Follow-up

Proper treatment of a prostate cancer patient always includes follow-up and monitoring. The patient is monitored either in specialized medical care (HUCH) or in basic health care. PSA level monitoring can also be partly automated (mobile monitoring). Active surveillance is always carried out at the Urology Outpatient Clinic.

The post-operative check for surgery to remove the prostate, or radical prostatectomy, is six weeks from the operation. There is an interim check after six months and a final check one year from surgery. Prior to these checks, PSA measurements are always taken, a quality-of-life questionnaire is filled in, and, if necessary, a urinary flow-rate measurement is taken.

At the post-operative check:

• the patient’s recovery and the healing of incisions are checked.
• the pathology results indicating the aggressiveness of the tumor, its size, and the status of the lymph nodes, among others, are reviewed together with the patient
• the need for adjuvant therapy is assessed

At the final check:

• it is ensured that the patient is not experiencing adverse side effects from the treatment (incontinence, erectile dysfunction)
• it is ensured that there is no need for further treatment
• the patient’s further monitoring is planned. This usually means mobile monitoring (mobile PSA).

In mobile monitoring, an extended PSA referral to the laboratory is made for the patient. During the first three years after surgery, the patient will have PSA measurements taken at six-month intervals. The patient will receive the results automatically by SMS to his mobile phone, often on the same day. If the PSA level remains unmeasurable (<0.05 µg/l), monitoring is continued. After three years, the frequency of monitoring can be decreased to one-year intervals. If the PSA becomes measurable, the patient is automatically invited to the Urology Outpatient Clinic for further examinations.

The treatment of cancer that recurs after surgery has been shown to be more effective if started at a sufficiently early stage. Further treatments are considered if the PSA rises to a level of 0.20–0.40 µg/l.

The outcome of radiotherapy is assessed with repeated PSA measurements. The decrease of PSA to its lowest level may take more than a year. After radiotherapy, PSA is not reduced to an unmeasurable level, and it can vary throughout the monitoring. According to international standards, the indicator of recurrence after radiotherapy is the rise of PSA to 2 µg/l above the lowest level achieved (e.g. 0.8 µg/l to level 2.8 µg/l). After radiotherapy is completed, the patient is monitored at the Urology Outpatient Clinic. The first follow-up appointment is about six months after the completion of radiotherapy.