After prostate cancer treatment
What PSA follow-up means, recovery of urinary and sexual function, and the long-term effects of hormone therapy on bone, heart and mood.
4 min read · Part of Cancer Types
Written by The LifeAfterward editorial team from the sources listed at the end of this page.
Not individually reviewed by a clinician. This page is written from published clinical guidance, listed in full at the end, and is general information rather than medical advice — your own team knows your case. See our editorial standards.
Last checked against its sources · Last updated · Next check due
In short
- PSA testing is the backbone of follow-up, and what counts as a concerning result differs between surgery and radiotherapy.
- Urinary control and erectile function usually improve for up to two years — active rehabilitation speeds this up.
- Androgen deprivation therapy affects bone, heart, metabolism, mood and sexual function, and each of those has management.
- A rising PSA is not an emergency; it triggers investigation and often further treatable options.
What this means
Prostate cancer follow-up is unusually numerical: a single blood test carries most of the information, and many people find themselves living from PSA to PSA. Understanding what the numbers mean for your treatment type takes a great deal of heat out of that, and the functional side effects are more treatable than most people are told.
Understanding PSA follow-up
- After surgery (prostatectomy)
- PSA should become undetectable. A confirmed rise above a defined threshold is usually called biochemical recurrence and triggers assessment — commonly imaging and a discussion of further treatment.
- After radiotherapy
- PSA falls slowly over months to years to a low point (the nadir). A rise of a defined amount above that nadir is the usual definition of recurrence. A temporary "bounce" is well recognised and does not necessarily mean recurrence.
- On hormone therapy
- PSA is usually very low. Interpretation depends on the treatment; your team will explain what change matters.
- Schedule
- Typically every three to six months in the early years, then annually. Continuing for many years is normal.
Urinary and sexual function
- Continence usually improves over the first year and can continue improving into the second. Pelvic floor physiotherapy makes a measurable difference — ask for a referral rather than doing exercises from a leaflet.
- Erectile function can take up to two years to recover after surgery and may change gradually after radiotherapy. Early rehabilitation — medication, vacuum devices, injections — is commonly recommended.
- Orgasm may change: dry orgasm after prostatectomy is expected, and leakage of urine at orgasm is common and treatable.
- Radiotherapy can cause bowel urgency or bleeding, sometimes months later. Report it — it is treatable, and should not be assumed to be piles.
- See sex and intimacy after cancer for the practical and relationship side.
If you are on hormone therapy
- Bone: androgen deprivation accelerates bone loss. Ask about DXA scanning, calcium and vitamin D, and bone-protecting medication.
- Heart and metabolism: blood pressure, cholesterol, weight and glucose should be checked at least annually.
- Muscle and weight: resistance training twice weekly counteracts muscle loss and fatigue better than anything else available.
- Hot flushes, mood changes and fatigue: common, and there are approaches for each — raise them rather than enduring them.
- Cognition and sleep: frequently affected; see memory and concentration.
What to report
- New or worsening bone pain, especially in the back, hips or ribs.
- Difficulty passing urine, or blood in urine or semen.
- Persistent bowel bleeding or urgency after radiotherapy.
- Unexplained weight loss or persistent fatigue.
What to ask your healthcare team
- What is my PSA now, and what change would concern you?
- How often will PSA be checked, and who reviews it?
- Can I be referred for pelvic floor physiotherapy?
- What treatments are available for erectile difficulty in my case?
- If I am on hormone therapy, do I need bone, heart and metabolic monitoring?
- What happens if my PSA rises — what are the options?
Save questions to My Journey so you have them in the room, or use a ready-made list.
When to seek medical advice
Contact your healthcare team if you have:
- New bone pain, particularly in the spine, hips or ribs.
- Difficulty or inability to pass urine.
- Blood in the urine or persistent rectal bleeding.
- Unexplained weight loss or worsening fatigue.
Get emergency help the same day if you have:
- Complete inability to pass urine — urgent same-day care.
- Back pain with leg weakness, numbness or loss of bladder or bowel control — possible spinal cord compression, an emergency.
If you are worried and unsure, contact your team anyway — they would far rather hear from you unnecessarily than late. What to do in an emergency.
Common questions
What PSA level means prostate cancer has come back?
It depends on your treatment. After surgery, PSA should be undetectable and a confirmed rise above a defined threshold prompts assessment. After radiotherapy, recurrence is usually defined as a rise of a set amount above the lowest level reached. A single raised result is always repeated first.
How long does incontinence last after prostate surgery?
Most men improve substantially over the first year, with further gains into the second. Pelvic floor physiotherapy improves outcomes, and persistent leakage has further treatment options — so it is worth pursuing rather than accepting.
Sources
This page was written from the guidance below and checked against it on . Links are re-checked at each review — see our editorial standards.
- ASCO (Cancer.Net). Survivorship
- National Comprehensive Cancer Network. NCCN Guidelines for Patients
- National Cancer Institute (US). Follow-up medical care after cancer treatment
- National Cancer Institute (US). Late effects of cancer treatment
- European Society of Cardiology (2022). Guidelines on cardio-oncology