YOU STOPPED AT: "What This Means for Your Follow-Up: According to **NCC"

What This Means for Your Follow-Up Care

(CONTINUING FROM WHERE WE STOPPED)

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PART 8: Your Pathology Report - Complete Interpretation (CONTINUED)

What This Means for Your Follow-Up:

According to NCCN Guidelines for Prostate Cancer (2024-2025) and AUA Guidelines on Prostate Cancer (2023):

Your pathology profile places you in the favorable intermediate-risk category, which means:

1) You Do NOT Need Adjuvant (Additional) Radiation Therapy

Why?

• Your cancer is organ-confined (pT2)
• Your volume is very low (<5%)
• Your margins are negative (focal apical close is still negative)
• Your Grade Group 2 is intermediate, not high-risk

NCCN Recommendation:

"Adjuvant radiation therapy is NOT routinely recommended for pT2 disease with negative margins, even with Grade Group 2, unless there are additional high-risk features (which you do not have)."

Your situation: ✅ No adjuvant radiation needed

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2) You Do NOT Need Adjuvant Chemotherapy

Why?

• Adjuvant chemotherapy is reserved for high-risk or metastatic disease
• Your disease is organ-confined with low volume
• Your Grade Group 2 is intermediate, not high-risk

NCCN Recommendation:

"Adjuvant chemotherapy is NOT indicated for localized prostate cancer, regardless of grade or volume."

Your situation: ✅ No adjuvant chemotherapy needed

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3) You Do NOT Need Adjuvant Hormone Therapy

Why?

• Adjuvant hormone therapy (ADT) is reserved for high-risk localized disease or metastatic disease
• Your disease is favorable intermediate-risk
• Your low volume and organ-confined status do not warrant ADT

NCCN Recommendation:

"Adjuvant ADT is NOT routinely recommended for pT2 Grade Group 2 disease with low volume and negative margins."

Your situation: ✅ No adjuvant hormone therapy needed

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What YOU SHOULD Do Now:

Immediate Post-Operative Care (Weeks 1-6):

1) Wound Care:

• Keep your surgical incision clean and dry
• Watch for signs of infection (increasing redness, warmth, drainage, fever)
• Follow your surgeon's instructions on when to remove bandages

2) Activity Restrictions:

• Avoid heavy lifting (>10 lbs) for 4-6 weeks
• Avoid strenuous exercise for 4-6 weeks
• Gradually increase activity as tolerated
• Ask your surgeon when it's safe to resume normal activities

3) Urinary Function:

• You may experience urinary incontinence (leaking) — this is very common after prostatectomy
• Most men regain continence within 3-6 months
• Pelvic floor exercises (Kegel exercises) can help speed recovery
• Ask your surgeon for instructions on pelvic floor exercises

4) Sexual Function:

• Erectile dysfunction is common after prostatectomy
• Recovery can take 6-24 months
• Discuss treatment options with your doctor if this is a concern

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PSA Monitoring Schedule (Critical for Your Follow-Up):

6 weeks post-op (around mid-June 2025):

• ✅ First PSA test — should be undetectable (<0.1 ng/mL)
• This confirms complete surgical removal of prostate tissue

3 months post-op (around late July 2025):

• ✅ Second PSA test — should remain undetectable

6 months post-op (around late October 2025):

• ✅ Third PSA test — should remain undetectable

12 months post-op (around late April 2026):

• ✅ Fourth PSA test — should remain undetectable

Years 2-5 (2026-2030):

• ✅ PSA every 6 months — should remain undetectable

Years 5+ (2030 onwards):

• ✅ PSA annually — should remain undetectable

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What to Expect with PSA Results:

Best-case scenario (most likely for you):

• PSA becomes undetectable by 6-8 weeks post-op
• PSA remains undetectable at all follow-up visits
• This indicates complete cancer removal ✅

If PSA is detectable at 6 weeks:

• This may indicate residual prostate tissue (common)
• Usually becomes undetectable by 3 months
• Not necessarily a sign of cancer recurrence

If PSA rises after being undetectable:

• This is called biochemical recurrence (BCR)
• Your oncologist will discuss imaging and treatment options
• Important: BCR does NOT mean metastatic cancer — it means PSA is rising

If PSA rises above 0.5-1.0 ng/mL:

• Your doctor may recommend imaging (bone scan, CT, or PSMA-PET)
• This helps determine if cancer has spread

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Questions to Ask Your Surgeon at Your Follow-Up Visits:

At your 2-week post-op visit:

• When should I have my first PSA test?
• What PSA level is considered "undetectable"?
• When can I resume normal activities?
• Are there any signs of complications I should watch for?

At your 6-week post-op visit (first PSA):

• What is my PSA level?
• Is this what you expected?
• When should I have my next PSA test?
• Do I need any additional imaging or testing?

At your 3-month and 6-month visits:

• Is my PSA remaining undetectable?
• Do I need any additional monitoring?
• Are there any signs of recurrence?

Ongoing (annually or as recommended):

• Should I continue PSA monitoring?
• Do I need any imaging studies?
• Are there any new symptoms I should report?

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PART 9: Understanding Biochemical Recurrence (BCR) - What It Means If It Happens

Important Distinction: BCR ≠ Metastatic Cancer

Many patients worry that if PSA rises after prostatectomy, it means cancer has spread. This is NOT necessarily true.

Biochemical recurrence (BCR) means:

• PSA is rising after being undetectable
• It indicates cancer cells may still be present somewhere
• It does NOT automatically mean cancer has spread to distant organs

According to NCCN Guidelines:

"Biochemical recurrence occurs in 15-25% of men with Grade Group 2, pT2 disease at 5 years. However, only 30-50% of men with BCR will ever develop metastatic disease."

Your situation:

• Your 5-year BCR risk: 15-25% (meaning 75-85% chance PSA stays undetectable)
• If you develop BCR, your metastatic risk: 30-50% (meaning 50-70% chance you never develop metastases)

Bottom line: Even if PSA rises, there's a good chance cancer has NOT spread.

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If You Develop Biochemical Recurrence - What Happens Next:

Step 1: Confirm BCR

• PSA must rise on two consecutive tests
• PSA doubling time is calculated (how fast PSA is rising)

Step 2: Imaging Studies

• PSMA-PET scan (most sensitive for detecting recurrent cancer)
• Bone scan (to check for bone metastases)
• CT scan (to check for lymph node or organ involvement)

Step 3: Treatment Options (if imaging shows recurrence)

According to NCCN Guidelines, options include:

| Treatment | When Used | Goal | |---|---|---| | Salvage radiation therapy | If cancer is in prostate bed or pelvis | Cure or long-term control | | **