Scribe BC - Radiation Oncology Prostate Cancer Consult

DIAGNOSIS [Describe the patient's primary cancer diagnosis, including grade, relevant pathologic and lab values including most recent PSA and ISUP risk group.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a single paragraph.) [Any prior treatment, including: radiation therapy dose, fractionation, treatment dates and treatment site; Systemic therapy such as ADT (Androgen Deprivation Therapy) and Abiraterone/dexamethasone, including drug, dosage, cycles completed, first administration date and date next administration is due; and local therapy such as surgery.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as separate bulleted lists for each treatment type with treatment type as a heading, with treatments in chronologic order.) PLAN SUMMARY [summary of the treatment plan, including type of radiotherapy and potential future treatments with conditions] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a single paragraph.) [Patient's full name], [patient's age]-year-old [gender], seen today for [reason for visit]. [State any companions to the patient who are also present at the visit] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; omit any placeholder that's not mentioned.) [patient's initial presentation, including relevant dates, initial PSA levels, referral details, biopsy results, initial treatment, and staging investigation findings] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full, grammatically complete, sentences.) [patient's response to initial therapy, subsequent treatment details, and any medication changes or interactions identified] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full, grammatically complete, sentences.) PSA History: [PSA values and dates in reverse chronologic order] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write as a bulleted list) [description of patient's current symptoms, pain levels, location of discomfort, aggravating factors, recent medical visits, and current pain management strategies. Also include details about urinary function, IPSS score, dynamic testing results, sexual function, hypogonadal symptoms, bowel habits, energy levels, appetite, weight changes, and overall performance status] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit completely. Write in paragraphs of full sentences.) INVESTIGATIONS [List all relevant imaging and procedural investigations with their dates and key findings, specifically detailing CT and bone scan results, TRUS prostate biopsy results including prostate volume, adenocarcinoma details, grade group, core involvement, tissue involvement, and presence/absence of other findings like cribriform glands, intraductal carcinoma, lymphovascular invasion, or perineural invasion and PET scan findings, including measurements, SUV max values, and absence of metastasis. Include any subsequent investigations related to incidental findings. Do not include outcomes from consultations.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a bulleted list and write out full dates. Sort in chronologic order) PAST MEDICAL HISTORY [list of patient's past medical diagnoses] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a bulleted list.) PAST SURGICAL HISTORY [list of patient's past surgical procedures] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a bulleted list.) CURRENT MEDICATIONS [list of all current medications, including drug names] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a bulleted list.) ALLERGIES [patient's reported allergies and associated reactions] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a single paragraph.) SOCIAL HISTORY [patient's living situation, including location, family details, cultural affiliation, occupation and work history, smoking status, alcohol consumption, and recreational drug use history] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full sentences.) FAMILY HISTORY [List significant family cancer history, specifying the relationship, the type of malignancy or condition, and including dates or ages of diagnosis and death, if available.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise include section mentioning that there is no relevant family history. Write as a bulleted list.) PHYSICAL EXAMINATION Height: [patient's height in cm] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a single paragraph.) Weight: [patient's weight in kg] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a single paragraph.) Vitals: [patient's vital signs including BP, HR, SpO2, and temperature] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write as a single paragraph.) [general appearance, ambulation assessment, and specific findings from examination related to pain and tenderness] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full sentences.) [DRE results] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise mention that DRE was not performed today. Write in paragraphs of full sentences. ) ASSESSMENT AND PLAN [Provide a summary of the patient's case, including the diagnosis. Discuss the differential diagnoses. Detail the management options discussed with the patient.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full sentences.) [Elaborate on the proposed treatment plan, including the planned fractionation and a comprehensive discussion of expected acute and delayed side effects, detailing potential complications such as fatigue, urinary and bowel toxicity, and erectile dysfunction. Include the estimated likelihood of long-term local control.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full sentences.) (If the addition of abiraterone and prednisone was discussed, print "We also had a conversation about the risks and benefits of adding abiraterone plus prednisone. Abiraterone is a selective, irreversible inhibitor of CYP17, which results in more effective androgen depletion than ADT alone. It is combined with prednisone to reduce side-effects of mineralocorticoid excess. Two RCTs from STAMPEDE platform showed metastasis-free survival (MFS) and overall survival (OS) benefits in the overall population with combined ADT (for 3 years) and additional abiraterone (for 2 years) in patients with high-risk disease in addition to prostate and whole pelvic RT. 6 year MFS improved from 69% to 82%, and 6 year OS from 77% to 86%. The European Association of Urology and NCCN recommend the addition of 2 years of abiraterone to very high risk cN0M0 patients with ≥ 2 high-risk factors (cT3-4, Gleason ≥8 or PSA ≥ 40 ng/ml), and to cN1M0 patients. I outlined the potential adverse effects of abiraterone plus prednisone that include but are not limited to: cardiac angina (<3%), arrhythmia (7%), cardiac failure (2%), diarrhea (20%), dyspepsia (10%), peripheral edema (25%), fatigue, increased liver enzymes (30-40%), hyperlipidemia (55%), hypokalemia (19%), arthralgia (27%), myopathy (36%), cough, rash (8%), hot flush, hypertension (10-20%). Prednisone 5 mg daily is prescribed to reduce the incidence of mineralocorticoid adverse effects related to abiraterone. We also reviewed the side effects of steroid therapy.") [State the patient's decision regarding treatment, the rationale behind their choice, and the next steps in their care plan, including scheduling appointments and providing contact information.] (Only include if explicitly mentioned in the transcript, contextual notes or clinical note; otherwise omit section entirely. Write in paragraphs of full sentences.) AI CONSENT The patient provided verbal consent to use the AI scribe during this visit, understanding its purpose, potential benefits, and limitations, as well as the need for a temporary audio recording for documentation and associated privacy and security risks. (Never come up with your own patient details, assessment, plan, interventions, evaluation, or plan for continuing care - use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely. Use as many lines, paragraphs, or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)