After surgery or radiotherapy, PSA tests are the best way to know whether the treatment has removed or destroyed all of the cancer. The PSA level will drop rapidly (within weeks) after surgery, but may take from 12–18 months to reach its lowest point after radiotherapy. PSA levels are expected to remain low in the long term: undetectable levels after surgery and ideally, less than 1.0 ng/mL after radiotherapy. If the PSA starts and continues to rise after treatment, it typically means that there is continued growth of prostate cancer, and the original treatment did not cure the disease.
Sometimes after radiotherapy, in particular brachytherapy, the PSA can drop, ‘bounce’ upwards for a few months, then drop again. This is usually only seen in the first 1–3 years after radiation treatment. The reason for this PSA bounce is not known.
If the cancer recurs or has spread beyond the prostate region, hormone treatment may be offered. Hormone treatment can usually control the cancer successfully for many years. Issues surrounding this treatment are discussed in Mr PHIP No. 4 and 5. External beam radiotherapy to the pelvic region is sometimes used after radical prostatectomy as the PSA starts to rise again, to achieve better control of the cancer. Surgery is not often used after radiotherapy if radiotherapy is the main treatment.
Although the time after a diagnosis can be difficult, for most men there are many good years of life ahead after treatment for prostate cancer. When it is caught early, the outcome of treatment for prostate cancer is very good – at 10 years after treatment, 60–75% men remain free of cancer and 94–98% of men have not died of prostate cancer.