Question Title: Question 1: Is there a protocol for post prostatectomy follow up screening?

My dad, at 55 years old, had his PSA routinely tested along with cholesterol, etc. His PSA was found to be elevated though he was asymptomatic. A digital exam, ultrasound, and needle biopsy all confirmed a small cancerous tumor which was promptly removed by prostatectomy. There was no lymph node involvement. His urologist never suggested a clear follow up plan for PSA testing, bone scans, any symptoms to be aware of, etc. It is now 7 years after his surgery and he has been complaining of low back and hip pain which he assumes is due to muscle strain or malalignment of the spine. I am an RN and I have searched the literature for some sort of protocol, but unless I am missing something, it seems there is little consensus of opinion about how closely such patients need to be monitored for spread of the disease after surgery. Based on the above information, these are my questions:

- How often does PSA need to monitiored after prostatectomy and would ANY elevation in the PSA warrant further screening?
- Would bone scan or other tests be indicated every few years or so for routine screening and/or for onset of certain symptoms ?
- Since the pelvic area is the most likely place for initial spread of disease, are there specific warning signs/symptoms the patient should be aware of?
-How would I determine who the top urlogists are in his area (NYC/Long Island)? Please don't suggest that we ask the urologist what his personal stats are - we have tried this before and no matter how politely we ask the question, we have found their responses to be either vague or defensive.

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Dear Chrisann,

You are asking some important questions, and I will try to answer each of them in a way that helps you to be as informed as possible.

First, you ask about frequency of PSA monitoring after prostate removal. The PSA level should essentially become undetectable after prostatectomy; this is because PSA is produced by the prostate, and if there is no prostate--or residual disease--there should be no level detected. Most urologists closely monitor PSA levels at three month intervals for the first year, followed by every six months for one to two years after that, and then once a year at an annual visit. If they detect a PSA level post-surgically, they will want to investigate this finding.

Second, bone scan is necessary only if there is an elevation of PSA following prostatectomy, or if the patient has constitutional symptoms, including, but not limited to, bone pain, weight loss, generalized malaise or weakness, and if any lower extremity weakness or neurologic deficit is noted.
Other than checking PSA levels and having a complete physical (including a digital rectal exam), there are no other routine tests that would be performed as part of a follow-up plan.

Third, looking for specific warning signs and symptoms: There are no specific symptoms, other than what is listed above, that would warrant further investigation. Anytime a man has urologic symptoms, such as blood in urine, difficulty urinating, or things of a urologic nature, he needs to follow up with a urologist, and this is true after prostate removal just as it is true anytime.

As for finding a top urologist, you might want to start with an academic center in your city. Teaching institutions often are on the cutting edge of medical treatment. Sloan-Kettering Memorial Hospital is one of the top facilities in your area. In addition, you can ask for a referral and the physician's training history from most Physician Referral resources across the country. Your primary care physician would be another source to consult. You sound like you know what you need from your father's physician. It is helpful to have your questions written down when you go to see the doctor, so that you can present them in order and as concisely as possible. It is your right to have your questions answered, so if you feel your questions are not being answered, let the physician know that, so s/he can better meet your needs. Medical care is a partnership between the physician and the patient, who ultimately must take responsibility for her or his own health care. I wish you and your father well as you seek the answers to your questions and find the urologist who best meets your needs.

This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-BE
*keyword: prostate cancer