From the Guidelines
PSA monitoring frequency after prostate cancer depends on your treatment type and risk level, with the most recent guidelines recommending monitoring every 3-6 months for the first 2 years, then every 6 months until 5 years, and annually thereafter if levels remain stable 1.
Key Considerations
- For patients who have undergone radical prostatectomy, PSA should become undetectable (less than 0.1 ng/mL) within a few weeks of surgery, and any detectable PSA level after surgery is an indication for referral to the primary treating specialist 1.
- After radiation therapy, PSA typically decreases gradually and may not reach zero, with a target PSA level of less than 1.0 ng/mL, and referral should be made for a rising PSA trend after the nadir is reached even when the absolute values are low 1.
- For patients on active surveillance, more frequent monitoring (every 3-6 months) is typically recommended, often with periodic biopsies 1.
- Men on hormone therapy usually have PSA checked every 3-4 months, with the goal of achieving a PSA level less than 0.05 or 0.1 ng/dL depending on the assay 1.
Monitoring Schedule
- The monitoring schedule should be individualized based on the patient's disease risk, age, comorbidity status, and preference, with the duration and interval of follow-up beyond 10 years being a shared decision 1.
- Urinary, bowel, and sexual function should be routinely queried, with the use of standardized/validated instruments recommended, to monitor the quality of life (QOL) impact from therapy 1.
Referral and Further Evaluation
- Any significant rise in PSA (particularly if it doubles in less than 12 months) warrants prompt medical attention as it may indicate cancer recurrence, and referral to the primary treating specialist is recommended for further evaluation and treatment 1.
- A digital rectal examination (DRE) and consultation with the primary treating radiation therapist is recommended after confirmation of a rising PSA in 3 months 1.
From the Research
Monitoring PSA with a History of Prostate Cancer
- The frequency of monitoring Prostate-Specific Antigen (PSA) in patients with a history of prostate cancer is not explicitly stated in the provided studies.
- However, according to 2, most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk.
- For patients with a history of prostate cancer, the primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer 2.
- In patients who have undergone radical prostatectomy and have evidence of prostate-cancer recurrence signaled by a persistently or recurrently elevated PSA level, salvage radiation therapy is often necessary 3.
- The PSA response following Androgen Deprivation Therapy (ADT) plus an Androgen Receptor Pathway Inhibitor (ARPI) therapy is significantly associated with overall survival across all metastatic and castration-resistant prostate cancer states 4.
- There is no specific recommendation on the frequency of PSA monitoring in patients with a history of prostate cancer, but it is essential to continue monitoring PSA levels to assess treatment response and detect potential recurrence 3, 4, 5, 6.