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Prostate Cancer Guidelines This guidance was developed by the Primary Care Sub-group of the Prostate Cancer Working Group . The Prostate Cancer Working Group is responsible for implementing the Prostate Cancer Awareness and Quality Improvement Programme (the AQIP) Unlike other cancers, prostate cancer often grows slowly. Therefore, routine PSA testing can lead to many men being diagnosed with a cancer that is not going to progress during their lifetime. This in turn may increase men’s exposure to unnecessary treatment-related harms. Some men will still develop aggressive and potentially life-threatening prostate cancer. These men may benefit from prompt diagnosis and treatment. New Zealand men currently receive conflicting advice about prostate cancer testing and treatment. Some men may benefit from early diagnosis and treatment, but have limited opportunity to access appropriate health services Prostate Cancer Management and Referral Guidance …to help primary care practitioners provide men and their whānau with: consistent, culturally appropriate information on prostate cancer testing and treatment. Aiming for Quality Improvement that will: ensure that men have better and more equitable access to information about prostate cancer support primary care practitioners to manage men presenting with prostate-related concerns removing barriers that restrict men’s access to diagnostic and treatment services ensuring that men receive consistent care and have equitable outcomes across the entire care pathway. This guidance is part of a suite of resources that will be developed under the AQIP. Other resources that will be developed over the next two years include: an electronic decision support tool to aid men’s decision. making around prostate cancer testing and treatment guidance on the use of active surveillance guidance on the pathologic diagnosis and staging of prostate cancer guidance on managing men with advanced or metastatic prostate cancer patient information for men and their whānau. . District health boards and primary health organisations will be responsible for : integrating this guidance into their clinical pathways for prostate cancer in a way that reflects the particular needs of their patients and communities. Primary care practitioners should be conscious of the disparities that exist in prostate cancer outcomes for different men, such as for Māori men or men who live in rural areas. . For example, Māori men are less likely to be diagnosed with prostate cancer than nonMāori men, but are 37 percent more likely to die from the disease (Ministry of Health, 2014). in part, they appear to be related to differences in Māori men’s access to appropriate information and to diagnostic and treatment services. . Normal PSA and DRE Prostate cancer unlikely . Discuss follow up including option of no further testing (unlikely to benefit men over 70 years) If FH first degree relative affected under age 65yrs, recommend repeat PSA and DRE every year Abnormal PSA (guidance cut off . 4.0 and 10.0) Check for red flags Treat if UTI or prostatitis present Repeat PSA 6-12 weeks Refer if abnormal (abnormal DRE -> refer)