Prostate cancer ranks first amongst all male urological cancers [1]. In the UK, 26027 new patients were diagnosed with prostate cancer during 2001 [1]. The evidence suggests an increasing trend in the incidence in the recent years, being 18201 in 1997 [2]. Nonetheless, better treatment modalities and earlier detection has resulted in a decrease in cancer related mortality [3]. This is shown in the age-standardized death rate per million population for prostate cancer, being 302 and 274 in 1991 and 2001 respectively.
Widespread PSA testing and increased awareness has led to the detection of early prostate cancer in many patients [4]. This has probably resulted in more patients requiring long periods of follow up. Nurse Specialists in UK health care system have evolved to share the increasing demand on the clinicians to meet the targets and waiting times in all the specialties. In urology, Nurse Specialists have assumed various roles including prostate assessment clinics, urodynamics and flexible cystoscopy [5]. In some health care trusts, Nurse Specialists are involved in the follow up of treated prostate cancer patients.
Faithfull et al studied the use of telephone follow up of prostate cancer patients by nurse specialists. They found that this method of follow-up at 3, 6 and 12 weeks post radiotherapy was effective and economical [6]. In addition a study on the follow-up of prostate cancer patients by on-demand contact with a nurse specialist was found to be as effective as traditional outpatient follow up by urologists [7].
The EAU guidelines [8] suggest that prostate cancer patients should be followed at regular intervals with a disease specific history and PSA estimation supplemented by digital rectal examination. This would suggest that all Nurse Specialists undertaking the role of follow-up of such patients should be trained in DRE. Data on the role of DRE in the follow up of prostate cancer patients is available only for the subgroup of patients who have had treatment with curative intent (radical prostatectomy or radical radiotherapy) and these studies show that PSA trend plays a more important role than DRE. However there is limited data available on the role of DRE and other factors (e.g. LUTS, Bone pain etc) in the follow up of diagnosed prostate cancer patients in the general setting involving all treatment varieties which is likely to be encountered in a nurse led follow up clinic.
The aim of this audit was to prospectively assess the various factors that influence a change in the management of the prostate cancer patients on follow up and to highlight the feasibility of nurse led clinics for the follow up of prostate cancer patients.