It includes recommendations on follow-up in primary care for people with a diagnosis of Prostate cancer.
This article covers diagnosing and managing Prostate cancer in secondary care. It offers the best information on the best way to diagnose and identify different stages of the disease, and how the best way to manage the adverse effects of treatment. It contains or includes recommendations on follow-up in very primary care for people with a diagnosis of Prostate cancer.
The United Kingdom saw a fast increase in prostate cancer incidence among the younger population in the last 10 years, according to Global Data or World Wide Data.
If we see the latest statistics from the data and analytics company reveals an alarming trend of an increasing rate of prostate cancer in younger age groups very fast across several key pharmaceutical markets, including the UK this year.
Prostate Cancer Rise Among Younger Men in 2019
Prostate cancer incidence among UK men aged 39 to 59 increased from 14 cases per 100,000 population to 20, while Spain saw an increase from 15 cases to 17.5 and Japan from just over 4 to 7 cases.
“The eight major markets can have 573,000 cases of prostate cancer in 2019, 12-tone music of which will occur in men aged 30–59,” said Kasey Fu, Director of epidemiology at GlobalData.
Prostate cancer symptoms in males
All most, most people who are diagnosed with prostate cancer are aged 60 years and older, and many may never experience symptoms and problems related to prostate cancer.
However, the population of those who develop prostate cancer at ages younger than 60 years tends to have more aggressive disease that progresses quickly.
Who is it for?
- Healthcare professionals of prostate cancer.
- Commissioners and providers of prostate cancer services.
- People with prostate cancer, their families and carers.
Prostate cancer diagnosis
We have reviewed the proper evidence on the assessment, diagnosis and staging, treatment and follow-up of prostate cancer.
Here, you are invited to comment on the new and updated recommendations, you can comment below. These are marked as 
Tell people with prostate cancer and their partners or carers about the effects of prostate cancer and the treatment options on their:
- Sexual function.
- Physical appearance.
- Other aspects of masculinity.
Support people and their partners or carers in making treatment 8 decisions, taking into account the effects on quality of life as well as 9 survival.
Localized and locally advanced prostate cancer
Advanced prostate cancer
- Before any radical treatment, you should explain to all people and, if they wish, their partner too, that radical treatment for prostate cancer will result in an alteration of proper sexual experience, and may result in loss of sexual function in their body.
- Explain to all affected people and, if they wish, their partner, about the potential loss of ejaculation and fertility associated with radical treatment for prostate cancer. Give them Offer sperm storage.
- Warn people undergoing radical treatment for prostate cancer of the likely effects of the treatment on their urinary function.
- Offer a urological assessment to people who have troublesome urinary symptoms before treatment.
- People with prostate cancer who are candidates for radical treatment should have the opportunity to discuss the range of treatment modalities and their serious side effects in relation to their treatment best options with a specialist surgical or doctor oncologist and a specialist clinical oncologist.
- Explain to people that there is a small increase in the risk of colorectal cancer after radical external beam radiotherapy for prostate cancer.
Low-risk localized prostate cancer
Radical prostatectomy OR Robotic prostatectomy
At the very low risk, offer a choice between active surveillance or positive prostate patients, radical prostatectomy or radical radiotherapy to people with low-risk localized prostate cancer for 25 whom radical treatment is suitable.
Radical treatment – Prostate Cancer
Commissioners of urology services should consider providing robotic prostate cancer surgery to treat localized prostate cancer.
Commissioners should base robotic systems for the surgical treatment of localized prostate cancer in centers that are expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies per year to ensure they are cost-effective.
For people having radical external beam radiotherapy for localized prostate cancer:
Radiation treatment for prostate cancer
- Offer hypofractionated radiotherapy (60 Gy in 20 fractions) using image-guided intensity-modulated radiation therapy (IMRT) unless contraindicated OR
- Offer conventional radiotherapy (74 Gy in 37 fractions) to people who cannot have hypofractionated radiotherapy.
Offer people with localized and locally advanced prostate cancer receiving radical external beam radiotherapy with curative intent planned treatment techniques that optimize the dose to the tumor while minimizing the risks of normal tissue damage.
Offer people with intermediate- and high-risk localized prostate cancer a combination of radical radiotherapy and androgen deprivation therapy, rather than radical radiotherapy or androgen deprivation therapy alone.
Consider brachytherapy in combination with external beam radiotherapy for people with intermediate- and high-risk localized prostate cancer.
Metastatic prostate cancer
Information and support
- Prostate cancer is a non-AIDS defining cancer and is not virally associated.
- Prostate cancer was the only cancer type with a higher incidence in virally suppressed than unsuppressed persons.
- In the HIV Cancer Match Study- lower prostate cancer incidence for men with CD4<50.
In the case of metastatic prostate cancer offer, people with metastatic prostate cancer tailored information and access to specialist urology and palliative care teams to deal with their specific needs. give them the chance to discuss any significant changes in their disease status or symptoms as these occur.
Integrate palliative interventions at any-best or any stage into coordinated care, and facilitate any transitions between care settings as very smoothly as possible.
We should discuss personal preferences for palliative care as early as possible with people or with a close person of metastatic prostate cancer, their partners and carers. Tailor treatment or care plans accordingly, and identify the preferred place of care.
Ensure that palliative care is available when needed and is not limited to the end of life. Care should not be restricted to being associated with hospice care.
Offer a regular assessment of needs or requirements to people with metastatic prostate cancer.
Prostate cancer treatment
Offer docetaxel chemotherapy to people with newly diagnosed metastatic prostate cancer who do not have significant comorbidities as follows:
Androgen deprivation therapy
- Start treatment within 12 weeks of starting androgen deprivation therapy and…,
- Use six 3-weekly cycles at a dose of 75 mg/m2 (with or without daily prednisolone).
- Offer bilateral orchidectomy to all people with metastatic prostate cancer as an alternative to continuous luteinizing hormone-releasing hormone agonist therapy.
- Do not offer combined androgen blockade as a first-line treatment for people with metastatic prostate cancer.
- For people with metastatic prostate cancer who are willing to accept the adverse impact on overall survival and gynaecomastia with the aim of retaining sexual function, offer anti-androgen monotherapy with bicalutamide (150 mg).
- Begin androgen deprivation therapy and stop bicalutamide treatment in people with metastatic prostate cancer who are taking bicalutamide monotherapy and who do not maintain satisfactory sexual function.
Screening for Prostate Cancer
PSA Level in men
- PSA= Prostate-Specific Antigen; a blood test used to screen for disease and assess response to treatment
- 80% of cases are localized disease at diagnosis.
- PSA screening has been associated w a decline in cancer-specific and age-adjusted mortality (nearly 40%)
- However- a high rate of detection and overtreatment of low-risk indolent cancers
- In 2012 the USPSTF issued a statement opposing PSA-based screening.
Prostate Cancer- Incidence in PLWHA
PLWHA(People Living with HIV/AIDS)
- Prostate cancer is a non-AIDS defining cancer and is not virally associated
- PLWHA have lower rates of prostate cancer
- VACS SIR 0.79
- HIV/AIDS Cancer Match Study SIR 0.48
- Johns Hopkins HIV Clinical Cohort SIR 0.50
- Kaiser Permanente Cohort- RR 0.73
Prostate Cancer Incidence and HIV suppression
- Prostate cancer was the only cancer type with a higher incidence in virally suppressed than unsuppressed persons
- In the HIV Cancer Match Study- lower prostate cancer incidence for men with CD4<50
Prostate Cancer Screening in PLWHA
- It was hypothesized that the lower incidence of prostate cancer in PLWHA is due to reduced PSA screening of this population.
- A study looking at PSA screening in an urban cohort of HIV+ men in Baltimore by Shiels et al found decreased PSA screening among this population.
PSA screening in PLWHA
- Kaiser Permanente study
- More HIV+ than HIV- received PSA testing by age 55
- Reduced risk for higher stage cancers among HIV+ men
- The risk remained when adjusted for testosterone deficiency
- HIV/Cancer match study
- Lower prostate cancer rates when stratified by stage
- Lower risk for larger more extensive tumors which would not be affected by lower screening rates
Future Prostate Cancer Burden in PLWHA
- Prostate cancer is a nonvirusNADC
- Estimated by 2020 and persisting at least 10 years, prostate cancer will be the most prevalent cancer among PLWHA (all genders)
Prostate Cancer Terms
- PSA= prostate-specific antigen; a blood test used to screen for disease and assess response to treatment
- Gleason score or grade= numerical score assigned by a pathologist based on their assessment of the tissue sample- each score is composed of a primary and secondary pattern (Ex: 3+4=7)
- T stage= describes the size of the primary tumor, based on AJCC staging for prostate cancer