Follow-up after treatment for prostate cancer
If you had treatment to cure prostate cancer you have regular check-ups every few months for the first year. These continue for several years but with longer gaps between appointments.
You will not have your PSA level checked until 6 weeks after you finish treatment. After this, you may have it tested:
- at least every 6 months for the first 2 years
- at least once a year after the first 2 years.
You will usually have a PSA test 1 to 2 weeks before your follow-up appointment, so your doctor can see the results. You do not usually need a rectal examination unless your PSA level changes.
Your PSA level tells doctors how well treatments are working or if you need treatment. For example:
- with active surveillance for early prostate your PSA tells your doctor if you need to start treatment
- after radical prostatectomy your PSA usually drops to a very low or undetectable level within 2 months
- after radiotherapy PSA drops more slowly and may take 6 months to a few years to reach its lowest level. Sometimes there is a temporary rise in the first couple of years after radiotherapy (PSA bounce).
If you have hormone treatment and radiotherapy, the PSA level will often be lower. It usually remains low for months or longer after the injections have stopped. It usually rises after this and stabilises at a slightly higher level.
If prostate cancer comes back, the first sign is usually a rise in the PSA level. You usually need more than one rise in the PSA level to find if prostate cancer has come back. Doctors also look at how quickly it rises.
It can also be helpful to be aware of symptoms to look out for. These symptoms may be linked to long-term or late side effects of treatment. Do not wait until your appointment to report any new symptoms or symptoms that do not go away. Tell your team about them immediately.
For example, these symptoms may include:
- urinary or bowel symptoms (including bleeding from the bladder or back passage)
- bone pain
- any changes in feeling or strength in your legs.
Treatment for early prostate cancer usually cures it. But if the cancer comes back in the area of the prostate (recurrence) it is more likely to happen in the first few years after treatment. It is important to have careful follow-up during this time. Recurrent prostate cancer may still be cured. The first sign is usually a rise in your PSA level.
Before any further treatment, your doctors need to check the cancer has not spread to other parts of the body. Treatment for recurrent prostate cancer is sometimes called salvage treatment.
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 had radiotherapy as your first treatment, it may be possible to have brachytherapy to treat a recurrence. Occasionally, surgery with a prostatectomy may be possible. Often this is not an option because of the risk of serious side effects. 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, you usually have intermittent treatment.
Treatments may cure locally advanced prostate cancer. But sometimes the cancer may come back. If this happens you can usually have further treatment. This will depend on the treatment you have already had and where the cancer comes back. Your doctor will explain what treatment options might be right for your situation.
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at email@example.com
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131) Available at www.nice.org.uk/guidance/ng131
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.
You can read more about how we produce our information here.