Follow-up care after completing treatment for prostate cancer is important. When a person is in remission, they enter the survivorship phase of their journey, where they are then monitored for several years for recurrence, secondary cancers from previous treatment and late side effects, as well as psychosocial effects. During the survivorship phase, a person may feel both physical and psychosocial effects, which is why it is important to monitor, manage and anticipate these needs.
Andrew Kennedy, MD, Physician-in-Chief of Radiation Oncology and Director of Radiation Oncology Research at Sarah Cannon and Emily Gentry, BSN, RN, OCN, Jordan Henderson, BSN, RN, OCN, ONN-CG, Katie Narvarte, LMSW, OSW-C, OPN-CG and Molly Sutton, MS, RN, OCN, Nurse Navigators with Sarah Cannon Cancer Institute at Medical City Healthcare, share what people should know about prostate cancer survivorship.
Understanding the importance of follow-up care after prostate cancer treatment
There are two important reasons for follow-up care after completing treatment for prostate cancer.
- To monitor for tumor response and ensure that all of the cancer is destroyed.
- To check for any side effects from treatment that can be addressed, and help the patient feel as close as possible to how they felt prior to the cancer diagnosis.
Knowing what to expect
At a minimum, follow-up care involves a physical exam and talking with your cancer specialist (urologist, radiation oncologist, medical oncologist). Depending on the stage of the cancer at treatment, or whether you are on active therapy, you might also have blood tests that include a tumor marker specific for prostate cancer called “PSA,” which stands for “prostate specific antigen.”
If there are symptoms that suggest the cancer might have returned, imaging studies might be recommended, such as a CT scan, bone scan, PET scan or specialized nuclear medicine scans designed specifically for prostate cancer.
Depending upon the stage of prostate cancer for which a patient was treated, they may be advised by their oncology team to follow up every three or six months until five years after curative treatment. This can change if concerning symptoms are being evaluated to more frequent visits until the cause of the symptoms is determined and treated. Additionally, routine screenings are important, including a flexible sigmoidoscopy every five years or a colonoscopy every 10 years after the age of 45 to screen for colon cancer. Men who received radiation therapy for prostate cancer may have a higher risk for bladder and colorectal cancer and may need screening that is more intensive.
Learning how to manage long-term side effects
All treatments can have side effects. Fortunately, with improvements in surgery (robotics) and radiotherapy (IMRT), there are significantly fewer side effects than just a few years ago with older technologies.
It is important to monitor your side effects, especially changes in sexual function, bladder/urinary leakage and bowel movements/rectal symptoms. There are varieties of interventions that can be given for sexual side effects due to erectile dysfunction that vary from surgery to oncology rehabilitation to daily medication. Similarly, there are multiple treatments if someone is experiencing an impaired ability to control urine, or is having pain and bleeding of the rectum. Additional side effects may include:
- Rectal inflammation
- Bladder inflammation
- Narrowing of the rectum or urethra
- Chronic diarrhea
- Urinary frequency or urgency
Recognizing symptoms and changes to be aware of
It is important for all men to make the time to have a yearly complete physical exam with their primary care physician, and a primary care physician is the first person who they should contact with any concerning symptoms.
Many prostate cancers are detected through either physical exam (nodules or a mass in the prostate) or by a blood test (PSA). Patients who have completed treatment for prostate cancer are always advised to make their physicians aware of any new symptoms related to urination or bowel function, loss of sexual function and new persistent pain in a localized part of the body. Patients should also be aware of symptoms such as:
- Leg edema
- Blood in urine
- Progressive fatigue
- Bone pain
- Back pain
Maintaining a healthy lifestyle
Maintaining a healthy weight through diet and exercise is important not only through the cancer treatment, but also in survivorship.
After prostate cancer treatment, it is important to start low and slow when it comes to physical activity. This refers to low weight lifting and minimal time for cardio exercises to ease into an exercise routine. Always speak to your physician before beginning an exercise regimen, especially after surgery.
When it comes to diet the saying is “eat your colors,” referring to one that is rich in vegetables and fruits. Limit meat and animal fat while increasing your fish consumption, and limit alcohol to two drinks/day for men.
Coping with the fear of recurrence
Fear of recurrence is common with people in the survivorship phase, but there are ways to cope.
- Take charge of what you can. You may feel afraid because of the lack of control you have over the situation. To take back some control in your life, try making positive changes, such as talking with a registered dietician about developing a survivorship nutrition plan, starting an exercise program, and staying on top of your screenings and checkups.
- Take a deep breath. If you feel yourself starting to get worked up, close your eyes, take a deep breath, and count to ten. Taking a second to gather your thoughts can make you feel a lot better.
- Find a hobby. Hobbies can be a great source of entertainment and can also take your mind off of negative things.
- Talk about it. You may find it helpful to talk to someone. It can be especially comforting to connect with other survivors. Hearing other survivors' stories can show you what you are feeling is normal, and you are not alone. You may also be able to help someone else by sharing your story.
- Educate yourself. Knowledge is power. Talk to your oncologist about your fear of recurrence. Ask about your chances of recurrence, what you can do to lower your risk and what signs you need to look for to know if the cancer has returned.
- Know what triggers your emotions, and avoid it. If you can identify the objects or activities that trigger negative feelings, you can make a special effort to avoid them.
It is important to know that the information in this post, including Sarah Cannon’s recommendations for screening, is accurate as of the publishing date.