This is a summary of the follow-up guidance for practices taking part in the Local Enhanced Service for prostate cancer shared care.

At point of transfer to shared care, the urologist will clearly identify the schedule to follow by specifying which of the groups below apply to that patient.

 

Active surveillance

  • Ongoing active urology follow-up
  • Any blood tests requested should be added to ordercomms by urology
  • Results should go to urology

After radical prostatectomy

Criteria for discharge to shared care:

  • PSA nadir < 0.1 mcg/l
  • Asymptomatic

PSA testing regime:

  • Every 3 months for first year
  • Every 6 months for second and third year
  • Annually thereafter

Refer back to urology if:

  • PSA 0.2 mcg/l or higher and remains so after repeat in 8 weeks
  • Troublesome symptoms

After radical radiotherapy

Criteria for discharge to shared care:

  • PSA nadir < 2 mcg/l or stable PSA
  • Asymptomatic

PSA testing regime:

  • Every 3 months for first year
  • Every 6 months for second and third year
  • Annually thereafter

Refer back to urology if:

  • PSA > 2 mcg/l above nadir
  • Troublesome symptoms

Brachytherapy

Criteria for discharge to shared care:

  • PSA nadir < 2 mcg/l
  • Asymptomatic

Note these patients are followed up by WGH team so advice will be from there.

Hormonal therapy

Criteria for discharge to shared care:

  • PSA nadir < 10 mcg/l
  • Or stable PSA >10 (letter will stipulate)
  • Asymptomatic

PSA testing regime:

  • Every 3 months for first year
  • Every 6 months thereafter

Refer back to urology if:

  • PSA doubled from baseline
  • Troublesome symptoms

Watchful waiting

Criteria for discharge to shared care:

  • PSA nadir < 10 mcg/l
  • Or stable PSA >10 (letter will stipulate)
  • Asymptomatic

PSA testing regime:

  • Every 3 months for first year
  • Every 6 months thereafter if stable

Refer back to urology if:

  • Doubling of PSA from baseline
  • Troublesome symptoms

Editorial Information

Last reviewed: 04/12/2023

Next review date: 04/12/2025

Author(s): Ian Russell.

Version: 1.0