February 9, 2015
To help doctors provide their patients with the highest quality care, the American Society of Clinical Oncology (ASCO) issued an endorsement of a guideline developed in 2014 by the American Cancer Society. This guideline provides recommendations for follow-up care for men who have received treatment for prostate cancer.
- Follow-up care for prostate cancer should include steps to take care of your general health and watch for long-term side effects.
- Regular doctor visits and additional testing may be recommended to watch for a return of the prostate cancer and for other types of cancer.
- Talk with your doctor about your risk of experiencing long-term side effects, having the cancer return, and develop an appropriate follow-up care plan for you.
The importance of follow-up care
After treatment for prostate cancer, follow-up care is important to help maintain good health, manage any side effects from treatment, watch for signs that the cancer has come back after treatment, and screen for other types of cancer. A follow-up care plan may include regular physical examinations and other medical tests to monitor your recovery during the coming months and years.
General health and cancer screening recommendations
Men recovering from prostate cancer are encouraged to follow established guidelines for good health, such as reaching and maintaining a healthy weight, exercising, not smoking, eating a balanced diet, and following cancer screening recommendations. Here are general recommendations for men recovering from prostate cancer:
- Focus on eating more fruits, vegetables, and whole grains. Eat fewer high-calorie foods and beverages and less saturated fat.
- Get at least 600 IU of vitamin D each day and no more than 1,200 milligrams of calcium per day from foods.
- If you have problems that affect how well your body absorbs nutrients from foods, consider talking with a registered dietitian (RD).
- Be physically active for at least 150 minutes each week.
- Limit alcohol consumption to no more than two drinks per day.
- Quit smoking or using other types of tobacco.
- Follow recommendations for general cancer screening. Men who received radiation therapy for prostate cancer may have a higher risk of bladder and colorectal cancers and need more intensive screening.
Talk with your doctor or other member of your health care team to help you develop an exercise plan, eating plan, and cancer screening schedule that is best for you. In addition, if you smoke or use tobacco, talk with your health care team about resources to help you quit.
Prostate cancer recurrence screening recommendations
In addition to regular physical examinations, the following tests are recommended to monitor for a prostate cancer recurrence:
Prostate Specific Antigen (PSA) testing
PSA is a type of protein released by prostate tissue found in higher levels in a man's blood when there is abnormal activity in the prostate, including prostate cancer, benign prostatic hyperplasia (BPH), or inflammation of the prostate.
- PSA testing is recommended every six to 12 months for the first five years after treatment, then each year.
- PSA testing may be recommended more often for some men if they have a higher risk of the cancer coming back or if they are able to have additional treatment intended to cure the cancer, such as radiation therapy or surgery.
- Discuss your PSA levels with your doctor. If your PSA level is increasing or your doctor is concerned about your PSA level, he or she may recommend that you visit your prostate cancer specialist to find out whether more testing or treatment is needed.
Digital Rectal Exam (DRE)
A doctor uses this test to identify abnormalities or changes in the prostate by feeling the area using a finger.
- Your oncologist and your doctor who provides your follow-up care should discuss how often DRE is needed.
Managing long-term side effects
Screening and monitoring for long-term side effects of prostate cancer treatment is an important part of follow-up care. ASCO recommends assessing whether you are experiencing any of the following long-term side effects of prostate cancer and managing them appropriately.
- Anemia, particularly for men who have received or are receiving hormone therapy
- Bowel problems, such as bleeding and needing to go to the bathroom urgently and/or frequently
- Urinary problems, such as difficulty emptying the bladder or difficulty controlling the bladder, called incontinence
- High blood pressure, high cholesterol, and blood sugar levels, particularly for men who have received or are receiving hormone therapy
- Depression and anxiety
- Bone health, particularly for men who have received or are receiving hormone therapy
- Hot flashes, particularly for men who have received or are receiving hormone therapy
- Sexual health, intimacy, and body image
What this means for patients
Regularly scheduled follow-up care helps increase the likelihood of finding a treatable recurrence and of managing any long-term side effects. Discussing your risk of recurrence and long-term side effects is important as you are nearing the end of your cancer treatment. Knowing this information helps your doctor develop an appropriate follow-up care plan.
Different people have different risks, so it is important to talk with your doctor about how your risk affects your schedule of follow-up care. Many people who have finished treatment for prostate cancer receive their follow-up care through their primary care doctor. Your prostate cancer specialist can provide you and your primary care doctor a written treatment summary, as well as recommendations for your follow-up care.
Questions to Ask the Doctor
To learn more about follow-up care for prostate cancer, consider asking the following questions of your health care team:
- What is my risk of recurrence?
- What follow-up tests will I need, and how often will I need them?
- Who will be coordinating my follow-up care?
- If I move or need to switch doctors, how do I make sure to continue my recommended follow-up care schedule?
- How often will I need PSA and DRE testing? Where will these tests be done? How will I learn about the results?
- What signs and symptoms should I watch for?
- What type of follow-up care do I need beyond five years after treatment?
- Where can I find more information about follow-up care?
Read the entire guideline endorsement at www.asco.org/endorsements/prostatesurvivorship.