From the Guidelines
The Prostate-Specific Antigen (PSA) test is the primary method used to follow up with prostate cancer patients after diagnosis and treatment. This blood test measures the level of PSA, a protein produced by the prostate gland, which typically increases when cancer is present or recurring 1. For most prostate cancer patients, regular PSA monitoring is recommended every 3-6 months for the first 1-2 years after treatment, then every 6-12 months for the next 3-5 years, and annually thereafter if levels remain stable. The frequency may vary based on individual risk factors, treatment type, and previous PSA results.
Key Points to Consider
- Rising PSA levels after treatment (known as biochemical recurrence) may indicate cancer recurrence before other clinical symptoms appear 1.
- The interpretation of PSA results depends on the type of treatment received - after radical prostatectomy, PSA should be nearly undetectable, while after radiation therapy, PSA typically decreases gradually and may never reach zero.
- Additional follow-up tests might include digital rectal exams, imaging studies like MRI or bone scans, and occasionally repeat biopsies if recurrence is suspected based on PSA trends.
Follow-up Protocols
Follow-up protocols varied across studies, using strict or modified NCCN, Prostate Cancer Research International Active Surveillance (PRIAS), Johns Hopkins, University of California San Francisco, Epstein, and other institution-specific protocols 1. All studies described PSA testing and biopsy schedules. Nine studies followed a protocol to assess PSA every three months for the first two years on AS, followed by every six months thereafter. For all other studies, PSA testing intervals ranged from one to 12 months.
Importance of PSA Testing
PSA testing is crucial in detecting prostate cancer early, and men who have regular PSA tests have a higher chance of finding out they have prostate cancer, whereas those who do not have regular PSA tests have a lower chance but a higher probability of having more advanced cancer when ultimately diagnosed 1.
From the Research
Prostate Cancer Follow-up Tests
- The test used to follow up with prostate cancer is indeed the Prostate-Specific Antigen (PSA) test, as evidenced by various studies 2, 3, 4.
- The PSA test is used to measure the level of PSA in the blood, which can be elevated in men with prostate cancer 2.
- Digital Rectal Examination (DRE) is also used in combination with PSA to detect prostate cancer, but its diagnostic value is limited 5, 6.
Diagnostic Value of PSA and DRE
- Studies have shown that PSA has a higher diagnostic value than DRE in detecting prostate cancer 2, 5.
- The combination of PSA and DRE can increase the detection rate of prostate cancer, but the benefit of using DRE is questionable 5, 6.
- PSA testing can detect prostate cancer at an early stage, but it is not perfect and can result in false-positive and false-negative results 3, 4.
Current Recommendations
- The current recommendations suggest that PSA testing should be discussed with average-risk men aged 55-69 years, and only those who express a definite preference for screening should have PSA testing 3.
- Emerging evidence suggests that multiparametric magnetic resonance imaging (mpMRI) may have a potential role in prostate cancer screening, but more research is needed to confirm its accuracy and safety 4, 6.