Follow-up after treatment for prostate cancer

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.

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.

You may have a CT scan, PET scan or an MRI scan. A newer scan called a PSMA PET scan may be able to detect very small amounts of prostate cancer, but it is not widely available.

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

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.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

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.

You can read more about how we produce our information here.