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 and 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 (pee) often (called urinary frequency), 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 you will need close follow-up during this time.

Follow-up after prostate cancer treatment depends on the risk group and the type of treatment you had.

If you had surgery, radiation therapy, hormone therapy or a combination of these treatments, follow-up visits are usually scheduled:

• every 3 to 6 months for the first 5 years
• once a year after 5 years

If you are having active surveillance, follow-up visits are usually scheduled every 3 to 6 months.

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 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.

The prostate-specific antigen (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 someone having active surveillance should start having treatment.

The PSA level should go down significantly after treatment for prostate cancer. It usually drops to a very low or undetectable level within 2 months after a radical prostatectomy. But the PSA level usually drops more slowly after radiation therapy, taking from 6 months to a few years to reach its lowest level. 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.

Your healthcare team will do blood tests to check your testosterone level. If your testosterone level is more than 50 ng/mL, it may mean that hormone 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 a CT scan, an MRI and a bone scan.

Doctors may do a prostate biopsy if brachytherapy was the main treatment and a follow-up DRE is abnormal or the PSA level rises. You may also have a prostate biopsy if you are having active surveillance.

To make the decisions that are right for you, ask your healthcare team questions about follow-up.