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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
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