NCCN Guidelines for Patients® | Prostate Cancer - page 59

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 6: Monitoring and salvage treatment
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Joint pain
calcium levels
A disease
that causes bones to
become thin and weak
The return of
cancer after a cancer-free
Read Part 2 for more
information on tests.
6.2 Monitoring
Test names and schedule
Risk level
Very high risk, N1, or
M1 not treated for cure
• PSA every 6–12 months
for 5 years, and
Very low – Very high
risk treated for cure
• Physical exam every 3–6 months, and
• PSA every 3–6 months
If results are normal,
then PSA every year
For many men, the goal of initial treatment is to cure the cancer. A cure is possible
when the cancer has not spread far. The cancer may have been cured if tests find
no signs of cancer after treatment. An undetectable PSA level after treatment is a
good sign. However, prostate cancer returns in some men after having no signs of
cancer for a period of time.
DRE and PSA testing done on a regular basis may catch a recurrence early. A DRE
can find a recurrence near the prostate. An increase in the PSA level can be a sign
of recurrence either near the prostate or in other areas. Besides PSA level, your
doctor will assess the PSA doubling time and velocity.
If the goal of your treatment is to cure the cancer, PSA testing every 6 to 12 months
for 5 years is recommended. However, PSA testing every 3 months may be needed
if you have a high risk of recurrence. If PSA levels remain normal during the 5
years, then PSA testing is recommended every year. A DRE can also help to find a
recurrence of prostate cancer early as well as cancer in the rectum or colon.
If your treatment controls but doesn’t cure the cancer, you should be checked
often by a doctor after treatment has begun. In addition to PSA testing, a complete
physical exam is recommended. A physical exam may tell if the cancer is still
growing despite undergoing treatment.
= Androgen deprivation
= Digital rectal exam
= Prostate-specific
• DRE every year unless PSA is undetectable
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