Having check-ups

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.

Your doctor will usually ask questions about the side effects of treatment and if you have any bowel, bladder or sexual problems. They also look at your PSA results.

Monitoring your PSA level

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.

Symptoms to look out for

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.

If early prostate cancer comes back

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.

If locally advanced prostate cancer comes back

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.

About our information

  • Reviewers

    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.

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