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Follow-up surveillance during and after treatment for prostate cancer

David F Penson, MD, MPH
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Prostate cancer is the most common malignancy in men, with approximately 161,000 new prostate cancer diagnoses and approximately 26,700 prostate cancer deaths estimated in the United States in 2017 [1]. Worldwide, there are an estimated 1,600,000 new cases of prostate cancer and 366,000 prostate cancer deaths annually [2].

Because of the prolonged natural history, there are a large number of cancer survivors who are being followed after initial definitive treatment, as well as men who have presented with or developed evidence of advanced disease. Those with advanced disease include men whose only evidence of advanced disease is an elevated serum prostate-specific antigen (PSA), as well as those with clinically detectable metastases, which may be either asymptomatic or symptomatic.

This topic will discuss the approach to follow-up both in those without evidence of disease after treatment and those with evidence of advanced disease. The follow-up of men with low-risk localized prostate cancer who are managed with active surveillance is discussed separately. (See "Active surveillance for men with low-risk, clinically localized prostate cancer", section on 'Surveillance strategy'.)


Most men with newly diagnosed localized prostate cancer undergo definitive therapy with curative intent (eg, radical prostatectomy, external beam radiation therapy [RT], brachytherapy, cryotherapy, high-intensity focused ultrasound). Most patients with low-risk disease can be managed with active surveillance, with definitive therapy deferred until there is evidence of progressive disease. (See "Initial approach to low- and very low-risk clinically localized prostate cancer" and "Active surveillance for men with low-risk, clinically localized prostate cancer".)

For patients who subsequently progress with either local or disseminated disease, recurrence generally is detected by a rise in the serum prostate-specific antigen (PSA), a highly specific marker for prostate tissue, prior to any radiologic or symptomatic evidence of recurrence or progression. The development of an overt local recurrence or distant metastases usually occurs significantly later in the natural history of the disease. (See 'Serum PSA' below and "Bone metastases in advanced prostate cancer: Clinical manifestations and diagnosis", section on 'Clinical manifestations'.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 03, 2017.
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