Follow-up and Surveillance

Why follow-up matters

Follow-up after prostate-cancer treatment has two main purposes: detecting any sign of cancer recurrence early, and supporting recovery from treatment (continence, sexual function, general wellbeing). The schedule is individualised based on the original cancer, the treatment received, and how recovery is going.¹

The information below is a general guide only. Your actual schedule is set by Dr Kooner based on your situation.

PSA after radical prostatectomy

After a radical prostatectomy, PSA should fall to very low (undetectable) levels. A typical follow-up pattern is:

• First PSA around 6 weeks after surgery.
• Then every 3 months for the first year.
• Every 6 months for years 2 to 3.
• Annually thereafter, if PSA remains stable.¹

A rising PSA after prostatectomy is called biochemical recurrence. It does not necessarily mean widespread cancer, but it does prompt further assessment to decide on next steps.¹

PSA after radiotherapy

After radiotherapy, PSA typically drops more slowly and does not reach undetectable levels. A rise of 2 ng/mL above the lowest post-treatment value (nadir) is usually used as the threshold for biochemical failure.¹ PSA is generally checked:

• Every 3 months for the first year.
• Every 6 months for years 2 to 3.
• Annually thereafter.

Follow-up during active surveillance

Active surveillance involves monitoring low-risk prostate cancer rather than treating it immediately. Typical monitoring includes regular PSA, clinical review, and periodic MRI and/or repeat prostate biopsy.¹ See Active Surveillance for more detail.

Imaging

Routine imaging is not required in most men with a stable low PSA after treatment. Imaging (MRI, bone scan, PSMA-PET where appropriate) is generally used when:

• The PSA is rising in a pattern consistent with recurrence.
• New symptoms suggest possible recurrence or spread.
• Treatment decisions require further staging.

Continence and sexual function

Follow-up visits review recovery of continence and sexual function, not just PSA. Support options include:

• Continence recovery, including pelvic-floor training and, where needed, procedural options.
• Sexual rehabilitation after prostatectomy.
• The men's health pharmacist service for medication and device support.

Red flags: when to contact the clinic sooner

Between scheduled appointments, contact Urology NSW or seek medical attention earlier if you notice:

• New or worsening bone pain, particularly in the back or hips.
• Unexplained weight loss or fatigue.
• Blood in the urine or semen.
• Difficulty passing urine, or sudden inability to pass urine (this needs urgent attention).
• New neurological symptoms such as leg weakness or numbness.

Urgent symptoms, particularly difficulty passing urine, severe bleeding or new leg weakness, should not wait – seek care through an emergency department or call 000.

General health

Cancer follow-up is also a good opportunity to look after general health: blood pressure, cholesterol, diabetes screening, immunisations and lifestyle. These are often coordinated with the GP.

How to access care

• Contact Urology NSW for follow-up appointments.
• Request a second opinion if you have a new PSA change and would like a review.
• Call the rooms on 02 8382 6980.