Prostate Cancer Survivorship Care Plan: Long-Term Follow-Up Guide

What is a survivorship care plan?

A survivorship care plan is a personalised roadmap for follow-up care after completing prostate cancer treatment. It includes:

• Schedule for PSA monitoring
• Management of long-term side effects (ED, incontinence, fatigue)
• Monitoring for treatment complications (bone loss, cardiovascular risk)
• Recommendations for healthy lifestyle changes
• Psychosocial support resources

Every prostate cancer survivor should have a survivorship care plan. Ask your oncologist or urologist for one.

PSA monitoring schedule – after surgery, radiation, ADT

After radical prostatectomy (surgery):

• First PSA: 3 months after surgery
• Frequency: Every 6-12 months for 5 years, then annually
• Goal: Undetectable (<0.1 ng/mL)
• Biochemical recurrence (BCR): Two consecutive rises >0.2 ng/mL

After radiation therapy (EBRT or brachytherapy):

• First PSA: 3-6 months after treatment
• Frequency: Every 6-12 months for 5 years, then annually
• Nadir (lowest PSA): Usually at 18-36 months
• Phoenix criteria for recurrence: Rise of 2.0 ng/mL above nadir

After hormone therapy (ADT):

• PSA is checked every 3-6 months while on ADT
• Castration-resistant prostate cancer (CRPC): PSA rise despite castrate testosterone (<50 ng/dL)

Managing long-term side effects – ED, incontinence, fatigue

Erectile dysfunction (ED):

• Continue penile rehabilitation (daily Cialis 5 mg) for 9-12 months
• Consider vacuum device, injections, or implants if needed
• ED may continue to improve for 24 months after surgery

Urinary incontinence:

• Continue pelvic floor exercises (Kegels)
• If still using pads at 12 months, consider sling or artificial urinary sphincter (AUS)
• Avoid bladder irritants (caffeine, alcohol, spicy foods)

Fatigue:

• Regular exercise (walking 30 minutes daily) – most effective
• Energy conservation (prioritise activities, rest before exhaustion)
• Treat depression or anaemia if present

Bone health monitoring – osteoporosis after ADT

Androgen deprivation therapy (ADT) accelerates bone loss, increasing fracture risk by 2-3x.

Monitoring schedule:

• Baseline DEXA scan: Before starting ADT
• Repeat DEXA: Every 1-2 years while on ADT

Prevention and treatment:

• Calcium 1,200 mg/day + vitamin D 1,000-2,000 IU/day
• Weight-bearing exercise (walking, resistance training)
• If osteoporosis (T-score < -2.5): Bisphosphonates (zoledronic acid) or denosumab

Cardiovascular and metabolic health – ADT-related risks

ADT increases risk of metabolic syndrome, diabetes, and cardiovascular disease.

Monitoring schedule:

• Blood pressure: Every 3-6 months
• Lipid panel (cholesterol): Every 6-12 months
• Fasting glucose or HbA1c: Every 6-12 months

Lifestyle interventions:

• Mediterranean diet (low saturated fat, high fibre)
• Regular exercise (150 minutes/week moderate activity)
• Weight management (BMI 18.5-24.9)

Medications if needed:

• Statins for elevated LDL cholesterol
• Metformin for diabetes or prediabetes
• Antihypertensives for high blood pressure

Second cancer screening – regular cancer screening

Prostate cancer survivors remain at risk for other cancers. Continue age-appropriate screening:

• Colorectal cancer: Colonoscopy every 10 years starting at age 45 (or earlier if family history)
• Lung cancer: Low-dose CT scan annually for current or former smokers (ages 50-80)
• Skin cancer: Annual skin exam
• Bladder cancer: No routine screening, but report any blood in urine

Psychosocial support – mental health, support groups

Emotional health is as important as physical health after cancer treatment.

• Anxiety and depression: Common (30-40% of survivors). Seek counselling or medication if needed.
• Fear of recurrence: Normal but can be managed with CBT and support groups.
• Support groups: Us TOO, CancerCare, American Cancer Society – in-person and online.
• Couples counselling: If sexual changes are straining the relationship.

When to see a doctor – red flags for recurrence

See your urologist or oncologist promptly if you experience:

• Rising PSA: Two consecutive rises (after surgery) or rise >2.0 above nadir (after radiation)
• New bone pain: Persistent back, hip, or rib pain (possible metastasis)
• Unexplained weight loss or fatigue
• Blood in urine or difficulty urinating
• New or worsening erectile dysfunction or incontinence (unlikely to be recurrence, but evaluate)

Interactive FAQ – Prostate cancer survivorship

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Disclaimer: This information is for educational purposes. Your survivorship care plan should be individualised. Discuss follow-up care with your urologist at Vivekananda Hospital.