Monitoring of hormone sensitive prostate cancer (pathway)
Initiate ADT
- At the onset of ADT the patient should receive medication along with education regarding potential adverse effects.
- PSA values should be obtained every 3-6 months
- In office evaluation for symptoms and adverse effects every 3-6 months
Initiate bone health plan
- Begin calcium supplementation (1200 mg daily)
- Initiate Vitamin D supplementation (1000 iu)
- Bone density measurement (DEXA)
- Encourage active exercise
- Prolia for Osteopenia or Osteoporosis
Initiate lipid, diabetes and weight management plan
- Periodic labs for glucose and lipids
- Periodic weights for development of obesity
- Exercise log
Initiate diagnostic surveillance to monitor for castrate resistant disease
- Monitor PSA
- If stable continue every 3-6 months
- If rising check testosterone to verify castrate status (T<50 ng/dL)
- Repeat measurement to calculate doubling time
- If continues to rise move to CRPC pathway
- Monitor bone density
- Periodic DEXA scan
Monitor for metastatic disease
- Image as indicated