Late toxicity printout — Prostate

Cited monitoring paradigm

Acute: ACS names fatigue, pelvic-field skin change, short-term rectal and bladder problems, and nausea. Late: radiation proctitis and cystitis, incontinence, fertility and sexual side effects, low testosterone, osteoporosis, heart problems after ADT, lasting fatigue, jaw osteonecrosis after bisphosphonates, and vision change after hormone therapy. Monitor: lingering rectal or bladder symptoms after 3 to 6 months; echoes after cardiotoxic chemo; lasting fatigue or sleep problems; dental check before bisphosphonates; vision change after hormone therapy; a treatment summary. Those names are not encoded. First-row prostate toxicity stays empty on purpose. Not a PSA-kinetics or testosterone engine.

Not a fourth printout section. Cadences stay placeholders. Named tests are not encoded.

Questions to ask

ACS long-term page lists questions to ask the care team: possible long-term and late effects, whether fertility or second-cancer risk is higher, which cancer screening tests belong later, which specialists should follow those effects, whether cancer rehabilitation could help, and when to call primary care versus cancer care. Those questions are not encoded. Not a screening, fertility, rehab, or specialist-interval engine.

ACS long-term page says not everyone who has cancer treatment gets long-term or late effects. Who does can depend on the cancer type, the type and dose of treatment, side effects during treatment, age at diagnosis, health before treatment, genetics, eating and exercise during and after treatment, care-team expertise, and support from others. Those reasons are not encoded. Not a late-effect risk-score engine.

ACS follow-up-care page lists questions to ask: how to get a treatment summary and follow-up care plan, who is in charge of follow-up, how often visits and which tests or screens belong later, signs of recurrence or a second cancer, and which survivor support services are available. Follow-up may stay with the cancer care team, move to a survivorship clinic, or return to primary care, depending on the cancer type and stage, the treatment, remaining side effects, insurance, and wishes. Those questions and choices are not encoded. Not a visit-interval, screening, or clinic-routing engine.

ACS long-term and follow-up-care lists, named not encoded. Not a fourth printout section.

Treatment summary and care plan

ACS follow-up-care page names what a cancer treatment summary most often includes: diagnosis date; cancer type, including where it started, stage, and grade if known; treatments and dates, including type, dose, and number of cycles; side effects and how they were managed; test results; and names and contacts for the treating doctors. A survivorship care plan most often names remaining treatment, how often follow-up should happen, which tests including screens for other cancers, possible long-term or late effects, and ways to improve overall health. Those named contents are not encoded. Not a records, visit-interval, or screening engine.

ACS follow-up-care named contents. Not a fourth printout section.

How late effects are managed

ACS follow-up-care page says long-term side effects begin during treatment and continue after, and late side effects can start months or years later. Follow-up care may include a review of symptoms, a physical exam, blood tests to check blood counts and how the liver, kidneys, and other organs are working, and other tests as needed. Special tests after some treatments stay named on this printout. Those named steps are not encoded. Not a lab-panel, visit-interval, or screening engine.

ACS follow-up-care named steps. Not a fourth printout section.

Acute toxicities

During or shortly after RT. ACS early side effects.

• Fatigue — ACS names fatigue as a common early RT side effect.ACS-radiation-body
• Radiation dermatitis — ACS names skin irritation in the pelvic field.ACS-radiation-body
• Short-term rectal problems — ACS names constipation, diarrhea, bowel urgency, rectal or anal skin irritation, and blood in the stool.ACS-radiation-body
• Short-term bladder problems — ACS names pain or burning, trouble passing urine, blood in the urine, and urinary urgency.ACS-radiation-body
• Nausea or cramping — ACS names nausea, vomiting, and belly cramping as possible pelvic-field effects.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Low testosterone after pelvic treatment or ADT · Osteoporosis after hormone-affecting treatment · Low estrogen or testosterone after hormone-affecting treatment · Osteonecrosis of the jaw after bisphosphonates · Vision change after hormone therapy · Heart problems after ADT · Heart problems after some cardiotoxic treatments

• Radiation proctitis — ACS names later belly or pelvis pain, blood in the stool, stool incontinence, nutrient absorption trouble, or rectal narrowing.ACS-radiation-body
• Bowel incontinence / urgency — ACS names trouble controlling bowels that may continue after RT.ACS-radiation-body
• Radiation cystitis — ACS names later blood in the urine or pain when passing urine.ACS-radiation-body
• Urinary incontinence — ACS names leakage or dribbling after prostate or bladder RT.ACS-radiation-body
• Fertility and sexual side effects — ACS names fertility and sexual side effects after pelvic RT. Not a testosterone or PSA-kinetics engine.ACS-radiation-body
• Low testosterone after pelvic treatment or ADT — ACS long-term page names low testosterone after orchiectomy, pelvic or prostate radiation, hormone-blocking medicines, or ADT, including erection difficulty. Not a testosterone engine.ACS-long-term-effects
• Osteoporosis after hormone-affecting treatment — ACS long-term page names osteopenia and osteoporosis after treatments that affect hormones. Named only on fields that already name hormone-affecting treatment. Not a DXA-interval engine.ACS-long-term-effects
• Low estrogen or testosterone after hormone-affecting treatment — ACS long-term page names low estrogen or testosterone after ovary or testis surgery, pelvic or prostate radiation, hormone-blocking medicines, chemo, or steroids. Highest named risks are breast, ovarian, testicular, and prostate cancer. Named only on fields that already name hormone-affecting treatment. Not a testosterone or hormone-lab engine.ACS-long-term-effects
• Osteonecrosis of the jaw after bisphosphonates — ACS long-term page names osteonecrosis of the jaw after radiation to the jawbone or medicines used to prevent bone loss, called bisphosphonates. Named only on fields that already name osteoporosis after hormone-affecting treatment. Not a dental-calendar engine.ACS-long-term-effects
• Vision change after hormone therapy — ACS long-term page names vision change, cataracts, or glaucoma after some hormone therapies, as well as some chemo, targeted therapies, or immunotherapies. Named only on fields that already name hormone-affecting treatment and do not already carry a head-or-eye RT vision row. Not an eye-screening engine.ACS-long-term-effects
• Heart problems after ADT — ACS long-term page names hormone therapy or androgen deprivation therapy among cardiotoxic treatments. Problems may show up years later. No dose reconstruction.ACS-long-term-effects
• Heart problems after some cardiotoxic treatments — ACS long-term page names heart problems after anthracyclines, cisplatin, checkpoint inhibitors, VEGF inhibitors, HER2-directed therapy, hormone therapy or ADT, or radiation to the lung, chest, or breast. Problems may show up years later. Named only on fields that already cite a cardiotoxic treatment. Not a heart-dose or echo-interval engine.ACS-long-term-effects
• Cancer-related fatigue that lasts — ACS long-term page names cancer-related fatigue as the most common long-term effect, lasting months or years and not always improving with rest. Sleep problems are also named and may have more than one cause.ACS-long-term-effects
• Joint or muscle pain after some treatments — ACS long-term page names joint or muscle pain after chemo, steroids, or hormone therapy. Symptoms may improve over time. People who are not physically active may have a higher risk. Not a rehab-interval engine.ACS-long-term-effects
• Mental health and distress after treatment — ACS long-term page names anxiety, depression, post-traumatic stress, loneliness, and fear of recurrence among common mental-health effects after cancer treatment. Not a mental-health screening engine.ACS-long-term-effects
• Second cancers after radiation or chemo — ACS adult second-cancers hub says a second cancer is a new unrelated cancer, not a recurrence. Radiation is linked to later AML, CML, ALL, or MDS, and to solid tumors that more often show up 10 years or more later, including breast, lung, thyroid, or bone and soft-tissue sarcomas. Chemo is linked most often to MDS and AML; ALL is also named. Chemo is named as a greater leukemia risk factor than radiation. Those names are not encoded. Complementary to the living-as pointer. Not a PSA-kinetics or testosterone engine.ACS-second-cancers-adults
• Follow-up care plan after treatment — ACS follow-up-care page, developed with ASCO review, names a cancer treatment summary and a survivorship care plan, plus watching for recurrence and for a second cancer. Regular cervical, breast, colorectal, or lung screening may be named. Those plans and screens are not encoded. Complementary to the living-as pointer. Not a PSA-kinetics or testosterone engine.ACS-follow-up-care

Named conditions to monitor

Red flags and suggested follow-up cadence placeholders. Not a personal calendar.

ACS follow-up tests named here: Echoes after cardiotoxic chemo

• Radiation proctitis after 3 to 6 months

  Radiation proctitis after 3 to 6 months — ACS names later rectal bleeding, pain, incontinence, or narrowing as reasons to talk with the care team. ACS names 3 to 6 months after RT for lingering rectal symptoms. Placeholder only — not encoded.

  ACS-radiation-body

• Radiation cystitis

  Radiation cystitis — ACS names later hematuria or painful urination. Visit-directed bladder check placeholder — not encoded. Not a cystoscopy-interval engine.

  ACS-radiation-body

• PSA after treatment

  PSA after treatment — ACS names PSA monitoring after surgery or radiation, including bounce and doubling time, without encoding those thresholds. PSA-after-treatment page is complementary. Placeholder only — not encoded. Not a PSA-kinetics engine.

  ACS-psa-after

• Bone and heart health after ADT

  Bone and heart health after ADT — ACS long-term page names osteoporosis after hormone-affecting treatment and heart problems after ADT. Bone-health and cardiac-check placeholders — not encoded. No cumulative doxorubicin-equivalent dose.

  ACS-long-term-effects

• Bone density after hormone-affecting treatment

  Bone density after hormone-affecting treatment — ACS long-term page names osteopenia and osteoporosis after treatments that affect hormones. Bone-health placeholder — not encoded. Not a DXA-interval or CA-125 engine.

  ACS-long-term-effects

• Hot flashes, bone loss, or sex-hormone change after hormone-affecting treatment

  Hot flashes, bone loss, or sex-hormone change after hormone-affecting treatment — ACS long-term page names hot flashes, cognitive changes, bone loss, changes in sex drive, and weight gain after low estrogen or testosterone. Named effects are not encoded. Not a testosterone, hormone-lab, or CA-125 engine.

  ACS-long-term-effects

• New heart symptoms years after cardiotoxic treatment

  New heart symptoms years after cardiotoxic treatment — ACS long-term page names later heart problems after some cardiotoxic treatments and asks which specialist should follow those effects. Referral placeholder — not encoded. Not a heart-dose or echo-interval engine. No cumulative doxorubicin-equivalent dose.

  ACS-long-term-effects

• Dental check before bisphosphonates

  Dental check before bisphosphonates — ACS long-term page names a dental check before jaw RT or bisphosphonates so tooth problems can be treated first. Named dental-check-before-start is not encoded. The named 6-month dental interval stays on the head-and-neck printout. Not a dental-calendar engine.

  ACS-long-term-effects

• Vision change after hormone therapy

  Vision change after hormone therapy — ACS long-term page says to ask the care team about seeing an eye doctor after vision change from cancer treatment. Referral placeholder — not encoded. Not an eye-screening engine.

  ACS-long-term-effects

• Cancer-related fatigue or sleep problems that last

  Cancer-related fatigue or sleep problems that last — ACS long-term page names cancer-related fatigue as the most common long-term effect, plus sleep problems after treatment. Named months-or-years window is not encoded. Placeholder only — not a fatigue-score engine.

  ACS-long-term-effects

• Joint or muscle pain after chemo, steroids, or hormone therapy

  Joint or muscle pain after chemo, steroids, or hormone therapy — ACS long-term page names joint or muscle pain after those treatments and says symptoms may improve over time. Named activity and rehab steps are not encoded. Placeholder only — not a rehab-interval engine.

  ACS-long-term-effects

• Anxiety, depression, or fear of recurrence after treatment

  Anxiety, depression, or fear of recurrence after treatment — ACS long-term page names those as common types of mental distress among cancer survivors and says very worried, depressed, or angry feelings can affect daily life. Named support steps are not encoded. Placeholder only — not a mental-health screening engine.

  ACS-long-term-effects

• Second-cancer awareness after radiation or chemo

  Second-cancer awareness after radiation or chemo — ACS adult second-cancers hub names later MDS or leukemia after some chemo or radiation, and later solid tumors after radiation. Complementary to the living-as pointer. Not a PSA-kinetics or testosterone engine. Named several-year and 10-year windows are not encoded. Symptom-directed placeholder — not a second-primary screening engine.

  ACS-second-cancers-adults

• Ask which late-effect tests belong on the follow-up plan

  Ask which late-effect tests belong on the follow-up plan — ACS follow-up-care page names special tests after some treatments. Ask which tests belong on the plan. Echoes are named after cardiotoxic chemo. Those named tests are not encoded. Complementary to the living-as pointer. Not a PSA-kinetics or testosterone engine. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care