From the Guidelines
Follow-up scans for prostate cancer should be tailored to the individual's risk level and treatment type, with a focus on detecting recurrence early when treatment options are most effective, as recommended by the most recent guidelines 1.
Key Considerations
- For patients with high-risk prostate cancer, imaging studies such as bone scans, pelvic multi-parametric magnetic resonance imaging (mpMRI), or CT scans should be obtained to evaluate the loco-regional extent of disease and presence of distant metastasis 1.
- For asymptomatic patients with low- or intermediate-risk prostate cancer, the probability of nodal or distant metastasis is low, and abdomino-pelvic CT scan and bone scan are unlikely to be helpful and should not be routinely obtained 1.
- Patients on active surveillance require more frequent monitoring, including PSA tests every 3-4 months, digital rectal exams every 6-12 months, and prostate MRIs annually 1.
Imaging Modalities
- MRI excels at soft tissue visualization and is preferred for local tumor staging, which may inform therapy 1.
- Bone scans detect skeletal metastases and are recommended annually for high-risk patients or those with symptoms suggesting bone metastasis 1.
- CT scans help identify lymph node involvement and distant metastases, and may be ordered every 1-2 years for high-risk patients 1.
Follow-up Protocols
- PSA blood tests should be done every 3-6 months for the first 5 years, then annually thereafter for most patients after initial treatment 1.
- The frequency of scans may increase if PSA levels rise significantly (typically a doubling time of less than 6 months) or if new symptoms develop 1.
- Recent imaging advances, such as prostate-specific PET agents, may allow for earlier detection of limited metastatic disease and targeted treatments that can impact patient outcomes 1.
From the Research
Follow-up Scans for Prostate Cancer
- The importance of follow-up scans for prostate cancer is highlighted in several studies, including 2, which emphasizes the need for strict protocol adherence in active surveillance for patients with low-risk prostate cancer.
- The study 2 found that noncompliance with the Prostate Cancer Research International Active Surveillance (PRIAS) follow-up protocol was associated with a higher rate of metastasis among PRIAS-ineligible patients.
- Another study 3 investigated the perceived benefits of routine follow-up of patients with prostate cancer and found that patients and health professionals agree on the main purpose of follow-up consultation, which is to review the prostate-specific antigen (PSA) blood test and assess urinary symptoms.
- The use of digital rectal examination (DRE) as an adjunct to PSA in the detection of clinically significant prostate cancer is discussed in study 4, which found that DRE demonstrated prognostic usefulness when PSA was greater than 3 ng/ml.
- Study 5 reviewed the current status of early detection of prostate cancer and developed an algorithm that uses DRE, PSA, and transrectal ultrasonography (TRUS) for detection, highlighting the importance of combining these methods for a complete evaluation of the prostate gland.
- Active surveillance for prostate cancer is analyzed in study 6, which found that AS is a safe approach for men with low-grade prostate cancer and some men with intermediate-risk disease, and that it should be more broadly implemented for eligible patients to avoid decreases in quality of life from undergoing active treatment.
- The role of PSA monitoring in follow-up scans is emphasized in several studies, including 2 and 6, which highlight the importance of regular PSA testing in detecting prostate cancer progression.
- The frequency and intensity of follow-up scans are also discussed in study 3, which found that patients and health professionals generally agree that assessments should be carried out every six months.