The monitoring of men with localized prostate cancer after first-line treatment

An article just posted in the journal Oncology offers readers a concise summary of the appropriate follow-up monitoring for men after initial, definitive treatment for localized prostate cancer who show no signs of progressive disease over time.

Shah and Denlinger give some very straightforward guidance that is closely aligned to guidance issued by the National Comprehensive Cancer Network. This guidance is based on the fact that the vast majority of prostate cancer recurrences occur within the first 5 years after initial treatment.

Basically, as they indicate, more is not necessarily better, and the key points that they make are the following:

  • Regular PSA testing for the first 5 years post-treatment is the gold standard for follow-up.
  • Patients treated with definitive therapy (e.g., radical surgery or radiation therapy given with curative intent) should have
    • A clinician visit, physical exam, and PSA test every 6 months after treatment for truly localized (TxN0) disease for 5 years post-treatment
    • A PSA test every 3 months and a clinician visit and physical exam every 6 months after treatment for locally advanced (TxN1) disease for 5 years post-treatment
  • If there are no signs of progression after 5 years, follow-up clinical visits and PSA tests are usually only needed on an annual basis.
  • If there are no signs of progression after 10 years, the need for further clinical follow-up and PSA testing depends on individual patient factors.
  • Digital rectal exams are not recommended (because they are not sufficiently sensitive to give any indication of progression).
  • Follow-up imaging tests (bone scans, MRIs, etc.) are only recommended when patients have a rapidly rising PSA or clinical symptoms of risk (e.g., back pain).

We would emphasize that higher-risk patients and those patients showing clear signs of possible disease progression would need to discuss appropriate follow-up and management with their doctors. The guidance above applies only for men who show every indication that they have been treated successfully for their prostate cancer.

One Response

  1. I wish I had had this guidance 4 years ago. I was not counselled to get PSA checked after my 6-month post-surgery follow-up, which was zero at the time. My PSA was not checked again until 18 months later during a routine physical. It measured 21.

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