health and well-being.
Dr. Anoop Meraney is director of urologic oncology at Hartford Hospital. For for more information, visit Hartford HealthCare’s Tallwood Urology & Cancer Institute.