Prostate Cancer Specialists Research Articles

Understanding of prognosis in non-metastatic prostate cancer: a randomised comparative study of clinician estimates measured against the PREDICT prostate prognostic model

PREDICT Prostate is an individualised prognostic model that provides long-term survival estimates for men diagnosed with non-metastatic prostate cancer (www.prostate.predict.nhs.uk). In this study clinician estimates of survival were compared against model predictions and its potential value as a clinical tool was assessed. Prostate cancer (PCa) specialists were invited to participate in the study. 190 clinicians (63% urologists, 17% oncologists, 20% other) were randomised into two groups and shown 12 clinical vignettes through an online portal. Each group viewed opposing vignettes with clinical information alone, or alongside PREDICT Prostate estimates. 15-year clinician survival estimates were compared against model predictions and reported treatment recommendations with and without seeing PREDICT estimates were compared. 155 respondents (81.6%) reported counselling new PCa patients at least weekly. Clinician estimates of PCa-specific mortality exceeded PREDICT estimates in 10/12 vignettes. Their estimates for treatment survival benefit at 15 years were over-optimistic in every vignette, with mean clinician estimates more than 5-fold higher than PREDICT Prostate estimates. Concomitantly seeing PREDICT Prostate estimates led to significantly lower reported likelihoods of recommending radical treatment in 7/12 (58%) vignettes, particularly in older patients. These data suggest clinicians overestimate cancer-related mortality and radical treatment benefit. Using an individualised prognostic tool may help reduce overtreatment.

Controversial issues in the management of patients with advanced prostate cancer: Results from a Canadian consensus forum.

The management of advanced prostate cancer (PCa) continues to evolve with the emergence of new diagnostic and therapeutic strategies. As a result, there are multiple areas in this landscape with a lack of high-level evidence to guide practice. Consensus initiatives are an approach to establishing practice guidance in areas where evidence is unclear. We conducted a Canadian-based consensus forum to address key controversial areas in the management of advanced PCa. As part of a modified Delphi process, a core scientific group of PCa physicians (n=8) identified controversial areas for discussion and developed an initial set of questions, which were then reviewed and finalized with a larger group of 29 multidisciplinary PCa specialists. The main areas of focus were non-metastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-sensitive prostate cancer (mCSPC), metastatic castration-resistant prostate cancer (mCRPC), oligometastatic prostate cancer, genetic testing in prostate cancer, and imaging in advanced prostate cancer. The predetermined threshold for consensus was set at 74% (agreement from 20 of 27 participating physicians). Consensus participants included uro-oncologists (n=13), medical oncologists (n=10), and radiation oncologists (n=4). Of the 64 questions, consensus was reached in 30 questions (n=5 unanimously). Consensus was more common for questions related to biochemical recurrence, sequencing of therapies, and mCRPC. A Canadian consensus forum in PCa identified areas of agreement in nearly 50% of questions discussed. Areas of variability may represent opportunities for further research, education, and sharing of best practices. These findings reinforce the value of multidisciplinary consensus initiatives to optimize patient care.

Determinants of quality prostate cancer survivorship care across the primary and specialty care interface: Lessons from the Veterans Health Administration.

BackgroundWith over 3 million US prostate cancer survivors, ensuring high‐quality, coordinated cancer survivorship care is important. However, implementation of recommended team‐based cancer care has lagged, and determinants of quality care across primary and specialty care remain unclear. Guided by the theoretical domains framework (TDF), we explored multidisciplinary determinants of quality survivorship care in an integrated delivery system.MethodsWe conducted semistructured interviews with primary (4) and specialty (7) care providers across 6 Veterans Health Administration clinic sites. Using template analysis, we coded interview transcripts into the TDF, mapping statements to specific constructs within each domain. We assessed whether each construct was perceived a barrier or facilitator, examining results for both primary care providers (PCPs) and prostate cancer specialists.ResultsCancer specialists and PCPs identified 2 primary TDF domains impacting their prostate cancer survivorship care: Knowledge and Environmental context and resources. Both groups noted knowledge (about survivorship care) and procedural knowledge (about how to deliver survivorship care) as positive determinants or facilitators, whereas resources/material resources (to deliver survivorship care) was noted as a negative determinant or barrier to care. Additional domains more commonly referenced by cancer specialists included Social/professional role and identity and Goals, while PCPs reported the domain Beliefs about capabilities as relevant.ConclusionsWe used the TDF to identify several behavioral domains acting as determinants of high‐quality, team‐based prostate cancer survivorship care. These results can inform prostate cancer survivorship care plan content, and may guide tailored, multidisciplinary implementation strategies to improve survivorship care across the primary and specialty care interface.

Consensus statements on the management of clinically localized prostate cancer from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology.

ObjectiveTo formulate consensus statements to facilitate physician management strategies for patients with clinically localized prostate cancer (PCa) in Hong Kong by jointly convening a panel of 12 experts from the two local professional organizations representing PCa specialists, who had previously established consensus statements on the management of metastatic PCa for the locality.MethodsThrough a series of meetings, the panellists discussed their clinical experience and the published evidence regarding various areas of the management of localized PCa, then drafted consensus statements. At the final meeting, each drafted statement was voted on by every panellist based on its practicability of recommendation in the locality.ResultsA total of 76 consensus statements were ultimately accepted and established by panel voting.ConclusionDerived from the recent evidence and major overseas guidelines, along with local clinical experience and practicability, the consensus statements were aimed to serve as a practical reference for physicians in Hong Kong for the management of localized PCa.

Nurse-Led Supportive Care Intervention for Men With Advanced Prostate Cancer.

To understand the context for implementing ProsCare by prostate cancer specialist nurses (PCSNs) and, in doing so, further develop the intervention and implementation strategy. 30 PCSNs participated in four semistructured focus groups to evaluate a telephone-based supportive care intervention led by nurses for men with advanced prostate cancer. Data were coded into the Consolidated Framework for Implementation Research to evaluate the ProsCare program content and guide the implementation and evaluation of this targeted program for men with advanced prostate cancer. Participants strongly endorsed specific ProsCare program components amid a recommendation of delivery mechanisms and a comprehensive centralized implementation strategy, including PCSN role promotion, education, and professional development. PCSNs validated ProsCare and supported its implementation as a supportive care intervention. ProsCare is a feasible nurse-led intervention closely matched with men's supportive care needs and the PCSN scope of practice.

Developing a Nurse-Led Intervention for Men With Advanced Prostate Cancer: A Preimplementation Study

Background: Men with advanced prostate cancer can experience poor life quality and health outcomes compared with men with localized disease. Closely matching men's needs and identifying barriers and facilitators to implementation were critical first steps for ensuring the feasibility of our nurse-led telephone-based supportive care intervention for men with advanced prostate cancer. Aim: The aim of this study is to understand the context for implementing ProsCare from PCSNs, and in doing so, further develop the intervention and implementation strategy. Methods: A total of 30 Prostate Cancer Specialist Nurses (PCSNs) participated in 4 semistructured focus groups. Data were coded into the Consolidated Framework for Implementation Research (CFIR) to evaluate the ProsCare program content and guide the implementation and evaluation of this targeted program for men with advanced prostate cancer. Results: Participants validated ProsCare components of (1) decision support; (2) treatment education with self-management and skills training for symptom effects, including exercise prescription; (3) routine screening for psychological distress with referral; (4) psycho-education with tailored distress management strategies; and (5) communicating with health professionals. Data supported a revised treatment schedule and a comprehensive implementation plan including professional education and centralised administration. Conclusion: ProsCare is a valid supportive care nurse-led intervention. The CFIR framework is useful for the structured identification of implementation factors.

Physician attitudes about genetic testing for localized prostate cancer: A national survey of radiation oncologists and urologists

IntroductionGenetic testing has been recently put forth as a strategy to improve decision-making in the management of localized prostate cancer. Little is known about how frequently prostate cancer specialists are using these tests, or whether they consider them important or effective. We performed a national survey of radiation oncologists and urologists on their perceptions and self-reported use of genetic testing. MethodsFrom January to July 2017, a 4-wave mail survey was performed involving 915 radiation oncologists and 940 urologists about genetic testing and decision-making for localized prostate cancer. The survey queried the frequency and type of genetic test and the degree of importance and confidence of such tests. Pearson chi-square and multivariable logistic regression analyses were performed to identify respondent characteristics associated with outcomes. ResultsOverall response rate was 37.3% (n = 691). One in six specialists reported frequently using genetic tests with urologists more likely than radiation oncologists to do so (26% vs. 4%; OR: 3.51, p < 0.001) and their perceived higher importance (46% vs. 20%; adjusted OR: 3.51, p < 0.001) as well as their confidence in doing so (70% vs. 39%; OR: 3.81, p < 0.001) for decision-making for localized prostate cancer. Prolaris and Oncotype represented the most commonly cited tumor-based genetic testings. ConclusionsFew radiation oncologists and urologists report frequently using genetic testing for treatment decision-making among patients diagnosed with localized prostate cancer, though more urologists use these tests and believe they yield meaningful results.

Recommendations of Active Surveillance for Intermediate-risk Prostate Cancer: Results from a National Survey of Radiation Oncologists and Urologists

BackgroundWhile active surveillance (AS) for intermediate-risk prostate cancer (PCa) remains controversial, perceptions of AS and treatment recommendations among PCa specialists are largely unknown. Thus, we performed a national survey of radiation oncologists (ROs) and urologists (UROs) to elicit attitudes and AS recommendations for intermediate-risk PCa. ObjectiveTo determine whether AS for PCa is becoming readily accepted by PCa specialists in the USA. Design, setting, and participantsFrom January to July 2017, we conducted a national survey of 915 ROs and 940 UROs on perceptions of AS and its use among patients with intermediate-risk PCa. Outcome measurements and statistical analysisPerceived effectiveness and comfort with AS and recommendation of AS from case presentations represented the primary outcomes. Pearson chi-square and multivariable logistic regression analyses were used to identify physician characteristics associated with primary outcomes. Results and limitationsOverall, the response rate was 37.3% (n=692) and was similar for ROs and UROs (35.7% vs 38.7%; p=0.18). For intermediate-risk PCa, both UROs and ROs expressed limited favorable views that AS is effective (39.8% vs 33.0%; p=0.06) and felt comfortable recommending it (37.6% vs 25.9%; p=0.001). From clinical scenarios, both specialties infrequently recommended AS for a healthy patient diagnosed with intermediate-risk PCa. For a healthy 55-yr-old patient with PSA of 8ng/ml and Gleason 3+4 PCa, few ROs and UROs recommended AS (2.8% vs 4.3%; adjusted odds ratio [AOR] 0.42; p=0.12). AS was more likely to be recommended equally by ROs and UROs for a healthy 75-yr-old with the same clinicopathologic characteristics (29.0% vs 35.4%; AOR 0.68; p=0.09). Limitations include a modest response rate for our survey. ConclusionsOur national survey revealed that many ROs and UROs do not believe that AS is effective or feel comfortable recommending it or selecting it as an option for younger patients with intermediate-risk PCa. Patient summaryWe performed a national survey of radiation oncologists and urologists to assess attitudes regarding active surveillance (AS) and its use among patients with intermediate-risk prostate cancer. Our study demonstrates that radiation oncologists and urologists are not yet comfortable with recommending AS and rarely endorse its use for younger patients.

A Qualitative Study Exploring Models of Supportive Care in Men and Their Partners/Caregivers Affected by Metastatic Prostate Cancer.

To explore the experiences of patients with metastatic prostate cancer and their partners/caregivers, as well as an interprofessional team, with a nurse-led multimodality supportive care intervention. . Qualitative study. . National Health Service (NHS), Tayside, Scotland. . 19 patients, 7 partners/caregivers, and 7 interprofessional members from four hospitals in NHS, Tayside, Scotland. . 33 semistructured interviews were conducted to explore patients' and partners/caregivers' experiences of supportive care, and a framework approach was used to analyze the data. . Men and their partners/caregivers experienced a range of unmet physical, psychological, and informational supportive care needs. The participants in the intervention group reported overall high satisfaction with the use of holistic needs assessments and self-management plans, with a decrease in unmet needs compared to the standard of care over time. The prostate cancer specialist nurse was perceived as the hub of survivorship care. Members of the interprofessional team perceived benefit in the nurse-led multimodal supportive care intervention. . An emphasis needs to be placed on personalizing care, with supportive care interventions targeted to individual needs. . Care can be improved by incorporating holistic needs assessment to target specialized interventions for optimized, individualized care plans. An intervention seminar encouraged self-management and self-efficiency, leading to greater satisfaction for participants.

What Gay and Bisexual Men Treated for Prostate Cancer are Offered and Attempt as Sexual Rehabilitation for Prostate Cancer: Results from the Restore Study

IntroductionThis is the first known study to investigate what gay and bisexual men are offered and what they try as rehabilitation to address the sexual and urinary effects of prostate cancer treatment. MethodsA total of 193 gay and bisexual men with prostate cancer were recruited from a large male cancer survivor support and advocacy website. Online participants completed survey questions asking what rehabilitation treatments were offered, what they tried and what their satisfaction was with outcomes. ResultsMost participants (68.4%) reported being out as gay/bisexual to at least 1 cancer specialist. Only 8.8% reported that a sexual history was taken. The most common problems reported were loss of ejaculate (93.8%), erectile difficulties (89.6%), change in sense of orgasm (87.0%), loss of sexual confidence (76.7%), changes to the penis (65.8%), increased pain in receptive anal sex (64.8%), urinary incontinence not related to sex (64.2%) and urinary incontinence during sex (49.2%). Of these factors only loss of ejaculate, erectile difficulties and nonsexual urinary problems were commonly discussed by clinicians during prostate cancer treatment. Satisfaction with specific rehabilitation options varied widely. ConclusionsTreatment for prostate cancer lacks adequate history taking and consensus around rehabilitation practices, resulting in idiosyncratic approaches to rehabilitation. Four clinical questions may improve outcomes. Prostate cancer specialists need education to become culturally competent in addressing the unique needs of gay and bisexual patients.

PD09-04 A RANDOMISED CONTROLLED FEASIBILITY STUDY: A MULTIMODAL SUPPORTIVE CARE INTERVENTION IN MEN AND THEIR PARTNERS/CARERS AFFECTED BY METASTATIC PROSTATE CANCER

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2017PD09-04 A RANDOMISED CONTROLLED FEASIBILITY STUDY: A MULTIMODAL SUPPORTIVE CARE INTERVENTION IN MEN AND THEIR PARTNERS/CARERS AFFECTED BY METASTATIC PROSTATE CANCER Catherine Paterson, Charlotte Primeau, and Ghulam Nabi Catherine PatersonCatherine Paterson More articles by this author , Charlotte PrimeauCharlotte Primeau More articles by this author , and Ghulam NabiGhulam Nabi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.554AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A metastatic prostate cancer diagnosis and its treatments carry significant morbidity and related unmet supportive care needs. Such unmet needs have a profound decrement on patients and their families. We aimed to deliver at multimodal intervention based approach that targeted unmet needs for men and their partner/carers and compared this to current standard care. METHODS A two arm randomised controlled feasibility trial compared standard care to a multimodal supportive care intervention that combined an educational seminar on prostate cancer thrivership and individualized care from a designated prostate cancer specialist nurse. This involved in-depth assessment using patient reported outcome measures (PROMs) in routine clinical practice, followed up with a tailored plan of ongoing support to address informational, emotional, social and practical needs. 38 participants and 10 carers/partners completed validated and reliable self-reported measures at baseline and at 3 months. 32 Semi-structured interviews were conducted with men, carers/partners and members of the multidisciplinary team. Self-efficacy was included as the potential moderator/mediator of intervention effect. Primary outcomes are unmet supportive care needs and quality of life. An economic evaluation was conducted alongside the randomised trial. RESULTS 29 participants in standard care arm (age 77.5, SD 6.2 years) identified a range of unmet supportive care needs related to physical, psychological/emotional, intimacy/sexual, practical, health system/informational, existential and patient/clinician communication needs. 19 participants (age 74.9, SD 8.2, years) in the interventions group, reported overall high satisfaction with the intervention and acceptance of PROMs in routine clinical practice, with less prevalence of unmet needs compared to standard care over time. Men and carers/partners perceived that they had derived benefit from this model of care. Certain themes clearly emerged as important for participants, including being listened to by someone who could facilitate emotional expression, being provided with individually tailored information and receiving practical help and evidence-based advice for managing the consequences of cancer and its associated treatments. Significant cost-savings emerged in favour of the intervention. CONCLUSIONS This study has demonstrated that a multimodality supportive care intervention for men and their carer/partners affected by metastatic prostate cancer can achieve optimal supportive care. The active components of the intervention have been distinguished and provide the basis for the development of a larger sufficiently powered trial. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e195 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Catherine Paterson More articles by this author Charlotte Primeau More articles by this author Ghulam Nabi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Interrogating Metastatic Prostate Cancer Treatment Switch Decisions: A Multi-institutional Survey

BackgroundEvaluation of responses to treatment for metastatic castration-resistant prostate cancer (mCRPC) remains challenging. Consensus criteria based on prostate-specific antigen (PSA) and clinical and radiologic biomarkers are inconsistently utilized. Circulating tumor cell (CTC) counts can inform prognosis and response, but are not routinely used. ObjectiveTo evaluate the use of biomarkers and trends in clinical decision-making in current mCRPC treatment. Design, setting, and participantsA 23-part online questionnaire was completed by physicians treating mCRPC. Outcome measures and statistical analysisResults are presented as the proportion (%) of physicians responding to each of the options. We used χ2 and Fisher's tests to compare differences. Results and limitationsA total of 118 physicians (22.1%) responded. Of these, 69.4% treated ≥50 mCRPC patients/year. More physicians administered four or fewer courses of cabazitaxel (27.9%) than for docetaxel (10.4%), with no significant difference in the number of courses between bone-only disease and Response Evaluation Criteria in Solid Tumours (RECIST)–evaluable disease. Some 74.5% of respondents considered current biomarkers useful for monitoring disease, but only 39.6% used the Prostate Cancer Working Group (PCWG2) criteria in clinical practice. PSA was considered an important biomarker by 55.7%, but only 41.4% discarded changes in PSA before 12 wk, and only 39.4% were able to identify bone-scan progression according to PCWG2. The vast majority of physicians (90.5%) considered clinical progression to be important for switching treatment. The proportion considering biomarkers important was 71.6% for RECIST, 47.4% for bone scans, 23.2% for CTCs, and 21.1% for PSA. Although 53.1% acknowledged that baseline CTC counts are prognostic, only 33.7% would use CTC changes alone to switch treatment in patients with bone-only disease. The main challenges in using CTC counts were access to CTC technology (84.7%), cost (74.5%), and uncertainty over utility as a response indicator (58.2%). ConclusionsA significant proportion of physicians discontinue treatment for mCRPC before 12 wk, raising concerns about inadequate response assessment. Many physicians find current biomarkers useful, but most rely on symptoms to drive treatment switch decisions, suggesting there is a need for more precise biomarkers. Patient summaryIn this report we analyse the results of a questionnaire evaluating tools for clinical decision-making completed by 118 prostate cancer specialists. We found that most physicians favour clinical progression over prostate-specific antigen or imaging, and that criteria established by the Prostate Cancer Working Group are not widely used.

Non‐medical prescribing in prostate cancer care: a case study reflection

ABSTRACTThere are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non‐medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence‐based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non‐medical prescribing.A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence‐based recommendations were integrated into a narrative synthesis.A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non‐medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies.Non‐medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost‐effectiveness and a more detailed understanding of how team working and inter‐team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.

Establishing nurse-led active surveillance for men with localised prostate cancer: development and formative evaluation of a model of care in the ProtecT trial

ObjectivesTo develop a nurse-led, urologist-supported model of care for men managed by active surveillance or active monitoring (AS/AM) for localised prostate cancer and provide a formative evaluation of its acceptability...

Shared decision making and use of decision AIDS for localized prostate cancer : perceptions from radiation oncologists and urologists.

The current attitudes of prostate cancer specialists toward decision aids and their use in clinical practice to facilitate shared decision making are poorly understood. To assess attitudes toward decision aids and their dissemination in clinical practice. A survey was mailed to a national random sample of 1422 specialists (711 radiation oncologists and 711 urologists) in the United States from November 1, 2011, through April 30, 2012. Respondents were asked about familiarity, perceptions, and use of decision aids for clinically localized prostate cancer and trust in various professional societies in developing decision aids. The Pearson χ2 test was used to test for bivariate associations between physician characteristics and outcomes. Similar response rates were observed for radiation oncologists and urologists (44.0% vs 46.1%; P=.46). Although most respondents had some familiarity with decision aids, only 35.5% currently use a decision aid in clinic practice. The most commonly cited barriers to decision aid use included the perception that their ability to estimate the risk of recurrence was superior to that of decision aids (7.7% in those not using decision aids and 26.2% in those using decision aids; P<.001) and the concern that patients could not process information from a decision aid (7.6% in those not using decision aids and 23.7% in those using decision aids; P<.001). In assessing trust in decision aids established by various professional medical societies, specialists consistently reported trust in favor of their respective organizations, with 9.2% being very confident and 59.2% being moderately confident (P=.01). Use of decision aids among specialists treating patients with prostate cancer is relatively low. Efforts to address barriers to clinical implementation of decision aids may facilitate greater shared decision making for patients diagnosed as having prostate cancer.

Prostate cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline endorsement.

The guideline aims to optimize health and quality of life for the post-treatment prostate cancer survivor by comprehensively addressing components of follow-up care, including health promotion, prostate cancer surveillance, screening for new cancers, long-term and late functional effects of the disease and its treatment, psychosocial issues, and coordination of care between the survivor's primary care physician and prostate cancer specialist. The American Cancer Society (ACS) Prostate Cancer Survivorship Care Guidelines were reviewed for developmental rigor by methodologists. The American Society of Clinical Oncology (ASCO) Endorsement Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. The ASCO Endorsement Panel determined that the recommendations from the 2014 ACS Prostate Cancer Survivorship Care Guidelines are clear, thorough, and relevant, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorses the ACS Prostate Cancer Survivorship Care Guidelines, with a number of qualifying statements and modifications. Assess information needs related to prostate cancer, prostate cancer treatment, adverse effects, and other health concerns and provide or refer survivors to appropriate resources. Measure prostate-specific antigen (PSA) level every 6 to 12 months for the first 5 years and then annually, considering more frequent evaluation in men at high risk for recurrence and in candidates for salvage therapy. Refer survivors with elevated or increasing PSA levels back to their primary treating physician for evaluation and management. Adhere to ACS guidelines for the early detection of cancer. Assess and manage physical and psychosocial effects of prostate cancer and its treatment. Annually assess for the presence of long-term or late effects of prostate cancer and its treatment.

Bone health management in men undergoing ADT: examining enablers and barriers to care.

The study determined prostate cancer specialists' knowledge and concordance to guidelines regarding the diagnosis, management, and prevention of androgen deprivation therapy-induced osteoporosis. Despite high knowledge regarding bone health, most respondents did not routinely measure bone mineral density or use fracture risk assessment tools, suggesting a significant gap in the screening/monitoring of bone health. The purpose of this study was to determine prostate cancer specialists' knowledge, practices, self-perceived competencies and barriers to providing guideline-concordant care in the diagnosis, prevention, and management of androgen deprivation therapy (ADT)-induced osteoporosis (OP). A number of 73 Canadian radiation oncologists and 83 urologists completed questionnaires assessing (i) knowledge regarding OP and consensus guidelines for bone health management in men receiving ADT, (ii) self-assessed competencies regarding bone health management, (iii) current practices regarding OP prevention and management, and (iv) self-perceived barriers to providing guideline-concordant care. The majority of respondents were able to correctly identify the guideline-concordant frequency of repeat dual-energy X-Ray absorptiometry (DXA) scans (76.3%), vitamin D (70.3%), and calcium (53.2%) intake and that bisphosphonates/denosumab should always be considered for patients with a history of one low-trauma fracture (57.6%). Just under 1/3 (32.5%) reported routinely measuring bone mineral density (BMD) prior to starting ADT and routinely measuring BMD 1-2 years following the initiation of ADT (36.6%). Only 4.6% of respondents routinely used a validated fracture risk assessment tool. Lowest self-assessed competency levels were reported in providing self-management education to patients to foster the uptake of healthy bone behaviors (HBBs) and managing patients who present with or develop osteopenia and OP. The most significant barriers to providing OP prevention and management were lack of time and lack of supporting structures. Despite high knowledge about appropriate bone health care among prostate cancer specialists, there remain significant gaps in screening and monitoring of bone health, suggesting the need to develop innovative strategies to overcome barriers to implementation.

‘Carrying on the way we are is becoming shambolic’ – An interview study with prostate cancer specialists about their usual practice of follow-up

Aim: This study aims to clarify what practice for the follow-up of prostate cancer is occurring at present and to explain the reasons behind any variation. Background: Prostate cancer has been increasing in incidence in the UK for several years. It has been suggested that men with prostate cancer could be better managed, and that some aspects of care are duplicated by primary and secondary care professionals. Methods: This study aimed to interview the prostate cancer specialists identified as working within the district general hospitals of a large health board. The interviews used a qualitative semi-structured approach. Analysis was performed using The Framework method. Findings: Current practice for the follow-up of prostate cancer is variable both within and between hospitals. Patients are followed up in secondary care for longer than National Institute for Health and Care Excellence (NICE) recommends due to a lack of trust of general practitioners’ management. This inevitably impacts upon waiting lists, and many patients’ appointments are long overdue. A remote prostate-specific antigen (PSA) surveillance system may be beneficial. It is generally thought that change to the usual practice of follow-up of prostate cancer patients is required.

Establishment of a new prostate cancer multidisciplinary clinic: Format and initial experience.

The use of multidisciplinary clinics (MDCs) for outpatient cancer evaluation is increasing. MDCs may vary in format, and data on whether MDCs change prostate cancer (PCa) care are limited. Here we report on the setup and design of a relatively new PCa MDC clinic. Because MDC evaluation was associated with a comprehensive re-evaluation of all patients' staging and risk stratification data, we studied the frequency of changes in PCa grade and stage upon MDC evaluation, which provides a unique estimate of the magnitude of pathology, radiology, and exam-based risk stratification in a modern tertiary setting. In 2008-2012, 887 patients underwent consultation for newly diagnosed PCa at the Johns Hopkins Hospital (JHH) weekly MDC. In a same-day process, patients are interviewed and examined in a morning clinic. Examination findings, radiology studies, and biopsy slides are then reviewed during a noon conference that involves real-time collaboration among JHH attending specialty physicians: urologists, radiation oncologists, medical oncologists, pathologists, and radiologists. During afternoon consultations, attending physicians appropriate to each patient's eligible treatment options individually meet with patients to discuss management strategies and/or clinical trials. Retrospective chart review identified presenting tumor characteristics based on outside assessment, which was compared with stage and grade as determined at MDC evaluation. Overall, 186/647 (28.7%) had a change in their risk category or stage. For example, 2.9% of men were down-classified as very-low-risk, rendering them eligible for active surveillance. 5.7% of men thought to have localized cancer were up-classified as metastatic, thus prompting systemic management approaches. Using NCCN guidelines as a benchmark, many men were found to have undergone non-indicated imaging (bone scan 23.9%, CT/MRI 47.4%). The three most chosen treatments after MDC evaluation were external beam radiotherapy ± androgen deprivation (39.3%), radical prostatectomy (32.0%), and active surveillance/expectant management (12.9%). A once-weekly same-day evaluation that involves simultaneous data evaluation, management discussion, and patient consultations from a multidisciplinary team of PCa specialists is feasible. Comprehensive evaluation at a tertiary referral center, as demonstrated in a modern MDC setting, is associated with critical changes in presenting disease classification in over one in four men.

Prostate cancer support groups: Canada-based specialists' perspectives.

To understand prostate cancer (PCa) specialists’ views about prostate cancer support groups (PCSGs), a volunteer sample of Canada-based PCa specialists (n = 150), including urologists (n = 100), radiation oncologists (n = 40), and medical oncologists (n = 10) were surveyed. The 56-item questionnaire used in this study included six sets of attitudinal items to measure prostate cancer specialists’ beliefs about positive and negative influences of PCSGs, reasons for attending PCSGs, the attributes of effective PCSGs, and the value of face-to-face and web-based PCSGs. In addition, an open-ended question was included to invite additional input from participants. Results showed that PCSGs were positively valued, particularly for information sharing, education and psychosocial support. Inclusivity, privacy, and accessibility were identified as potential barriers, and recommendations were made for better marketing PCSGs to increase engagement. Findings suggest prostate cancer specialists highly valued the role and potential benefits of face-to-face PCSGs. Information provision and an educational role were perceived as key benefits. Some concerns were expressed about the ability of web-based PCSGs to effectively engage and educate men who experience prostate cancer.