This locally enhanced service provides routine annual follow-up for patients with stable prostate cancer in primary care. This is only valid for Homerton Urology  patients  (since April 2021) with a treatment summary and instructions for ongoing care in the community.

Practices then provide annual follow-up, including PSA monitoring and a holistic needs assessment.

The service delivers more holistic care in a setting closer to home and reduces the pressure on Homerton Urology. 

The key action for practices is to ensure discharged patients are coded on EMIS Web using the CEG Template- this will ensure that the patient can be recalled for PSA monitoring . 

Patients need to be dual coded ‘discharge from secondary care’ and ‘PSA monitored in primary care’ on the same day as this will form the basis for the PSA monitoring register. 

Eligibility criteria

Inclusions

•    Medically stable prostate cancer patients discharged from secondary care management.

Exclusions

•    Patients on active surveillance
•    Patients being treated with brachytherapy
•    Patients at high risk and who have had radical radiotherapy or surgery
•    Patients being treated with focal therapy
•    For individuals participating in clinical trials, follow-up will be determined by the clinical trial protocols.  All individuals taking part in trials will still access and benefit from the end of treatment clinical OPA (outpatient appointment) and health and wellbeing events.

Homerton Urology will assess the patient to determine their eligibility before transferring them to primary care.