"Best Practices" Medical Care
The PCCNC collaborates to help promote the availability of multidisciplinary "second opinion" clinics and navigation services for prostate cancer patients throughout the state. North Carolina is home to 3 National Cancer Institute (NCI) designated cancer centers and 37 American College of Surgeons (ACoS) Commission on Cancer (CoC) accredited community cancer centers.
Duke, Novant Health, UNC Lineberger, and Wake Forest Baptist Health all offer multidisciplinary "second opinion" clinics. Please note, insurance providers vary in their coverage of these important resources. The Association of Community Cancer Centers (ACCC) has published a useful guide of suggested "best practices" for developing a prostate cancer program.
Click here to create your customized prostate cancer patient profile.
Duke, Novant Health, UNC Lineberger, and Wake Forest Baptist Health all offer multidisciplinary "second opinion" clinics. Please note, insurance providers vary in their coverage of these important resources. The Association of Community Cancer Centers (ACCC) has published a useful guide of suggested "best practices" for developing a prostate cancer program.
Click here to create your customized prostate cancer patient profile.
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Brother to Brother Statewide Prostate Cancer Patient and Survivor Support Network Our statewide support network seeks to assure that men and those who care about them are aware of "best practices" throughout the continuum of care. Below are some of the tools we use to help explain cancer diagnosis to newly diagnosed men. |
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Understanding Diagnosis
Risk Groups
Risk group is identified by greatest risk clinical stage, PSA, or Gleason score as laid out in the color coded table below. For example, a man can have a very low risk clinical stage and PSA, but a very high risk biopsy result would make him very high risk. Alternately, a man could have a very low risk PSA and biopsy result, but a very high risk clinical stage. This would also make him very high risk. See images below table for graphical illustrations of clinical stage and Gleason score.
Risk group is identified by greatest risk clinical stage, PSA, or Gleason score as laid out in the color coded table below. For example, a man can have a very low risk clinical stage and PSA, but a very high risk biopsy result would make him very high risk. Alternately, a man could have a very low risk PSA and biopsy result, but a very high risk clinical stage. This would also make him very high risk. See images below table for graphical illustrations of clinical stage and Gleason score.
Data Source: National Comprehensive Cancer Network (NCCN) Guidelines for Patients - Prostate Cancer
Clinical Stage
Gleason Score
After a prostate biopsy, two grades are assigned by a pathologist using the Gleason scale based on what the cells look like under a microscope. These 2 grades are added together to make up a Gleason score. Grades 3-5 are considered be cancer. Totaled together, the Gleason score ranges from 6-10. The first number is the most common grade present. The second number is the second most common grade present. Occasionally a tertiary grade is also assigned (usually 5) to call out the presence of some very aggressive looking cancer.
After a prostate biopsy, two grades are assigned by a pathologist using the Gleason scale based on what the cells look like under a microscope. These 2 grades are added together to make up a Gleason score. Grades 3-5 are considered be cancer. Totaled together, the Gleason score ranges from 6-10. The first number is the most common grade present. The second number is the second most common grade present. Occasionally a tertiary grade is also assigned (usually 5) to call out the presence of some very aggressive looking cancer.
The National Comprehensive Cancer Network (NCCN) consistently updates evolving evidence supported "best practices." Using the information above, the NCCN FREE patient guide (pdf) can be used as a starting point for considering what treatment options might be right for an individual. Part 5 of this guide describes which treatments a man might consider based on his risk. Part 3 presents other points to consider when thinking about treatment. And parts 6 and 7 discuss monitoring and advanced disease.
Additionally, many medical professionals suggest the use of nomograms to help further personalize care and decision support.
Sample: Multidisciplinary "2nd Opinion" Clinic Experience
Source: Reiling R. A Prostate and Genitourinary Multidisciplinary Oncology Clinic in a Multi-Hospital System. Oncology Issues. September 2009: pages 52-57.
The following resources are available to newly diagnosed men, survivors, and those coping with end of life challenges:
- CancerCare: Online support group for prostate cancer patients and other educational resources.
- MaleCare: Specialized online support groups for men living with advanced disease, newly diagnosed men, coping with side-effects, and LBGT men living with prostate cancer.
- Navigate Cancer Foundation: This is an unbiased “3rd party” resource, whereby you gain access to an advanced practice oncology nurse who is not directly affiliated with any particular medical institution. He or she can help with understanding the complexities of your diagnosis, equipping you with the information you need to advocate for your own high quality individualized care.
- Patient Advocate Foundation: This resource can help with navigating the financial complexities involved with paying for care.
- Imerman Angels: Provides one-on-one peer support to cancer survivors.
- ClinicalTrials.gov: Allows you to search for clinical trials available to prostate cancer patients in NC. These studies contribute to the advancement of better patient care.