Follow-up after treatment

A PSA test may be done as regular monitoring after surgery or after other treatment (for benign enlargement or for cancer), either to see if prostate cancer has subsequently developed, or to see if a cancer has recurred.

For example, a surgeon may suggest the PSA test after a transurethral resection of the prostate (TURP). This simple operation is usually done for what appears to be a benign (non-cancerous) tumour. Sometimes a tumour presses on the urethra and prevents the passage of urine. A transurethral resection can relieve symptoms (see our prostate cancer section for more about TURP).

Explains what it is like to have a transurethral resection of the prostate (TURP) for an enlarged…

Age at interview 72

Gender Male

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For people that don’t know what that is can you explain a little bit what it [a TURP] is?

Yes from the bladder to the outlet the, there is this tube that takes the urine and it has to go through the prostate gland. Now if the prostate gland it becomes, as it does with most elderly men, begins to enlarge to it traps the outlet, consequently it’s very hard then for an elderly person to pass urine. So it’s a very common thing to have this, what they call a TURPS, it’s like a rebore and they bore the hole through the prostate gland and that allows then a freedom of passing water, passing urine. And that’s what the TURPS is. I don’t quite understands what TURPS means but…

Trans-urethral resection.

Is it okay yes [laughs].

And how long were you in hospital for that operation?

Five days, yeah I went in on the Thursday and I was out on the Sunday.

Do you want to say a little bit more about the operation, can you remember?

Yeah they just did the test on the Friday, ran various you know blood pressure, blood tests and so on and then on the, on the Saturday I went into, into surgery and I was offered the opportunity of having either a local anaesthetic or a general, so I opted for the local anaesthetic which was that epidural is it called in, yeah and just went dead from the waist downwards. And I was in surgery for about half an hour and chatting to the, the what’s the man, anaesthetist just chatting generally because I didn’t want to know what was going on. And then came out and had, when I came back into the ward I had a blood pressure machine fixed to me, I also I had a catheter. These were removed the day afterwards and then the day after that I was discharged from hospital. I had to be very careful, no driving for three weeks, but I was okay. Healed very quickly and my waterworks problems cleared up.

So after that you found it much easier to pass urine?

Oh yes, yes until about ten years later when it started all over again. And that was the mistake I made was that it could happen again, I thought that’s it, it’s finished, I don’t have any more problems. But I did of course.

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However, cancer may sometimes be diagnosed years after the original TURP operation. The man quoted above developed cancer of his prostate ten years after the initial surgery (see ‘Symptoms‘). Another man, who had had a TURP operation in 2005, said that his surgeon had recommended that he have a PSA test every three months initially to make sure that the remaining part of the prostate gland had not become cancerous.

Reads from a letter from his consultant recommending he have repeated PSA tests after his…

Age at interview 78

Gender Male

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So when did they decide to do a PSA test?

When I was finally discharged by the consultant he wrote me a short letter, very, very short, using what I would call consultant’s language, not Gps language but saying you know go and have a test, have one now and have another in three months’ time. And of course he notified my own GP anyway who was ready to deal with it.

Did he explain why you should have a PSA test?

He said in one letter, a little letter which I think I can find, would it help?

Could you summarise what the consultant said?

Dated 6th May, short letter I’ll just read what is here ‘Just a line to confirm that I have written to your doctor about your follow up. There is a small area of growth within the prostate which is not an uncommon finding as we discussed. May I suggest that you have your prostate blood test, PSA, measured every three months initially. I’ve asked if you can have this done through the surgery and I’d be grateful if you’d make contact with them. Meanwhile I’d like to see you for a further follow up in six months’ time so I can re-examine your gland to make sure that all is well.

Right.

They’re the consultant’s words if you like.

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The PSA test is also used to help doctors assess whether or not treatment for prostate cancer has been successful. One man, for example, said that he had recently had a prostatectomy for prostate cancer. After surgery his PSA result was very low, which suggested that the cancer had been removed, but he expected to have three monthly PSA tests for a while, to make sure there was no recurrence.

He expects to have three monthly PSA tests for a while so that his surgeon can check whether or…

Age at interview 52

Gender Male

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After the operation I recovered quite well and everything else. And I had an appointment to go back and see the consultant after six weeks. And I had a PSA test done with my general practitioner, and that is to look at, ‘Is there still any prostate cells that are left, even though I’ve had a radical prostatectomy?’ And the good news from that was that the, the PSA s-, result was less than 0.01. So it was virtually unreadable. And that’s, that is tremendously good news because that means that hopefully the problem has d-, then disappeared. So I went to see the consultant. He asked me a number of questions about how I was feeling, how my continence was feeling, impotence, talked about impotence, and talked about, about the result. But he also talked about the pathology of, of my prostate, which hed taken out, and unfortunately the Gleason score which was first at 7 had moved to 9. And so that was, that was slightly disappointing, on the good result of having a very low PSA count, was that the, the tumour that is now removed was very aggressive. So I’m now under a regime of, of seeing him again in three months. And he said he will continue to see me three-monthly until, until we decide that things are clear.

So you’ll have three-monthly PSA tests and then go and see him?

Yes. The situation now is I’ve, I’ve already put a date in my diary to go to see the GP to get a PSA test. And I’ve got another date to go and see him early November.

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Another man, whose prostate cancer had been picked up as a result of his PSA test, told us that he had been treated with hormones and radiotherapy. He was also having regular PSA tests as part of his follow-up. He felt frustrated that the PSA test results didn’t seem to help his doctors to give him a prognosis for his locally advanced prostate cancer.

His PSA will be checked every three months at first and then every six months to check that the…

Age at interview 57

Gender Male

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What do you expect the PSA to remain now?

The PSA should come down to may be 1.2, 1.4 and stay around there. If it starts to rise again I’m in trouble.

Have you been told that or have you just read that?

Oh I know that and I’ve been told that effectively, not in those words, far more delicately put but the only way of keeping track of things is to, for me to have a regular PSA reading and that will continue for 5 years.

Will that be done every 6 months or every?

In the first year I believe it’s going to be every 3 months and then it will go to 6 months. I have, I’m a firm believer in the PSA test for obvious reasons. I might well go and have a private PSA test every 3 months just to make sure because it did screen me, it did discover my cancer and I can’t understand why after I’ve had my cancer it’s sufficiently good to screen me for the future, why couldn’t I have been screened beforehand and logic just tells me, I’m a very logical person, medical opinions may say one thing but logic tells me everything I’ve gone through that the PSA test is a good way to screen for prostate cancer.

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Feels frustrated that he can’t get a specialist to give him a prognosis.

Age at interview 57

Gender Male

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And my reading came out as 1.9. I’ll be having another blood test in 3 months’ time when he expects the reading to, to have dropped further. I will be kept under observation every 3 to 6 months. I have locally advanced prostate cancer. I find it very frustrating personally that I can’t really obtain a prognosis from anyone as to my life expectancy. People with advanced prostate cancer who have gone through the treatment have a 50% chance of surviving 5 years. I have locally advanced prostate cancer which is slightly down from that but I can’t get any specialist, doctor, to give me any kind of prognosis and say look you, we think you should be okay for X amount of years and then I have a target and I can work at it and I can be determined to beat the hell out of it. I find personally that a little bit difficult.

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The PSA test is usually done about a month before a man has his follow-up appointment with the consultant.

Since having radiotherapy he has had a PSA test every six months. After each test he discusses…

Age at interview 71

Gender Male

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Then I went back to the doctors to tell him how things had gone on and he had, the information had come through from the hospital and he, on his website and he knew that the PSA was 0.1 and then he advised me that they’d be getting in touch again and that I’d have to go, oh no before that he said I’d need one more hormone injection to finish the course of hormone injections off which I had at my health centre. So I finished that off and then he said you’ll be hearing from the hospital and you’ll be having to go for another PSA test. So I waited and within about a week’s time I had an appointment for 6 months hence and so I made a note of that and about 5 months; before the, a month before I made an appointment for a PSA test and then went for the appointment after the 6 months. And they, theres a little room where the doctor there is waiting for you and he kind of dictates it into a, I don’t know microphone thing and the PSA, he gave me the results of the PSA, he was very pleased and now I go every 6 months for a check-up and if I can’t get on the 6 months you’ve just got to ring them up and they’ll change the appointment for you and you can go at a later date. But I’ve managed to be there every 6 months.

And when you go back every 6 months it’s just the PSA test and then a little chat with the specialist a couple of weeks later?

Yeah, yeah, yeah I go into the hospital and hes got the results and well even waiting to go and see him I’m only about 5, I’m in there 5 minutes and then I’m straight in and then hes got all my guff in front of him and we just talk about it and he tells what the PSA at the time is and have I got any problems and anything I want to know, we talk about that and then that’s fine. And that happens every 6 months. And I seem to see the same doctor each time which is very nice.

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One man had been having hormone treatment for prostate cancer for a number of years. He said that sometimes the consultant stopped his treatment because it seemed he was in remission, but when his PSA level started to rise again he was put back on his medication.

The consultant is now checking his PSA level every 6 weeks to see whether or not he needs to go…

Age at interview 70

Gender Male

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I’ve got to go back and see, see the consultant in six weeks. So instead of seeing him in six months, three months, he said, ‘No, I want to keep an eye on you.

Hmm.

‘Six weeks time. So I said to him, I said, ‘You’re joking. I said, ‘Well why not give me three months?’ He said, ‘No, oh [laughs]’ he said, ‘No way. Six to seven, I’ll see you in six weeks’ time.

And did the consultant explain to you what they can discover from the PSA test, in relation to the prostate?

Yes, they, they, yes they did. From the test they, they can determine how the cancer’s behaving, whether the, it’s going in, oh how you call it, the

Remission?

Remission, yeah. I must emphasise here at this point, whenever my PSA is in remission they take me off the medication.

When the cancer’s in remission?

Yeah. They take me off of it. Sometimes I off, I’ll be off of it for 6 months. The last time I can remember being off of it, is about, for, for 14 months.

Ahh.

Yeah.

That’s interesting.

Yeah. So, in that time I’m off of it, I’m off medication.

And then what happens?

Until it started behaving badly, I would say.

And they can tell that from looking at the PSA test?

Yeah from the blood tests, they can tell whether the figures is going up.

Hmm.

And when it reaching double figures, say about, hmm, for the last time when it was 7, he said, ‘Ah, that’s nothing, they’re not worried about that. That’s nothing to them. But to me, I don’t want it to go that high. So he said, ‘Well come back and see me in such and such a time. And from that it went up to 17. He said, ‘Right, I’m going to put you on medication.

Back on the Zoladex?

Back on the Zoladex and the flutamide tablets. Well some, from day one that’s what’s the medication I was on. So they never change, change me on any other medication.

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Last reviewed May 2016.

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