Editing Patient Pathways: Prostate Cancer (section)

= Patient pathways =

Developing a comprehensive prostate cancer treatment plan includes steps from initial presentation and diagnosis to treatment and follow-up. Below is a detailed plan:

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== 1. Diagnostic ==

The patient presents with symptoms such as: difficulty urinating, frequent urination, pelvic pain, blood in the urine or semen, or bone pain.

'''Consultation with a doctor''' general practice.

'''Medical history and physical examination:''' Detailed medical history of the patient, digital rectal examination (DRE).

'''Initial tests:''' Prostate-specific antigen (PSA) test, complete blood count (CBC).

'''Referral to a urologist''' for further evaluation.

'''Diagnostic evaluation'''

'''Magnetic resonance: MRI of the pelvis''' to assess the local extent of the cancer and the stage of the cancer. The MR scan shows whether a biopsy should be done and if so, where exactly the tissue sample should be taken.

'''Transrectal ultrasound:''' visualization for taking prostate tissue samples (biopsy). The biopsy sample is sent for pathological examination to confirm the diagnosis of cancer.

'''CT scan:''' chest, abdomen and pelvis to check the spread of cancer and the presence of metastases.

'''Bone scintigraphy:''' assessment of bone metastases.

'''Laboratory tests:''' further assessment of PSA levels.

'''Genetic testing for BRCA1 and BRCA2 mutations''' can show how aggressive the tumor is.

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== 2. Treatment ==

'''Multidisciplinary Team (MDT) meeting'''

Review of diagnostic findings with experts including oncologists, urologists, surgeons, radiologists, pathologists and radiotherapy specialists. Development of a treatment plan based on the stage of the tumor, risk assessment and general health of the patient.

'''Active Surveillance:''' for patients with low risk and less aggressive cancer. Regular PSA tests, DRE and occasional biopsies.

'''Treatment procedures'''

'''Surgical treatment'''

'''Radical prostatectomy:''' a traditional surgical method with a larger incision to remove the prostate and surrounding tissue.

'''Laparoscopic prostatectomy:''' minimally invasive method with smaller incisions.

'''Robot-assisted prostatectomy:''' uses robotic technology for greater precision.

'''Radiotherapy'''

Radiotherapy uses ionizing radiation to damage the DNA of cancer cells, causing them to die. She can be:

'''External Radiotherapy (EBRT):''' external radiation source directed at the prostate.

'''MRT (intensity modulated radiotherapy):''' precise targeting of radiation to the tumor while minimizing damage to the surrounding tissue.

'''SBRT (stereotactic radiotherapy):''' highly precise targeting of a high dose of radiation in short intervals.

'''Brachytherapy:''' internal radiation by implanting radioactive sources directly into the prostate.

'''Hormonal therapy'''

Reducing the level of male hormones (androgens) that promote the growth of prostate cancer. It is often used in combination with radiotherapy for locally advanced cancer.

'''LHRH agonists/antagonists:''' Medicines that reduce testosterone production.

'''Antiandrogens:''' Medicines that block the action of testosterone.

'''Orchiectomy:''' Surgical removal of the testicles to reduce testosterone levels.

'''Chemotherapy'''

Using drugs to destroy cancer cells. It is usually used in advanced cancer that is resistant to hormone therapy.

'''Immunotherapy'''

A personalized vaccine that uses the patient’s own immune cells to fight prostate cancer.

'''Targeted therapy'''

Medicines that target cancer cells with certain genetic mutations (PARP inhibitors).

'''Radionuclide therapy'''

A radioactive drug that targets bone metastases in patients with advanced prostate cancer.

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== 3. After treatment: follow-up, rehabilitation and survival ==

'''Rehabilitation'''

'''Physical therapy''' for the recovery of pelvic function and general fitness.

'''Sexual health support:''' counseling and therapy for sexual function.

'''Psychosocial support:''' counseling and support groups for emotional well-being.

'''Follow-up after treatment'''

'''Regular control examinations with physical examinations and PSA tests.'''

Periodic CT or MR for relapse monitoring.

'''Long-term follow up'''

Monitoring of late effects of treatment.

'''Health promotion and lifestyle changes''' to improve general well-being.

'''Secondary prevention:''' Screening for other malignancies and maintaining a healthy lifestyle.

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== 4. Palliative care (if applicable) ==

'''Palliative treatments:''' To relieve symptoms and improve quality of life in advanced cancer.

'''Pain management:''' Medicines, nerve blocks.

'''Symptom control:''' Management of shortness of breath, pain, etc.

'''Hospice care:''' For end-of-life care if curative treatment is no longer an option.

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