revised 26 March 2001

​Rare younger patients (fit men under 70 years) irradiated for stage T1-T2a disease may be candidates for salvage prostatectomy and should be identified by periodic follow up including PSA (see definitions of relapse below), and clinical examination. The redevelopment of a palpable nodule (biopsy confirmed) is indicative of recurrent local disease. Six-monthly clinical and biochemical examination for three years, then increasing to annually, is suggested.

​For remaining patients, early detection of recurrent disease through PSA, and subsequent earlier hormonal intervention, have not been shown to improve quality of life or overall survival. Results of ongoing randomized studies may lead to the identification of sub-groups of patients who may benefit directly from routine follow-up and subsequent early treatment. In general however, routine examination or tests in such patients are unhelpful and are not recommended.

Long-term complications following radiation are rarely severe (~1% RTOG grade 4 and ~5% grade 3 toxicity). Minor ano-rectal bleeding, alteration of bowel habit, and impotence are more common. Typical post-radiation changes in the rectum are of anterior wall telangiectasia. This area should only be biopsied with caution, as healing may be impaired. Urethral stricture is usually only seen in those who had TURP or other urethral surgery prior to radiation therapy. Urinary incontinence is very unusual (<1%).

Selected groups of patients may be asked to attend routine follow-up at one of the BC Cancer Agency clinics. They are being followed with the aim of providing accurate outcomes information to the treating oncologist.

It should be noted that prostatic cancer usually regresses slowly after radiation and palpable nodularity is frequently present in excess of one year post-radiation. A biochemical nadir may also take up to three years to be reached following radiation.