Follow-Up after Prostate Radiation Therapy

Once the radiation is all finished you will start your follow-up program.  The purpose of follow-up appointments is to

    1. Verify the cancer has responded
    2. Monitor for any cancer recurrence
    3. Manage any side effects and complications
    4. Coordinate any additional hormone therapy injections
    5. Provide feedback to the doctor.

If you have been receiving hormone therapy injections such as Lupron, you may still need to have regularly scheduled appointments to receive your future hormone shots for a period of time.  Hormone therapy is typically prescribed for 6, 12, or 24 months total, so you may require a few more injections even after radiation has finished.

You will typically see your radiation oncologist for at least one or two follow-up visits after you complete your radiation.  After that, he may discharge you back to your urologist for your future visits.  You should see either your urologist or radiation oncologist or both every 3 – 6 months for the first 5 years after treatment.   After that time you may be discharged back to your family doctor if your PSA is less than 1.0 and stable, because there will be a good chance that you are cured.

We usually monitor the prostate cancer by doing PSA blood tests every 3 – 6 months for the first few years, and then every 6 months after that.  The first PSA is taken about 3 months after the radiation has been completed, to allow time for the inflammation to settle down, as the inflammation from radiation can make the PSA spike up.

The PSA can bounce up and down a little on follow-up lab tests.  However, if the PSA starts to follow a definite rising trend then the cancer could be recurring.  Scans and possibly a repeat biopsy would be done then.  If the cancer is discovered to be returning in the prostate gland, there may be things that can be done such as cryotherapy – freezing the prostate.  If the cancer is ever discovered to have spread to the bones or lymph nodes then the treatment for metastatic cancer is  hormonal therapy.

Q) How do you know the treatment has been successful?
A) By making sure the PSA drops down and stays down.

Q) How low should the PSA go after radiation?
A) The PSA typically drops down to 1.0 – 3.0 by the 3 month check, and is usually less than 1.0 by 12 months.  It can continue dropping for 5 years or longer.

Q) Can you do a scan or a biopsy to prove the cancer is cured?
A) No.  Even if those tests are normal, that is not proof the cancer is cured.  There still may be some cancer cells in the body that were missed by the biopsy or too small to be seen on scans.

Q) When can I say that I’m cured?
A) The longer you go after treatment and have a low / stable PSA, the greater the statistical chance that you’re cured.  If 5 years have passed since treatment your PSA is 0.5 or less and is stable, then there is about a 98% chance that you are cured permanently.

Q) I have heard that being on hormonal therapy can cause false test results?
A) Sort of.  The hormone therapy will help drive the PSA down to 0.0 quickly.  After the hormone therapy has ended, the PSA may rise a little to 0.3 – 1.0, but then should level off and drop back down.  You need to wait about 1 year after ending hormonal therapy to get an idea about how successful the radiation was.

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