Recommendations for Follow-Up Care After Treatment for Prostate Cancer

After treatment for prostate cancer, it is important for you to adhere to your provider’s plan for follow-up care. This article reviews the most common follow-up recommendations. You should talk with your care team about your specific follow-up plan.

Screening for Recurrence or New Cancer

If you haven’t received treatment, you should:

(this can also be called “active surveillance,” “observation,” or “watchful waiting,”)

• Have a PSA (prostate-specific antigen) every 6 months.
• Have a digital rectal exam (DRE) every year.
• Have a repeat prostate biopsy no more than once a year.
• Have a prostate MRI no more than once a year.

If you have had surgery and/or radiation therapy you should:

• Have a PSA every 6-12 months for 5 years. After 5 years, this test can be done every year.
• You should have a DRE every year. If your PSA is undetectable you can skip this test.

If you have advanced or metastatic prostate cancer you should:

• See your healthcare provider for a physical exam and PSA every 3-6 months.
• Your provider may also want to order radiology tests like CT, MRI or bone scans every 6-12 months if you have signs that your cancer has spread to your bones or your PSA is increasing.

Healthy Living After Prostate Cancer

Survivors often wonder what steps they can take to live healthier after cancer. There is no supplement or specific food you can eat to assure good health, but there are things you can do to live healthier, prevent other diseases, detect any subsequent cancers early, and in some cases, reduce the risk of your cancer coming back.

• Having one cancer does not mean you cannot get another cancer. Be sure to have recommended cancer screenings. These can include screening for breast, colorectal, skin, and cervical cancers and having recommended adult vaccinations.
• Having an active lifestyle and maintaining a healthy body weight can reduce the risk of some cancers.
• Get 30 minutes of moderate exercise/activity most days of the week with a goal of 150 minutes per week. Talk with your healthcare team about how to get started with (or back to) an exercise program.
  • Exercise can help with bone strength in prostate cancer survivors who are also taking hormone therapy. This should include weight-bearing and muscle-strengthening exercises.
• Eat a healthy diet rich in whole grains, fruits, and vegetables. Try to limit red and processed meats.
• Limit alcohol use to 2 or fewer drinks per day
• Quit tobacco. While the research has not shown a direct link between prostate cancer recurrence and tobacco use, smoking causes many other cancers and health issues. Learn more about quitting here.
• It is also important to maintain your health insurance so that you can continue to receive your follow-up care as recommended. If you are having insurance issues, ask your team for a referral to a social worker who can assist with this.
• Be sure to report any new or unusual symptoms to your healthcare team.

If You are Taking a Bisphosphonate or Denosumab

Pay special attention to their dental health.

• You may be at risk of developing a rare side effect called osteonecrosis of the jaw (ONJ). Normally, the maxilla (upper jaw bone) and mandible (lower jaw bone) are covered by gum tissue. In the case of ONJ, the bone becomes exposed.
• It is important to pay special attention to your dental health before, during, and after treatment with bisphosphonates.
• Symptoms of ONJ can include pain, swelling, or infection of the gums, loosening of the teeth, and exposed bone (often at the site of previous tooth extraction).
• Learn more about dental health when taking bisphosphonates or denosumab.

If you are Having Hormone Therapy

Many prostate cancers are also treated with hormone therapies. These include anti-androgens (bicalutamide, nilutamide, flutamide), LHRH agonists (goserelin, degarelix, leuprolide), and abiraterone acetate. These medications can have many side effects that can impact survivorship including:

• Sexual dysfunction.
• Hot flashes.
• Fatigue.
• Loss of muscle.
• Osteoporosis (thinning of the bones).
• Weight gain (especially in the belly).
• Increased risk of diabetes, high cholesterol, and some heart problems such as stroke and heart attack.

There are several things you can do to help manage these side effects and improve your post-cancer quality of life. These include:

• Educate yourself about erectile dysfunction, sexual health, and communication with your partner.
• Get 1000-1200mg of calcium and 1000 IU of vitamin D-3 a day to help strengthen your bones and reduce the risk of fracture due to osteoporosis.
• Your provider may want you to have a DEXA scan to measure the thickness of your bones.
• To help manage hot flashes, decrease or eliminate caffeine, hot beverages/food, alcohol (particularly red wine), and spicy foods. Keep your bedroom cool and wear layers of lightweight, breathable fabrics.
• Learn more about coping with the side effects of hormone therapy here.