Question of the Week # 72

A 55 y/o african american man with newly diagnosed Stage B prostate cancer undergoes radical prostatectomy and is referred to you from surgical clinic for routine follow up. The patient requests how often he should follow up with you and what tests he would need. Your best response is:

A) You do not need any follow up because you had a local cancer that was completely resected
B) PSA need to be tested every six months for 5 years and thereafter, every year
C) Bone scan to evaluate metastasis is needed every year
D) Digital Rectal Exam every year to look for local recurrence
E) You need endocrine therapy before we proceed further

2 Responses

  1. The answer is: B) PSA needs to be tested every six months for 5 years and thereafter, every year.

    Digital rectal exam can or may accompany PSA but NOT as an alternative.

    Endocrine (hormonal) therapy this includes Flutamide followed two weeks later with Lueprolide is purely palliative and is offered for patients with metastatic disease ALSO for patients with notably LARGE GLANDS who are undergoing External-Beam Radiotherapy (different than Bradytherapy with I-125), however our patient here just lost his prostate and he has no metastasis soooo no hormonal therapy for him.

    REMEMBER Finesteride (5 alfa reductase) is to treat Benign Prostatic Hyperplasia not Cancer.

    Bone scan if the pt. has elevated PSA and / or bone pain or back pain or whatever Sx you think are related to this.

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