The evidence-based recommendations described below outline the standard follow-up procedures for prostate cancer surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.
Surveillance Activities & Timelines
Once a patient has been discharged from Cancer Care Alberta, their primary care provider is asked to organize the following surveillance activities:
- Prostate Specific Antigen (PSA) testing every 6-12 months for 5 years from treatment completion date, then annually (refer to oncologist dictation to confirm the follow-up schedule).
- Regular evaluation of late effects/treatment complications.
Red Flags
- After radiation therapy for prostate cancer, the serum PSA should reach its nadir (i.e., the lowest value of PSA) by 24 months. Transient PSA rises can occur in the post-radiation therapy setting.
- Should the PSA rise to 2 µg/L above nadir, the treating radiation oncologist should be contacted regarding the possibility of repeat consultation for biochemical relapse.
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Referrals for Recurrence
The patient’s treating radiation oncologist should be contacted if the patient’s PSA rises to 2µg above nadir. If the oncologist’s contact information is not available, search “prostate cancer” in the Alberta Referral Directory for the most up-to-date information and instructions for referral.
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Complications & Late Effects of Treatment
Radiotherapy-related side effects, if they occur, are usually minor in severity and self-limiting. However, if they are persistent and bothersome, referral to the following specialty clinics should be considered:
- Urologist: cystitis, hematuria, urethral stricture or urinary incontinence, impotence and sexual dysfunction
- Gastroenterologist: proctitis or rectal bleeding, persistent diarrhea or fecal incontinence
- Psychosocial Oncology: illness adjustment issues such as anxiety about recurrence, changes in sexual function, incontinence, self-image, employment, and financial concerns
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Specific Concerns for Prostate Cancer Patients
Androgen Deprivation Therapy
- For patients on long-term androgen deprivation therapy, i.e., leuprolide (Eligard®), bone density scans (DEXA scans) should be performed:
- At baseline
- Every 2-3 years after
- If the patient is found to have osteopenia or osteoporosis, treat according to clinical practice guidelines (osteoporosis.ca). Standard recommendations in terms of optimizing bone health include:
- Calcium: 500 mg per day
- Vitamin D: 2000 IU per day
- Regular physical activity and risk factor assessment
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Note: The information on this page was adapted from the AHS Guideline Resource Unit's Prostate Cancer Guideline, and the accompanying Prostate Cancer Transfer of Care Physician Letter. Also available is the Prostate Cancer Transfer of Care Patient Letter.
