Surveillance for Prostate Cancer
Following diagnosis, most men undergo an aggressive and definitive treatment for their prostate cancer. Most commonly this is either radical prostatectomy or radiation therapy. The surveillance for cancer does not stop after initial treatment, however.
One of the most common sources of concern for men who have been treated for their localized prostate cancer is how they will be monitored over the ensuing years for recurrence of their cancer. It is important to have a basic understanding of how your physician is likely to monitor you after your treatment has ended.
What Your Doctor Is Looking For During Surveillance
When monitoring you for cancer recurrence in the months and years following treatment, your doctor is looking for any sign that your prostate cancer has returned.
Evidence that your cancer may have returned include the new onset of symptoms such as difficulties with urinating or bone pain, a rise in your post-treatment prostate specific antigen (PSA) levels (which should be essentially zero after definitive treatment), new abnormalities on the digital rectal examination (DRE) or other parts of the physical exam, and abnormal growths seen on imaging exams such as a CT scan.
How Will Your Doctor Monitor You for Cancer Recurrence?
Unfortunately, there is no set-in-stone standard of care that all physicians agree upon for how surveillance follow-up testing should be done for initially-treated prostate cancer. Some important organizations such as the National Comprehensive Cancer Network (NCCN) have published their own guidelines, however, and many physicians agree with these.
Just as with all other aspects of prostate cancer, your personal health and preferences play a huge role in deciding how to go about monitoring for disease recurrence.
If you and your doctor decide that your other health conditions are so serious that prostate cancer is not a top priority, then your schedule of follow-up testing will likely be very different from someone who is young, otherwise healthy, and has a great deal of incentive to catch any recurrence as early as possible. That’s why it’s so important to go over your concerns with your physician before deciding on a surveillance plan.
How Often and By What Means Will I Need to Get Tested?
- Annual Complete Physical Examination Including a Digital Rectal Exam (DRE)
All men who have had prostate cancer should be seen at least annually by their doctor for a complete physical examination including a DRE. The overall physical examination is an important part of picking up cancers earlier and of maintaining overall health.
While detecting abnormalities in the treated area on DRE is quite uncommon, it does happen occasionally that your physician can detect a small focus of cancer tissue that remains after surgery or that has recurred in that area.
- PSA Testing
This aspect of follow-up testing is one of the most unclear and there is no strong consensus among urologists or other physicians about how often to do PSA testing.
Most physicians say that PSA testing every six months following initial treatment is appropriate for men with low-risk, early-stage disease such as those with Gleason scores of six or less, a low pre-treatment PSA, and no evidence of cancer outside of the prostate.
PSA testing every three months for the first two years, then every six months for the next two years, and then annually thereafter may be appropriate for men with higher-risk, early-stage disease such as those with Gleason scores of seven or above, a high pre-treatment PSA, or positive surgical margins.
PSA testing every three months for men with cancer that has spread to the lymph nodes or distant parts of the body may also be appropriate.
The frequency of post-treatment PSA testing needs to be based very heavily on your individual circumstances, however. If you have a very strong family history of recurrent, aggressive cancer, if you are young, or if you have other considerations that make it especially important to detect any recurrence as early as possible, then your frequency of PSA testing should be adjusted accordingly.
- Other Tests
Bone scans, biopsy of the treated prostate or prostate bed (where the prostate used to be located before it was removed), CT scans or MRIs, and other tests currently do not have much of a role in post-treatment surveillance. They are used to detect the extent of metastases or to try to find the location of a recurrence that is already known to exist from elevated PSA levels.
Regular PSA testing has largely taken over for these tests as the primary method of surveillance.
Evans, CP. Follow-up surveillance strategies for genitourinary malignancies. Cancer 2002; 94:2892.
National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines available online at www.nccn.org/physician_gls/f_guidelines.html.