After treatment, a new, calmer phase begins
Once the actual treatment is completed, the aim is to secure its success and to detect early whether the disease returns. In prostate carcinoma this succeeds better than in most other tumors, because in the PSA value we have a reliable marker in the blood that indicates, long before any symptoms, whether something is starting to move. Follow-up care is therefore not a rigid program but is guided by how you were treated and how your course develops.
Follow-up Care After Surgery
After the complete removal of the prostate (radical prostatectomy), no PSA originates from healthy glandular tissue anymore. The PSA value should therefore fall below the detection limit, usually within a few weeks. This is precisely what makes follow-up care so informative: every measurable and rising value is an early signal and not only a late one.
We determine the first PSA value about three months after surgery. If it remains undetectable, we monitor at quarterly intervals during the first two years in an uncomplicated course, half-yearly in the third and fourth years, and once a year from the fifth year onward. These intervals are not arbitrary; they reflect that a relapse is most likely in the first years.
If the PSA value rises to 0.2 ng/mL after surgery and this rise is confirmed in a second measurement, this is termed a biochemical recurrence. This does not mean that the disease has visibly returned, but that PSA-producing cells are active again. In this situation, we use modern imaging, in particular PSMA-PET, to clarify where the activity is located, and we discuss the next steps. Often a targeted irradiation of the surgical region (salvage radiotherapy) is possible, and the earlier it is carried out, the better the prospects.
Continence and Erection After Surgery
Two functions concern men most after prostate removal, and both belong explicitly in follow-up care: urinary control and erectile function. We raise the subject ourselves, because many men hesitate to do so.
A certain degree of urinary incontinence immediately after surgery is normal and improves markedly in most men over the following weeks to months. The most effective first step is targeted pelvic floor training, which is best started early. If a distressing, persistent loss of urine remains beyond that, which affects only a small proportion of patients, there are reliable solutions. These include the placement of a sling (male sling) for mild to moderate incontinence and the artificial sphincter for pronounced incontinence. Which path makes sense in a given case is something we clarify after precise diagnostics. You can read more about this under Incontinence after prostate surgery (listed under News)
Erectile function depends on whether the nerves responsible for erection could be preserved, and that in turn depends on the tumor findings. Where it is oncologically justifiable, we operate in a nerve-sparing manner. Recovery requires patience and often extends over many months up to about two years. During this time, we support the blood flow of the erectile tissue, among other things with PDE5 inhibitors such as sildenafil (Viagra) or tadalafil (Cialis). If that is not sufficient, further steps are available, from the vacuum pump through intracavernosal injection with alprostadil (Caverject) to the penile prosthesis, when other methods do not achieve the goal. We discuss openly what is realistic and which path suits you. The detailed treatment of erectile dysfunction can also be found in the Andrology section. (see there)
Follow-up Care After Drug Therapy
In advanced or recurrent disease, drug-based treatment is the priority. The basis is usually the withdrawal of the male sex hormone (androgen deprivation therapy, ADT), which drives the growth of the tumor cells. Often modern agents that intervene in the hormone signaling pathway are added, such as abiraterone (Zytiga), enzalutamide (Xtandi), apalutamide (Erleada), or darolutamide (Nubeqa), and depending on the stage also chemotherapy or a targeted therapy.
Follow-up care here looks different from that after surgery, because the goal is a different one. The aim is to control the disease over the long term and to steer the treatment. We check the PSA value at regular intervals to assess efficacy, and under hormone withdrawal we additionally check the testosterone level, which should reliably lie within the castration range. Where needed, we add imaging to assess the course.
Equally important is the management of side effects, because these therapies run over a long period. Hormone withdrawal places demands on the bones, metabolism, and cardiovascular system. We monitor bone density and prevent osteoporosis, keep an eye on blood sugar, blood lipids, and blood pressure, and speak openly about complaints such as hot flashes, fatigue, or mood swings. These things can be treated when they are named, instead of being accepted as inevitable.
A Word on Follow-up Care After Radiotherapy
If the prostate was irradiated rather than removed, glandular tissue remains, and the PSA value falls more slowly and not to zero. A different measure applies here: if the PSA value rises by more than 2 ng/mL above its lowest reached value (nadir), this indicates a recurrence. Here, too, the further course of action is guided by imaging and the overall situation.
What You Can Expect From Us
Follow-up care is more than a laboratory value. We take time for the conversation, put findings into context for you, and state clearly what a value means and what it does not, so that a number does not become unnecessary worry. Throughout this phase, you keep a consistent point of contact.