There is an urgent need for consensus on monitoring frequency and referral pathways for men discharged into primary care following prostate cancer, suggests a study published in the European Journal of Cancer Care.
The study included men who had been discharged from hospital-based follow-up to GP management in two different Greater Manchester boroughs over a 10-year period (2007–2017). Questionnaires were sent to patients exploring their understanding of the follow-up process.
A total of 300 patient records were accessed. Patients were registered under 74 different GP practices.
Most patients received radiotherapy (42.3%) and most were not monitored according to their discharge guidelines (58%). Fifty-nine per cent of men were being monitored on a six-monthly basis. Thirty-eight per cent had never had their prostate-specific antigen (PSA) checked on time, and 16% had previously had their PSA checked on time but were now not being monitored frequently enough.
There was disparity amongst discharge instructions about the frequency of PSA testing. The most common time interval advised was six months but in 10% of patient records, no instruction was given to the GP about frequency of testing.
The PSA level at which GPs were instructed to re-refer patients differed considerably, with 16 different readings ranging from 0.1 to 50 ng/ml. In 39% of discharge letters, no re-referral PSA level was provided.
A total of 222 patient questionnaires were returned. Sixty-seven per cent felt GPs should be responsible for PSA monitoring, and 60% felt confident that their GP was doing so effectively. Conversely, 12% felt their PSA monitoring had been neglected.
The findings highlight the complex nature of the follow-up and monitoring processes for prostate cancer patients.
The authors say there is an urgent need for consensus on monitoring frequency and referral pathways. These findings will be used to create an evidence-based, uniform Greater Manchester PSA monitoring service which is safe, acceptable, and effective, they say.
