Post treatment
Prehab into rehab should also be considered, particularly for those with advanced prostate cancer on long term/ lifelong ADT. These patients should be treated as a long-term condition which may differ from other tumour groups. As much as these factors are key at the point of diagnosis they remain relevant years into, or after, treatment and should be treated accordingly and signposted, as above, as and when required.
Over half of patients report their emotional needs are not looked after as much as their physical needs. In the year following diagnosis, around 10% of patients will experience symptoms of anxiety and depression severe enough to warrant intervention by specialist psychological/psychiatric services, this rises to 50% among those who experience recurrent disease. Give patients space to talk if they choose; for many just voicing worries will be helpful. A general question about quality of life, well-being or mood is a good place to start.
Following the signposting set out above can, and should, be utilised throughout the patient's journey.
Referrals can be made to specialist teams such as Physiotherapists, Continence Physiotherapists, Dieticians.
Upon discharge of treatment patients should be provided with a final treatment summary.pdf [PDF only] 
to be copied to GP with re-referral advice (link offers example of a treatment summary).
Erectile dysfunction
Penile rehabilitation is defined as the use of any drug or device at or after radical prostatectomy or to maximize recovery of erectile function- treatment for this will be dependent on whether patient has had nerve sparing or non-nerve sparing surgery or radiation.
Prostate Scotland - Help and support for you > surgery remove prostate
In nerve sparing surgery and radiated patients:
1st line treatment - PDE-5 inhibitors +/- Vacuum Device Therapy as per local policy +/- psychosexual therapy
In nerve sparing surgery and radiation patients and non-nerve sparing patients:
2nd line – Vacuum Device Therapy / Intracarvernosal Injections
3rd line – Penile prosthesis
Urinary issues
Late effects of radiotherapy
Pelvic Radiation Disease (PRD) can affect one or more of: bladder, bone, bowel, nerves, sexual organs, blood supply, stomach and digestion, lymphatic system, skin, and mental health. Symptoms arise because of damage to internal organs or skin. Symptoms often settle in the few weeks after radiotherapy finishes but PRD can be defined as symptoms starting or continuing three months or more after the end of radiotherapy. Sometimes they start many years or decades after radiotherapy.
The term Pelvic Radiation Disease therefore encourages a multi-professional approach to patient care to be taken. Regions (locally, regionally, and nationally) should be examining ways to support these patients.
*An updated version of the document is expected soon.
*Guidance from The British Society of Gastroenterologist due December
SACT
Androgen Deprivation Therapy Side (SACT) effects - refer to electronic medicines compendium (emc)
Prostate Scotland - Hormone therapy for prostate cancer.pdf [PDF only]
Patients should be offered support or signposted should they find side effects affect their quality of life. Listed below are some of the most common side effects, refer to SmPC for others, and suggested support. Please refer to local guidelines also.
Fatigue
Hot flushes
Other
Relationship and Intimacy:
Living well after cancer treatment
For many, psychological distress increases after primary treatment finishes. Patients frequently report they feel “they should be coping better” which adds to distress, it is therefore important to acknowledge that a period of psychological distress and adjustment during and after treatment is normal. Specific concerns which are often very relevant to psychological wellbeing include sexual dysfunction and relationship issues; insomnia; and fear of cancer recurrence or progression.
There are various support groups/ networks that patients may benefit from following or throughout cancer treatment.
Fear of cancer recurrence
Fear of Cancer Recurrence (FCR) is one of the most persistent and prevalent problems for those living with and beyond cancer and one of the most commonly reported unmet needs, which can be highly debilitating and persist over many years after treatment. FCR is not linked to prognosis and may occur in those with a relatively good prognosis. Many patients report significant levels of anxiety soon after active treatment finishes, although this can also be triggered by events, such as a routine follow-up appointment or hearing of someone else who has had a recurrence of cancer.
Many people describe this period as more distressing than diagnosis or treatment. As this is often not recognized by others, this can also be very isolating. Being able to talk about these fears and being offered assurance that they are common will enable many patients to manage this distress and anxiety effectively. Evidence shows this can also reduce additional health utilization, such as extra phone calls, clinic visits and screening and support other aspects of post treatment wellbeing.
- Acknowledge it, is very common to worry about recurrence and to become preoccupied by changes, twinges or pain that would not previously have been a concern
- Provide information and encourage discussion of concerns
- The FCR4 is a brief screening tool which can be helpful to give an indication of the level of distress associated with fears of cancer recurrence and can open up a supportive conversation at a follow up appointment
- Communication training for staff has also been shown to increase patients' expression of their anxiety and reduce subsequent rates of anxiety,
- Consider referral to specialist psychological services (see above) for those with more severe FCR.
Scottish Cancer Network: Clinical Management Pathways
