Prostate Cancer Follow-up

Generally, early stage prostate cancer is followed with a PSA blood test and digital rectal examination. More advanced prostate cancers may require radiographic imaging such as bone scan or CT or MRI depending on symptoms. After any type of radiotherapy it would be typical to have scheduled visits at 1 month, 3 months, 6 months, 1 year, and beyond (for out of town patients these can be performed by your local urologist or radiation oncologist). In particular cases more frequent visits may be required. Urinary or rectal symptoms immediately after treatment often do require medical management and follow-up visits are scheduled to monitor progress and taper medication dosages. Although development of new side effects after treatment is uncommon, we encourage patients to call us with questions or concerns so that we can monitor their progress.

Medications often used temporarily after treatment include Tamsulosin (Flomax) or an equivalent medication to improve urinary flow, anti-inflammatory oral medication, and occasional corticosteroid creams. For some patients PDE5 inhibitors such as Viagra or Cialis are prescribed long term.

The PSA can take quite a long time to ‘nadir’ or reach its lowest point. Therefore patients should not be alarmed if their first few PSA measurements are still within an ‘abnormal’ range.Typically, 18 months is required for the PSA to bottom out. Although cells cannot divide and spread, the cancer cells can remain stagnant for many months before dying.  Basic science research shows that it can take this long for prostate cancer cells to die, and be cleared away by the immune system. It appears that it is at the moment when the cell attempts to divide that the cell recognizes the DNA damage present as a result of the radiation and the cell at that point dies. PSA measurements can also ‘bounce’ after treatment, which is not worrysome. One much monitor several PSA measurements over time before making any conclusions regarding the result of treatment.