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70

NCCN Guidelines for Patients

®

Prostate Cancer, Version 1.2016

6

Treatment guide: Monitoring

Treatment after prostatectomy

Treatment after prostatectomy

Guide 16. Treatment by M stage

Health tests

Test results

What are the options?

Main tests:

• PSA doubling time

Possible tests:

• Chest x-ray

• CT/MRI, TRUS, or both

• Bone scan

• PET scan

• Biopsy

Ü

No distant

metastases

(M0 stage)

Ü

• EBRT ± ADT for 2–3 years

Ü

• Observation

Ü

Distant

metastases

(M1 stage)

Ü

• ADT ± EBRT to distant site

Ü

• Observation

After a radical prostatectomy, your PSA level

should fall to near zero since the whole prostate

was removed. If this doesn’t happen, it may be

a sign of persistent cancer. Persistent cancer

is cancer that was not completely removed or

destroyed by initial treatment. If tests find that

your PSA level increases twice in a row after

falling to near zero, the cancer may have returned

(recurrence).

Guide 16

lists the tests and treatment options

when PSA scores or a DRE suggest there’s

cancer. Since high PSA levels don’t always mean

cancer is present, tests to find distant metastases

may be done. A fast PSA doubling time is a sign

of aggressive cancer with possible spread to the

bone. A chest x-ray, CT, MRI, or TRUS may be

used to look for cancer spread to lymph nodes or

other organs. A bone scan shows if the cancer has

spread to the bone. It is usually done when there

are symptoms of bone metastases or when your

PSA level is rising quickly.

If imaging tests suggest there’s cancer near to

where the prostate was, a biopsy can be used to

confirm if cancer is present. A biopsy may be done

under the guidance of MRI images combined with

real-time ultrasound images. This type of biopsy is

called MRI-US fusion biopsy and may help detect

higher-grade cancers. Higher-grade cancers

include those with Gleason score 7 through 10.

If there is little reason to suspect distant

metastases, EBRT with or without long-term

ADT is advised. However, observation may be a

better choice depending on your overall health

and personal wishes. For long-term ADT, an

LHRH antagonist or LHRH agonist may be used.

However, doctors often use CAB, which includes

an antiandrogen. Side effects may be worse with

CAB, but CAB may control cancer growth for a

longer period of time. If you will receive ADT, it will

be given before, during, and after radiation therapy

for a total of 2 to 3 years.