Expert Offers Advice to Transition Patients With Prostate Cancer to Survivorship

Kristie L. Kahl: We know patients have a care team and they go from diagnosis through to treatment, but what happens when treatment is over?

Dr. Daniel P. Petrylak: Let's take a specific example. A patient who's had localized prostate cancer has undergone anywhere between six to 18 months of androgen deprivation therapy and radiation therapy. So a lot of patients ask, what happens? When is my testosterone going to recover? Is it going to recover? Should I undergo testosterone supplementation in that situation so they can regain energy and regain muscle mass and lose some weight? In general, it takes about anywhere between six to 18 months for the testosterone to come back to normal. About half of patients don't have the testosterone returned to baseline. Interestingly, the patients who are likely to have their testosterone recover are those of a younger age, as well as those patients who have a high/normal testosterone to begin with. So that's actually one of the questions: When is that going to come back?

And I think it's also important for the patient to follow up with their internist, check their cholesterol, check their sugar (levels), check their blood pressure, because these are known complications of androgen deprivation therapy. And interestingly, the most common cause of death in men with prostate cancer is cardiovascular disease. So that's actually something that we can make an impact on. Watch your diet, watch your cholesterol, exercise, watch your blood pressure, just good common sense health measures of things that can be met and monitored. I mean, I think for survivorship, those in my mind are the most important issues.

Kahl: We've heard about survivorship care plans. Wre we utilizing those in prostate cancer to help patients go from their treatment team back to their primary care provider?

Petrylak: I don't quite think that we do. I think normally, at least in my patients, they're followed for at least five years, and we'll check their PSAs. And if the PSAs are normal, they will maybe check it once a year and come back to us. But there really isn't any set survivorship program, such as there is in testicular cancer, where you have 20 to 30 years of life after patients are diagnosed, (this) tends to be a little bit shorter in patients (with prostate caner) because more older patients are diagnosed, but there are younger men who are diagnosed as well. And that's an important issue, especially if you're diagnosed in your 50s. And then undergo androgen deprivation therapy, these will have long-term side effects. Because obviously, we want to see these men live into their 80s.

Kahl: What exactly does that follow-up entail?

Petrylak: That depends upon their disease, but generally involves just measuring PSA, measuring the testosterone levels. If they've had no metastatic disease, then we will monitor those patients and probably give scans intermittently. But generally, we don't do that for a patient who's got localized disease, just monitoring the blood test.

Kahl: How can we make sure to raise awareness so that men are making sure that they're being proactive about still being under surveillance after they're done treatment?

Petrylak: I think you have to discuss this with your physician. I think you have to utilize some of the patient support groups that are out there as well. All of these I think are important to good health.

Kahl: Wre there any resources or do you have any advice to offer our patients about survivorship?

Petrylak: Well, Fans For The Cure has support groups. We have a regular podcast to discuss different aspects of the disease. So they're very supportive, and with these groups with patient discussions, in terms of making sure that the patients are aware of what's ahead and what they should be looking out for.

Transcription edited for clarity and conciseness.