Appendix 1 Patient Group GP Surveillance of PSA

Appendix 1 Patient Group GP Surveillance of PSA Levels and Prostate Cancer Follow Up LCS Group Treatment Status at referral to GP Frequency of Follow Up Threshold for re-referral Please use email Advice and Guidance Prostate Cancer Treatment Follow-up Curative treatment Men with localised low/intermediate risk disease with a life expectancy of ten years or more A Monthly PSA 3 -4 monthly for 2 years then repeat MRI, if stable 6/12 PSA for 2 years then repeat MRI +Biopsy (MRI and biopsies can be brought forward if PSA rising) Radical Prostatectomy • Undetectable PSA for 2 years in Secondary care • No non-cancer-related complications 1 year (for at least 5 years post-op) • PSA detectable (>0. 5 ng/ml) • High sensitivity PSA 0. 05 mg/ml (if available) Radical Hormone. Radiotherapy or Brachytherapy • PSA <1 ng/ml or stable above 1 ng/ml • after 1 year off hormones 6 months • PSA over 2 ng/ml Hormones • PSA <10 ng/ml on LHRH analogue 6 months • PSA DT < 1 year • Or Symptoms (bone pain, Weight loss) Watch & Wait ‘surveillance with palliative intention’ • Asymptomatic and PSA <30 ng/ml 6 months • PSA >30 ng/ml • Or Symptoms B C Palliative treatment Men with localised disease and a life expectancy of less than 10 years or men with extensive disease Active Surveillance ‘deferred curative treatment’ D E Persistently raised PSA +/-normal TRUS biopsies Men with >10 -year life expectancy Men with <10 -year life expectancy F G PSA Surveillance in primary care • Normal biopsy or low risk MRI • Stable serial PSA 6 months, DRE if change in symptoms • Increase of PSA by 25% at 6 months • Or significant change in DRE Observation • Normal biopsy/biopsy not indicated 1 year • PSA >15 • Or presenting PSA at referral to GP is higher then threshold as stated by urologist • Or symptoms Infection: If there is a suspicion of (not necessarily proven) infection (symptoms of UTI, urine dipstick or MSU) as the cause for a PSA rise, treat with prolonged course of antibiotics and repeat PSA at 6 weeks. Symptoms: new LUTS, new bone pain or weight loss. Authors: Dr A Thornton-Smith, Mr P Carter, Dr G Mitchell, Mr S Woodhams, Mr J Hicks Others Involved: GP Referral Guidelines group References: https: //cks. nice. org. uk/urological-cancers-recognition-andreferral#!scenario Published: 09/12 Reviewed: 06/18 12/19 Review due: 12/20 Annual review of this guidance will take place