title: Initial experience of an algorithm-based protocol for the community follow-up of men with prostate cancer.
abstract: OBJECTIVE
  To evaluate the implementation of a novel algorithm-based discharge programme for the community follow-up of men with prostate cancer.
  
  
  METHODS
  Men with prostate cancer considered suitable for discharge were identified from consultant-led and clinical nurse-specialist telephone clinics at Nottingham University Hospitals National Health Service Trust. Patients were discharged on to one of four discharge pathways: watchful waiting, androgen-deprivation therapy (ADT), post-prostatectomy, and post-radiotherapy. Primary care providers were asked to adhere to specific surveillance measures and refer patients back to secondary care after breach of pre-defined prostate-specific antigen (PSA) level threshold criteria. Reasons for non-compliance, re-referral, and cause of death were determined for all discharged men.
  
  
  RESULTS
  In all, 573 men were discharged across all four pathways; 169 on the watchful-waiting pathway, 229 on the ADT pathway, 95 on the post-prostatectomy pathway, and 80 on the post-radiotherapy pathway. All patients had ≥12 months of follow-up. In all, 48 of 54 (88.9%) men were re-referred promptly after a PSA-threshold breach. Of the remaining six patients there were three refusals, one unrelated death before referral, and two late referrals at 4 months. Three patients were lost to follow-up due to database non-registration and were subsequently recalled, none of whom had a PSA-threshold breach. There were three unexpected deaths attributed to prostate cancer: two were community deaths with no biochemical or clinical evidence of prostate cancer progression, while one was due to a likely progressive PSA non-secreting tumour.
  
  
  CONCLUSIONS
  Initial results suggest the algorithm-based protocol is a viable, effective, and oncologically safe method for the controlled discharge of men from secondary to primary care. Longer-term follow-up, patient satisfaction and cost-effectiveness data are required to assess the true impact of the initiative.
authors.affiliation: Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodall
authors.affiliation: Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Little
authors.affiliation: Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Robinson
authors.affiliation: Nottingham City Clinical Commissioning Group, Nottingham, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Trimble
authors.affiliation: Royal Guernsey Hospital, Guernsey, the Channel Islands.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Cole
authors.affiliation: Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walton
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols; D003153:Community Health Services; D019091:Critical Pathways; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010351:Patient Discharge; D011320:Primary Health Care; D011471:Prostatic Neoplasms / Q000628:therapy*; D013997:Time Factors
keywords: PSA surveillance; community follow-up; prostate cancer