Benefits of pre‐biopsy multi‐parametric magnetic resonance imaging scanning in the initial assessment of prostate cancer

Traditionally, men referred for investigation of raised prostate specific antigen (PSA) could expect to be investigated via blind TRUS biopsy. In recent years, the availability of pre‐biopsy imaging with multi‐parametric magnetic resonance imaging (mp‐MRI) has allowed urology centres to improve their triage and care of this patient cohort. The ability to identify discrete lesions for more accurately targeted TRUS, stream patients with anterior lesions for trans‐perineal biopsy, and of course to prevent those with no evidence of clinically significant prostate cancer from being subjected to unnecessary procedures has proved pre‐biopsy mp‐MRI a valuable tool in the assessment and diagnosis of prostate cancer. Our service recently audited the impact of the introduction of mp‐MRI on our prostate cancer assessment pathway. An analysis of the outcomes of 1558 referrals over a 2‐year period, and found that pre‐biopsy imaging has resulted in a marked reduction in unnecessary procedures and more accurate targeting of lesions, leading to improved outcomes for patients.     

Evaluation of a nurse‐led service for follow up of patients with prostate cancer

The incidence of prostate cancer in Scotland continues to grow; men are now living with their disease which can be seen as an increased burden for the health service and in particular the Uro‐Oncology team which delivers its treatment and manage its follow up. A new model of follow up was established for men who have received treatment for prostate cancer, replacing conventional outpatient clinic. The virtual prostate cancer follow‐up clinic was set up for men who are 2 years post radiotherapy with stable prostate‐specific antigen. The aim of this follow up was to improve the patient experience of living with prostate cancer and reduce the high demand to the service. A successful bid to Macmillan allowed a nurse to be employed by the department for a 3‐year project post. The aim of this role was to develop the prostate cancer follow‐up clinic and evaluate this new way of working. Method A questionnaire was designed to obtain the views of the patients who were recipients of care and treatment from the clinical nurse specialist rather than the oncologist. The questionnaire was sent to all 302 men recruited to this new clinic. The patients were asked six questions which focused on support/communication, problems experienced and improvement. Results for 191 questionnaires were returned out of the 302 questionnaires sent, giving a 63·2% response rate. About 98% was very happy with the new service, 98·8% of patients reported being well supported by this new service. The success of this new follow‐up system will allow us to use this model for men post prostatectomy and receiving hormone suppression treatment. The role of the uro‐oncology nurse is vital to ensure that this clinic continues to be effective and give positive outcomes for patients with prostate cancer and the team involved in their journey.     

The development of nurse-led clinics in cancer care

This paper provides a review of current literature which focuses on issues relating to the care of cancer patients in the 21st century and the evolving role of the advanced practitioner in nurse-led clinics in cancer care. The review, in particular, identifies more specifically the skills used and the patient needs which can be met by innovative nurses working in nurse-led clinics. An in-depth discussion of a specific nurse practitioner's experience allows some of the skills of advanced nursing practice to appear more visible, for example, the assessment and investigation of patients experiencing symptoms associated with colorectal cancer. The implications for clinicians and educationalists in cancer care is highlighted within the conclusions.     

A case study: Concurrent palliative care based on SENS‐structure for patients with advanced prostate cancer

On an acute urological ward, it is challenging to meet all needs of patients with life‐limiting progressive cancer disease in complex situations. The focus shifts from curation to the holistic palliative approach aiming at patients' and their families' needs and planning care in advance with an interprofessional attitude. Based on a patient with castration refractory prostate carcinoma with multiple metastasis, the aim of this case study is to describe the palliative care approach, using the established so‐called SENS‐structure (Symptoms, End‐of‐life decisions, Network and Support of the carer) in which the bio‐, psycho‐, social and spiritual needs are addressed. We report on our practice experience using the SENS‐structure, in which the team discusses palliative care interventions with patients and their family: management of (potential) symptoms and self‐supporting strategies, expectations and end‐of‐life decisions including advance care planning, evaluation of patients' social and professional network and setting up additional support. The palliative care team provides advice to the treating team on future treatment strategies and care activities. The complex situation of a patient with metastatic prostate cancer and his personal sufferings illustrate the interprofessional use and person‐centred focus of the SENS‐structure. Important in this phase is—next to the family carers—the involvement of all professions and disciplines to break down the complexity of the situation into manageable proportions. Early involvement of palliative care for patients with advanced cancer is highly recommended. The SENS‐structure helps to prioritize and include the personalized approach which is strongly supported by nurses.     

Health technology assessment and implications for clinical practice: the case of prostate cancer screening

We describe an initiative to disseminate evidence from systematic reviews about the clinical effectiveness of prostate cancer screening to general practitioners and urologists in Norway. The Norwegian Centre for Health Technology Assessment invited The Norwegian Medical Association, The Norwegian Cancer Society, The Norwegian Board of Health, The Norwegian Urological Cancer Group and The Norwegian Patient Association to develop and disseminate clinical practice recommendations. The clinical effectiveness of prostate cancer screening has been assessed in nine independent systematic reviews, which are summarized in a joint INAHTA report. The conclusion was that there is no evidence from appropriately designed trials that early detection and treatment of prostate cancer can reduce mortality, morbidity or improve quality of life. The number of prostate‐specific antigen (PSA) tests analysed in Norway increased by 30% from 1996 to 1999; at the county level the increase ranged from 12 to 48%. On this background we disseminated leaflets with information about PSA and prostate cancer to 4100 general practitioners and specialists in urology. The main message was, i) PSA should not be taken in healthy men, ii) if the test is wanted, the physician is obliged to give information about the possible consequences. Despite efforts to anchor the information campaign within the mentioned organizations, this met with notable opposition from The Norwegian Urological Society. A survey among agencies within the INAHTA network showed that more than half of the countries within this collaboration have implemented guidelines or recommendations on prostate cancer screening. In conclusion, evidence obtained through an international collaboration such as the INAHTA collaboration may be used to develop and implement national guidelines or recommendations.     

Management and treatment of men affected by metastatic prostate cancer: evidence‐based recommendations for practice

Currently, 250 000 men are affected by prostate cancer in the UK. Clinical guidance is crucial for nurses involved in the care delivery for men with advanced prostate cancer and for their families to maximize their quality and quantity of life. It is essential that nurses understand how prostate cancer is diagnosed, can recognize signs of disease progression, are familiar with disease management, and can educate patients and manage any symptoms appropriately and effectively. Therefore, the aim of this paper is to review current evidence‐based guidelines in relation to care delivery for men with metastatic prostate cancer in order to optimize best supportive care. A literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL) to identify studies employing qualitative and/or quantitative methods. National (UK) and European clinical guidelines were also reviewed. Methodological evaluation was conducted and the evidence‐based recommendations were integrated in a narrative synthesis. Supportive care is a person‐centred approach to the provision of the necessary services for those living with or affected by cancer to meet their informational, spiritual, emotional, social or physical needs during diagnosis, treatment or follow‐up phases including issues of health promotion, survivorship, palliation and bereavement. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective supportive care delivery. Nurses involved in the care delivery for this patient group need to be aware of the complex physical and psychological supportive care needs, and evidence‐based management care plans to ensure a personalized and tailored support to optimize quality of life.     

Clinical effectiveness and cost‐effectiveness of nurse‐led care in Chinese patients with rheumatoid arthritis: A randomized trial comparing with rheumatologist‐led care

Background and aim

The concept of nurse‐led care (NLC) was not familiar in China. This study was designed to evaluate the clinical effectiveness and cost‐effectiveness of NLC versus rheumatologist‐led care (RLC) in Chinese patients with rheumatoid arthritis (RA).

Methods

Patients of either gender (aged ≥18 years) with RA were enrolled at Wenhai Central Hospital, China (January 2015 to December 2015). The participants were then randomized to NLC or RLC. Outcomes of both the groups were compared in terms of effectiveness by measuring the Disease Activity Score 28, visual analogue scores pertaining to pain and fatigue, and duration of morning stiffness. Costs associated with resource use for RA were assessed and compared between both groups.

Results

A total of 214 RA patients in 2 groups (n = 107 in each group) were enrolled and analysed. Improvements in clinical outcomes (disease activity, pain, fatigue, and morning stiffness) over 12 months were significantly greater in the NLC group compared to RLC (P < 0.001). Overall, costs associated with resource use were higher in the RLC group compared to the NLC group (P < 0.05).

Conclusions

Our preliminary finding suggested that RA patients managed by NLC compared to RLC may have better clinical outcomes and more cost‐effective care in China.     

Patients' and practice nurses' perceptions of secondary preventive care for established ischaemic heart disease: a qualitative study

A significant proportion of patients with established ischaemic heart disease remain unrecognized in general practice and those who are receiving treatment are experiencing sub-optimal care. The provision of coronary prevention by practice nurses may be an important strategy to improve the quality of this care, and this is feasible and effective. This study explored what occurred during patients' initial assessment for secondary prevention of ischaemic heart disease with a practice nurse and investigated patients' and practice nurses' views ofnurse-led clinics in primary care. Nurses were effective in history taking and offering reassurance and dietary advice, yet were less confident in discussing patients' understandings of heart disease and related medication. Practice nurse-led coronary preventive care is acceptable to both nurses and patients. Further practice nurse education is required in heart disease, cardiac medications and skills necessary for exploring and challenging patients' understandings of these issues.     

One stop nurse‐led macroscopic haematuria clinic: waiting times and patient satisfaction

In 2011, a large District Health Board Hospital in New Zealand established a nurse practitioner‐led, one stop macroscopic haematuria clinic (OSMC) in an effort to improve the timeliness and quality of the investigative process offered to individuals referred with macroscopic haematuria. Patients were identified during the referrals triage process and graded to be seen at OSMC within 30 d. The OSMC process allows for completion of all basic investigations (urine microscopy and culture, urine cytology, renal tract ultrasound and flexible cystoscopy) by the end of the single clinic visit. This report outlines the OSMC process and reports on adherence to the 30‐d timeframe for the first 100 patients, along with patient satisfaction data from patients 51 to 100. The dates of referral and OSMC visits were recorded prospectively for 100 patients and analysed to determine compliance with the 30‐d timeframe. For patients 51–100, an anonymous, self‐administered questionnaire was utilized to evaluate satisfaction with pre‐appointment information, waiting times, interactions with clinicians and education. Of the first 100 patients at OSMC, 81% were seen within 30 d, with all patients rating the clinic timeframes, processes and personnel highly. While the reliability of the Haematuria Clinic Questionnaire results could have been influenced by multiple factors, the OSMC appears to offer service users timely access to diagnostic investigations with clinics timeframes, processes and personnel they rate highly. While 81% of patients were seen within 30 d, work is needed to increase compliance to 100%. This model of care could be adopted at other public hospitals.     

Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non‐pharmacological interventions for managing cancer‐related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer‐related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer‐related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non‐pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.     

Methodology of patient care for elevated PSA after prostate cancer treatment: A primary care perspective

Prostate cancer (PCa) remains one of the most common cancers in men. Each year there are 230,000 new cases and it causes nearly 30,000 deaths. Elevations in prostate-specific antigen (PSA) after treatment with radiation or surgery can indicate the presence of PCa recurrence. About 15–18% of men treated for PCa will have an elevation of their PSA, which is a source of great concern and will lead to a management discussion with the patient. Approximately 25–33% of men with PCa will experience a recurrence of their cancer after surgery or radiation. This article will discuss the different options for men with a rising PSA after definitive therapy or an attempt at curative treatment for PCa. The purpose of this article is to help the primary care doctor, internist and geriatrician to become knowledgeable about the treatment options of recurrent PCa so that they can participate in the discussion with the patient and help the patient reach a decision regarding treatment and management of the elevated PSA levels, which signal recurrent disease.     

Promising tumor‐associated antigens for future prostate cancer therapy

Prostate cancer (CaP) is one of the most prevalent malignant diseases among men in Western countries. There is currently no cure for metastatic castrate‐resistant CaP, and median survival for these patients is about 18 months; the high mortality rate seen is associated with widespread metastases. Progression of CaP from primary to metastatic disease is associated with several molecular and genetic changes that can affect the expression of specific tumor‐associated antigens (TAAs) or receptors on the cell surface. Targeting TAAs is emerging as an area of promise for controlling late‐stage and recurrent CaP. Several reviews have summarized the progress made in targeting signaling pathways for CaP but will not be discussed here. We describe some important CaP TAAs. These include prostate stem‐cell antigen, prostate‐specific membrane antigen, MUC1, epidermal growth factor receptor, platelet‐derived growth factor and its receptor, urokinase plasminogen activator and its receptor, and extracellular matrix metalloproteinase inducer. We summarize recent advancements in our understanding of their role in CaP metastasis, as well as potential therapeutic options for targeting CaP TAAs. We also discuss the origin, identification, and characterization of prostate cancer stem cells (CSCs) and the potential benefits of targeting prostate CSCs to overcome chemoresistance and CaP recurrence. © 2009 Wiley Periodicals, Inc. Med Res Rev, 30, No. 1, 67–101, 2010