Abstract
The optimal role for primary care in providing follow-up for men with prostate cancer is uncertain. A systematic review of international guidelines was undertaken to help identify key elements of existing models of follow-up care to establish a theoretical basis for evaluating future complex interventions. Many guidelines provide insufficient information to judge the reliability of the recommendations. Although the PSA test remains the cornerstone of follow-up, the diversity of recommendations on the provision of follow-up care reflects the current lack of research evidence on which to base firm conclusions. The review highlights the importance of transparent guideline development procedures and the need for robust primary research to inform future evidence-based models of follow-up care for men with prostate cancer.
Highlights
Management options for localised and locally advanced prostate cancer include curative treatment, active surveillance and watchful waiting
In the context of current widespread interest in greater involvement of primary care in cancer follow-up (Pascoe et al, 2004), we reviewed existing guidelines on follow-up for prostate cancer as part of a larger study to determine the optimal role for primary care
Monitoring prostate-specific antigen (PSA) remains the cornerstone of follow-up for men with prostate cancer, the diversity of guideline recommendations on the frequency and duration of PSA testing, and components of follow-up other than PSA testing, reflects the current lack of research evidence on which to base firm conclusions
Summary
Management options for localised and locally advanced prostate cancer include curative treatment, active surveillance and watchful waiting. Active surveillance is an option for men with low- or intermediate-risk localised disease that involves close monitoring to target curative treatment to those who would benefit most. Watchful waiting is a way to manage men who are unsuitable for curative treatment that involves relatively lax monitoring and palliative treatment when symptoms develop (NICE, 2008). Various alternative models of cancer follow-up care have emerged, including nurse specialist and primary-care-led followup, and ‘shared care’ approaches. Specialist nurse-led prostate cancer follow-up has been evaluated in randomised trials, which found it to be a safe alternative to consultant-led follow-up (Helgesen et al, 2000; Faithfull et al, 2001). It is timely to review international guidelines to help (1) identify key elements of existing models of care and (2) establish a theoretical basis for evaluating future complex interventions
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