Follow-up after treatment for prostate cancer
Follow-up after treatment is an important part of cancer care. Follow-up for prostate cancer is often shared among the cancer specialists including the oncologist, urologist, surgeon and your family doctor. Your healthcare team will work with you to decide on follow-up care to meet your needs.
Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:
- a need to urinate often, a sudden or strong urge to urinate (called urinary urgency) or trouble urinating
- pain or stiffness in the bones of the hips, back or chest
- loss of sensation or muscle strength in the legs
- loss of bladder control or bowel function (called incontinence)
- a cough that doesn’t go away or shortness of breath
- blood in the urine
- bleeding from the anus or pain in the rectum
The chance that prostate cancer will come back (recur) is greatest within 5 years, so close follow-up is needed during this time.
Schedule for follow-up visits
Follow-up after prostate cancer treatment depends on the type of treatment you had.
If you had surgery, radiation therapy, hormonal therapy or a combination of these treatments, follow-up visits are usually scheduled:
- 6 to 8 weeks after treatment starts
- every 3 to 6 months for the first 5 years
- once each year after 5 years
If you are undergoing active surveillance, follow-up visits are usually scheduled every 6 months.
During follow-up visits
During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping. They will likely ask if you have any bowel, bladder or sexual problems. Your doctor will take a medical history and do a physical exam, including a digital rectal exam (DRE).
The following tests are often part of follow-up care. If the cancer comes back, your healthcare team will assess you to determine the best treatment options.
Prostate-specific antigen (PSA) test
The PSA test is used to measure the level of PSA in the blood. The PSA level can tell doctors how well prostate cancer treatments are working or if a man undergoing active surveillance should start treatments.
The PSA level should go down significantly after treatment for prostate cancer. It usually drops to less than 0.3 ng/mL within 2 months after a radical prostatectomy. The PSA level usually drops to less than 1.0 ng/mL after 6 months or up to several years after radiation therapy. If the PSA level rises over time (called biochemical recurrence or biochemical failure), the healthcare team will do more tests to check for cancer.
Sometimes the PSA level can temporarily rise in the first couple of years after radiation therapy. This is called a PSA bounce. In most cases, the PSA level will fall the next time it is checked. Treatment isn’t needed unless the PSA level continues to rise.
Find out more about the prostate-specific antigen (PSA) test.
Other blood tests
Your healthcare team will do blood tests to check your testosterone level. If the testosterone level is more than 50 ng/mL, it may mean that hormonal therapy is no longer working.
You will also have blood tests to check the number and quality of your blood cells and to find out how well your other organs are working. Find out more about a complete blood cell count (CBC) and blood chemistry tests.
If your PSA level starts to rise, your doctor may send you for imaging tests, such as a CT scan, an MRI or a bone scan, to check for cancer.
Find out more about imaging.
Doctors may do a prostate biopsy if brachytherapy was the main treatment and a follow-up digital rectal exam is abnormal or the PSA rises. You may also have a prostate biopsy if you are undergoing active surveillance.
Questions to ask about follow-up
To make the decisions that are right for you, ask your healthcare team questions about follow-up.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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