Follow-up after treatment for prostate cancer

During a follow-up visit, your doctor or specialist nurse will usually ask questions about the side effects of treatment and whether you have any changes with your bowel, bladder or erections. 

It can sometimes feel embarrassing to talk about these kinds of problems, but your doctor and specialist nurse are used to talking about them every day. They would rather know so they can offer you the right information and support. They can suggest treatments or refer you to other specialists who can help. You do not need to use medical words. Use the words you usually use so they can understand your concerns.

You might find it helpful to write down any questions before your appointment. It can also help to bring someone with you, or have someone listen if the appointment is by phone. They can help you remember what was said or take notes.

You should be given a copy of the letter the doctor or specialist nurse writes after your appointments.

If you have questions or concerns between appointments, you can call your specialist nurse for information and support.

You will not have your PSA level checked until 6 weeks after you finish treatment for locally advanced prostate cancer. After this you may have it tested every 3 to 6 months for the first few years, then every 6 to 12 months. Your cancer doctor and specialist nurse can tell you how often it will be checked.

You will usually have a PSA test 1 to 2 weeks before your follow-up appointment, so your doctor can check the results. You do not usually need a rectal examination unless your PSA level rises.

Your PSA level tells doctors how well treatments are working.

If prostate cancer comes back, the first sign is usually a rise in the PSA level. You usually need more than 1 rise in the PSA level to find out whether prostate cancer has come back. Doctors also check how quickly it rises.

The aim of treatment for early prostate cancer is usually to cure it. Hormonal therapy in addition to radiotherapy helps to reduce the risk of the cancer coming back. But if prostate cancer comes back in the prostate or area around it, you can usually have further treatment that may cure it. This treatment is sometimes called salvage treatment. You can often continue to live a long and active life. Prostate cancer that comes back in the prostate area is called recurrent prostate cancer.

If your PSA level rises quickly or over time, your doctor usually does tests to check for cancer. Before you have further treatment, they need to check the cancer has not spread to other parts of the body.

You may have a CT scan, PET scan or an MRI scan. Or you may have a newer scan called a PSMA PET scan. This may be able to detect very small amounts of prostate cancer.

If tests show the cancer has come back, treatment will depend on:

• your general health
• results of your scans
• whether you have any symptoms
• the treatment you have already had.

If you have had a radical prostatectomy as your first treatment, you can usually have external beam pelvic radiotherapy. You may also be given hormonal therapy.

If you had external beam radiotherapy as your first treatment, it may be possible to have brachytherapy to treat a recurrence. Occasionally, surgery with a radical prostatectomy may be possible. But this is not often an option because of the risk of serious side effects. High-intensity focused ultrasound (HIFU) or cryotherapy may also be used.

If the cancer is slow growing, your doctor may suggest monitoring it for a time instead of treating it straight away.

If you have hormonal therapy alone, and the cancer has not spread to other parts of the body, you usually have intermittent treatment.