***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose : We examined the frequency of followup prostate specific antigen testing and prostate biopsy  among men treated with active surveillance in the academic and community urology practice s comprising MUSIC ( Michigan Urological Surgery Improvement Collaborative ) . Material s and Methods : MUSIC is a consortium of 42 practice s that maintains a prospect i ve clinical registry with vali date d clinical data on all patients diagnosed with prostate cancer at participating sites . We identified all patients in MUSIC practice s who entered active surveillance and had at least 2 years of continuous followup . After determining the frequency of repeat prostate specific antigen testing and prostate biopsy  , we calculated rates of concordance with NCCN Guidelines ® recommendations ( ie at least 3 prostate specific antigen tests and 1 surveillance biopsy ) collaborative‐wide and across individual practice s. Results : We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup . Among the 431 men ( 84 % ) who remained on active surveillance for 2 years 132 ( 30.6 % ) underwent followup surveillance testing at a frequency that was concordant with NCCN ® ( National Comprehensive Cancer Network ® ) recommendations . At the practice level , the median rate of guideline concordant followup was 26.5 % ( range 10 % to 67.5 % , p < 0.001 ) . Among patients with discordant followup , the absence of followup biopsy was common and not significantly different across practice s ( median rate 82.0 % , p = 0.35 ) . Conclusions : Among diverse community and academic practice s in Michigan , there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy . These data highlight the need for st and ardized active surveillance pathways that emphasize the role of repeat surveillance biopsies Introduction Active surveillance is a strategy for managing low-risk , localised prostate cancer , where men are observed with serial prostate-specific antigen assessment s to identify signs of disease progression . Currently , there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression , ultimately delaying transition to active treatment before it is clinical ly required . Recently , we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance . Methods and analysis A single-blinded , two arm , multicentre r and omised controlled trial will be undertaken with 168 patients r and omly allocated in a ratio of 1:1 to exercise or usual care . Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting , and during months 7–12 , a progressive stepped down approach will be used with men transitioning to once a week supervised training . Thereafter , for months 13 to 36 , the men will self-manage their exercise programme . The primary endpoint will be the time until the patients begin active therapy . Secondary endpoints include disease progression ( prostate specific antigen ) , body composition and muscle density , quality of life , distress and anxiety and an economic analysis will be performed . Measurements will be undertaken at 6 and 12 months ( postintervention ) and at 24 and 36 months follow-up . The primary outcome ( time to initiation of curative therapy ) will be analysed using Cox proportional hazards regression . Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences . Data will be analysed using an intention-to-treat approach . Ethics and dissemination Outcomes from the study will be published in peer- review ed academic journals and presented in scientific , consumer and clinical meetings . Trial registration number ACTRN12618000225213 Background : Care coordination has received increased attention in recent years because it critically affects patient safety and care quality across services and setting s. Objective : The effectiveness of systematic ally developed nurse navigator interventions for newly diagnosed cancer patients was evaluated . Methods : Seventy-eight patients participated in a nonequivalent control group pretest-posttest design study . The study design spanned a 3-month period for all participants . Patient outcome measures included quality of life , satisfaction with care , and length of hospital stay . Results : Participants in the experimental program reported significant increases in several components of quality of life and with satisfaction with care and experienced fewer hospital stay days compared with the control group . Conclusion : This study provides evidence that st and ardized nurse navigator programs can improve patient outcomes in cancer care . Implication s for Practice : Positive outcomes of the reduced length of stay and improved quality of life and patient satisfaction may help transform the cancer care delivery model toward more nurse-initiated cost-effective model Background The Distress Thermometer ( DT ) is widely recommended for screening for distress after cancer . However , the validity of the DT in men with prostate cancer and over differing time points from diagnosis has not been well examined . Method Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT compared with three commonly used st and ardised scales in two prospect i ve and one cross-sectional survey of men with prostate cancer ( n = 740 , 189 and 463 , respectively ) . Comparison scales included the Impact of Event Scale – Revised ( IES-R , Study 1 ) , the Hospital Anxiety and Depression Scale ( HADS , Study 2 ) and the Brief Symptom Inventory-18 ( BSI-18 , Study 3 ) . Results Study 1 : the DT showed good accuracy against the IES-R at all time points ( area under curves ( AUCs ) ranging from 0.84 to 0.88 ) and sensitivity was high ( > 85 % ) . Study 2 : the DT performed well against both the anxiety and depression subscales for HADS at baseline ( AUC = 0.84 and 0.82 , respectively ) , but sensitivity decreased substantially after 12 months . Study 3 : validity was high for the anxiety ( AUC = 0.90 , sensitivity = 90 % ) and depression ( AUC = 0.85 , sensitivity = 74 % ) subscales of the BSI-18 but was poorer for somatization ( AUC = 0.67 , sensitivity = 52 % ) . A DT cut-off between ≥3 and ≥6 maximised sensitivity and specificity across analyses . Conclusions The DT is a valid tool to detect cancer-specific distress , anxiety and depression  among prostate cancer patients , particularly close to diagnosis . A cut-off of ≥4 may be optimal soon after diagnosis , and for longer-term assessment s , ≥3 was supported Abstract As the global burden of cancer increases healthcare services will face increasing challenges in meet the complex needs of these patients , their families and the communities in which they live . This raises the question of how to meet patient need where direct clinical contact may be constrained or not readily available . Patients and families require re sources and skills to manage their illness outside of the hospital setting within their own communities . Aim . To propose a framework for the development and delivery of psycho-educational and supportive care interventions drawing on theoretical principles of behaviour change and evidence -based interventions , and based on extensive experience in developing and testing complex interventions in oncology . Approach . At the core of this intervention framework are considerations of efficiency : interventions are design ed to cater for individuals ’ unique needs ; to place minimal dem and s on the health system infrastructure and to be rapidly disseminated into usual care if successful . There are seven key features : 1 ) Targeting cancer type and stage ; 2 ) Tailoring to unique individual needs ; 3 ) Promotion of patient self-management of their disease and treatment side effects ; 4 ) Efficient delivery of the intervention ; 5 ) Training and adherence to protocol ; 6 ) Ensuring the intervention is evidence -based ; 7 ) Confirming stakeholder acceptability of the intervention . Application . A case study of a r and omised controlled trial which tested psycho-educational oncology interventions using this framework is presented . These interventions were design ed to cater for individuals ’ unique needs and promote self-management while placing minimal dem and s on the acute health care setting . Discussion . Innovative ways to realise the potentially major impact that psycho-educational and supportive care interventions can have on psychological morbidity , coping , symptoms and quality of life in serious and chronic illness are needed . This framework , which is driven by theory , evidence , and experience , is design ed to ensure that interventions are effective , clinical ly feasible and sustainable PURPOSE To characterize changes in lean body mass ( LBM ) in men with prostate cancer receiving and rogen-deprivation therapy ( ADT ) .  PATIENTS AND METHODS We prospect ively evaluated LBM in a prespecified sub study of a r and omized controlled trial of denosumab to prevent fractures in men receiving ADT for nonmetastatic prostate cancer .  LBM was measured by total-body dual-energy x-ray absorptiometry at study baseline and at 12 , 24 , and 36 months . The analyses included 252 patients ( 132 , denosumab ; 120 , placebo ) with a baseline and at least one on- study LBM assessment . Patients were stratified by age ( < 70 v ≥ 70 years ) and by ADT duration ( ≤ 6 v > 6 months ) . RESULTS Median ADT duration was 20.4 months at study baseline . Mean LBM decreased significantly from baseline , by 1.0 % at month 12 ( 95 % CI , 0.4 % to 1.5 % ; P < .001 ; n = 248 ) , by 2.1 % at month 24 ( 95 % CI , 1.5 % to 2.7 % ; P < .001 ; n = 205 ) , and by 2.4 % at month 36 ( 95 % CI , 1.6 % to 3.2 % ; P < .001 ; n = 168 ) . Men age ≥ 70 years ( n = 127 ) had significantly greater changes in LBM at all measured time points than younger men . At 36 months , LBM decreased by 2.8 % in men age ≥ 70 years and by 0.9 % in younger men ( P = .035 ) . Men with ≤ 6 months of ADT at study entry ( n = 36 ) had a greater rate of decrease in LBM compared with men who had received more than 6 months of ADT at study entry ( 3.7 % v 2.0 % ; P = .0645 ) . CONCLUSION In men receiving ADT  , LBM decreased significantly after 12 , 24 , and 36 months BACKGROUND Men with prostate cancer on active surveillance ( AS ) are advised to follow strict follow-up schedules and switch to definitive treatment on risk reclassification . However , some men might not adhere to these strict protocol s. OBJECTIVE To determine the number of noncompliers and disease reclassification rates in men not complying with the follow-up protocol of the Prostate Cancer Research International Active Surveillance ( PRIAS ) study . DESIGN , SETTING , AND PARTICIPANTS A total of 4547 men with low-risk prostate cancer were included and prospect ively followed on AS . Men were regularly examined using prostate-specific antigen ( PSA ) , digital rectal examination , and repeat biopsies , and were advised to switch to definitive treatment on disease reclassification ( > cT2c , Gleason score > 3 + 3 , > 2 cores positive , or PSA doubling time [ PSA-DT ] 0 - 3 yr ) . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Rates of men not complying with follow-up visits or a recommendation to discontinue AS are reported . Biopsy outcome ( Gleason ≥7 or > 2 cores positive ) was compared between compliers and noncompliers using Cox proportional hazards analysis . RESULTS AND LIMITATIONS The compliance rate for PSA visits was 91 % . By contrast , the compliance rate for st and ard repeat biopsies decreased over time ( 81 % , 60 % , 53 % , and 33 % at 1 , 4 , 7 , and 10 yr after diagnosis , respectively ) . Yearly repeat biopsies in men with faster rising PSA ( PSA-DT 3 - 10 yr ) was low at < 30 % , although these men had higher upgrading rates at repeat biopsy ( 25 - 30 % vs 16 % ) . PSA-DT of 0 - 3 yr was the most common recommendation for discontinuation , but 71 % continued on AS . Men with PSA-DT of 0 - 3 yr were at higher risk of upgrading on repeat biopsy ( hazard ratio 2.02 , 95 % confidence interval 1.36 - 3.00 ) compared to men without fast rising PSA . CONCLUSION Some men and their physicians do not comply with AS follow-up protocol s. In particular , yearly repeat biopsies in men with fast rising PSA are often ignored , as is the recommendation to discontinue AS because of very fast rising PSA . Although these men are at greater risk of higher Gleason scores on repeat biopsy , the majority still exhibit favorable tumor characteristics . Fast rising PSA should therefore not trigger a recommendation to receive active treatment , but should rather serve as a criterion for stricter follow-up . In addition , we should aim to find ways of safely reducing the number of biopsies to increase adherence to AS protocol s. PATIENT SUMMARY We looked at compliance with an active surveillance protocol for low-risk prostate cancer in a large active surveillance study . We observed reluctance to undergo yearly biopsies because of fast rising prostate-specific antigen , despite a higher risk of disease progression . Further research should aim to safely reduce the number of repeat biopsies in men on 
    Output:
    
Exercise and psychosocial interventions were effective for improving men 's survivorship outcomes in the domains of health promotion , physical side effects , and psychosocial management .