Surviving cancer: Medical monitoring matters
Case notes: Mr G, 62 years old
‘Mr G’ was at risk of prostate cancer. His father had died of this disease, and his older brother had developed prostate cancer at the age of 62 years. Mr G himself had urinary frequency and regularly got up twice at night to pass urine. His GP measured his prostate-specific antigen (PSA) and it came back elevated at 29.8µg/L, so he was referred to the Urology Department. Mr G attended a one-stop shop with blood tests, a short history and an MRI examination followed. A suspicious area in the prostate was identified on the MRI and was biopsied two weeks later, confirming prostate cancer.
Within two weeks, Mr G underwent elective surgery for a radical prostatectomy, followed by local radiotherapy and hormone treatment. At his next clinic visit, Mr G’s PSA was <2 µg/L. He could no longer ejaculate and erectile function was intermittent, depending on how much he felt flushed. The hospital arranged a six-monthly review (in line with NICE guidelines), with a short clinic appointment, PSA measurement and other blood tests. All was going well, and after 18 months Mr G began to relax, attending the clinic when appointments arrived by post. His next appointment was due in late March 2020, but Covid struck. Mr G was worried that his radiotherapy and hormone treatment might make him at risk and he should shield, but try as he might, he could not find out as his GP surgery had closed. There were no hospital appointments, but over time MR G felt more relaxed about his situation, and when he was vaccinated the following February, he started to feel safe again.
By the beginning of 2022, Mr G felt much safer. He’d been vaccinated three times, but he did wonder whether he should ask for a review at the hospital as the clinic appointment in 2020 just never happened. The GP organised a repeat PSA for reassurance, but it came back at 96 µg/L. Mr G was referred back urgently to the Urology service who diagnosed local recurrence of the prostatic cancer, with bony secondaries. A review of the previous monitoring had shown that his PSA had increased from <2 µg/L to 4.2 µg/L at his last clinic visit in September 2019, and in retrospect the small increase in PSA was the first indication of early recurrence of the prostate cancer.
Regardless, for the last two years, Mr G had felt otherwise fine. But his cancer was slowly growing from an easily treatable local recurrence into one with metastatic disease and a universally fatal outcome. In short, it was too late.
With our Cancer Monitor software
Following his successful treatment, Mr G is registered for prostate cancer monitoring. Our software automatically generates a blood test request for PSA every six months, regardless of clinic appointments or a Covid pandemic. It also creates a timetable of blood tests for advance booking, sends out a digital blood form and requests for a test to be carried out at the local hospital.
The results are sent to Mr G, as well as to his urologist. In March 2020, Mr G receives a repeat PSA request. He can see that his PSA has increased from 4.2 last September to 9.2 µg/L, supported by a graph of results. The urology team are alerted automatically and the prostate clinical nurse specialist calls Mr G to inform him that they will organise an MRI prostate. This is completed within the two-week pathway. A local recurrence is identified, and Mr G undergoes brachytherapy, where the radiation dose is delivered internally into the prostate gland. Treatment is successful and Mr G remains free from prostate cancer two years later.
Better outcomes are possible with software created by clinicians, for clinicians.