Guidelines for the long-term care of prostate cancer survivors

This article evaluated recommendations regarding the continued care of prostate cancer survivors following successful treatment. The authors reported that regular screening, as well as proper treatments and lifestyle interventions, are important in maintaining physical and psychological health among prostate cancer survivors.

Advances in treatment and early detection of prostate cancer have increased survival and led to a growing number of men living with prostate cancer. Monitoring prostate cancer after successful treatment and identifying risk factors that could impact the long-term prognosis of prostate cancer are, therefore, increasingly important. This review of evidence by the American Cancer Society was conducted in an effort to provide guidelines for follow-up care, and to address long-term and late effects that prostate cancer survivors may face. 

The American Cancer Society suggested four main categories of guidelines for the long-term care of prostate cancer survivors.

Health promotion

Obesity has previously been associated with an increased risk for cancer recurrence and mortality due to prostate cancer. Weight loss may help improve long-term health outcomes in patients who are overweight or obese. A number of studies have reported that physical activity could protect against disease recurrence, reduce side-effects from cancer treatment, and improve overall survival. In two separate studies, 3 or more hours of vigorous activity per week was associated with a 61% reduction in mortality risk due to prostate cancer, as well as a 50% reduction in all-cause mortality. There is also evidence suggesting that a balanced diet (high in vegetables, fruits, whole grains, calcium, and vitamin D) can decrease the risk of second cancers and chronic diseases among cancer survivors. Alcohol consumption should be avoided, or at least limited to 2 drinks per day. It is recommended that cancer survivors stop smoking. Smoking significantly increases the risk of prostate cancer recurrence and second cancers.

Surveillance for recurrence

Blood tests typically measure PSA levels (prostate-specific antigen) to detect prostate cancer recurrence. Evidence is mixed regarding the frequency of blood tests during active surveillance. Some studies have recommended blood tests every 6 to 12 months for the first 5 years after successful treatment, followed by annual blood tests and rectal exams. Following surgical removal of the prostate gland, any detectable increase in PSA levels after surgery is an indication for further screening. Among men successfully treated with radiation therapy, further screening was recommended if increased PSA levels are detected and continue to rise for 3 months. PSA levels may be more variable among men treated with hormone therapy, but remain a good predictor of survival.  

Physical long-term effects

Men undergoing radiation therapy for prostate cancer often experience bowel dysfunction. Most bowel-related symptoms subside after treatment. However, long-term side effects (such as rectal ulcers, persistent rectal bleeding or pain) can occur in some cases and may require additional treatment.

Anemia (low red blood cell count) is a common complication of hormone therapy. Treatment may not always be necessary, but complete blood counts should be included in regular screenings. Regular screenings for risk factors related to cardiovascular disease (such as blood pressure, cholesterol levels, and blood sugar levels) were recommended among patients undergoing hormone therapy for more than 6 months.

A loss of bone mineral density (bone strength) is a long-term complication associated with both hormone therapy and radiation therapy. Adequate calcium and Vitamin D intake was recommended during treatment, and for up to one year following. Bisphosphonates (treatment to prevent bone loss) such as alendronate (Fosamax) can be offered to men at high risk of fracture.

Urinary dysfunction and urinary incontinence are common long-term complications following prostate surgery. Physical therapy, such as pelvic-floor muscle training, or drug therapy with anticholinergic medication, such as oxybutynin (Ditropan), are often recommended as first-line treatments.

Psychosocial long-term effects

Studies suggest that around 30% of men with prostate cancer experience significant psychological distress, 25% experience anxiety, and up to 10% experience major depressive disorder. Possible risk factors include advanced cancer stage, being single, poor educational background, younger age, additional medical conditions, as well as hormone therapy. Early identification and treatment of psychological distress are key in improving quality of life among prostate cancer survivors.

All prostate cancer treatments may affect men’s sexual and erectile function. Erectile dysfunction (ED) can start soon after some treatments or be delayed. Following radiation therapy, ED may be delayed from 6 to 36 months. ED can significantly affect quality of life, sexual intimacy, and body image. If men do not tolerate or respond to medications such as Viagra, additional treatment may be sought. Other treatments for ED include local treatment with injections or suppositories, vacuum erection devices, or penile implants. Psychological interventions and couples therapy have also been effective in improving sexual function.

The authors concluded that proper screening and treatment of long-term physical and psychosocial effects, as well as recommended lifestyle changes, can improve long-term health outcomes and quality of life among prostate cancer survivors. 

If you have concerns regarding your aftercare, please consult your doctor for further information on your course of action.